Menopause acne: causes and treatment

Acne is usually thought of as a teenage problem, so it can be a shock when it starts, or comes back, in your 40s or 50s. The American Academy of Dermatology (AAD) says acne that starts for the first time in adulthood is most common among women going through menopause. This guide covers why acne appears around menopause, what it tends to look like, how it is treated on older skin, and when it can signal something else. For the full plan, see the hormonal acne treatment guide.

Skinli gives general education and is not a doctor. New acne after menopause, especially with new hair growth or a deeper voice, should be checked by a doctor.

Perimenopause and menopause, in plain words

The American College of Obstetricians and Gynecologists (ACOG) says menopause is when periods stop because the ovaries stop making estrogen, and that the average age is 51. The years before it are called perimenopause. ACOG says estrogen from the ovaries starts to rise and fall unevenly in your 30s and 40s, and that the most common sign is a change in your cycle: cycles get longer or shorter, or you skip periods.

The National Institute on Aging (NIA) says most women begin this transition between 45 and 55, that it can last several years, and that the average age of menopause in the US is 52. You know you have reached menopause after a full year with no period or spotting. ACOG gives 51 and the NIA gives 52 as the average age.

How common acne is at this age

A 2008 survey of 1,013 adults in the Journal of the American Academy of Dermatology found that 26.3% of women in their 40s and 15.3% of women aged 50 and older reported acne, against 12.0% and 7.3% of men. The answers were people's own reports. When does hormonal acne stop? shows the numbers for every age group.

The 2019 review describes three types of acne around menopause: acne that has lasted since the teenage years, acne that starts for the first time in adult life, and acne that cleared after the teenage years and came back. It says acne that has lasted since the teenage years is the most common. The AAD says 20% to 40% of women with adult acne get it for the first time as adults.

Why acne appears around menopause

A 2019 review in the International Journal of Women's Health says hormone imbalance is the main cause of menopausal acne. After menopause, estrogen falls sharply while androgens, the male-type hormones women also make, fall more slowly. A protein in the blood that binds these hormones also drops, which leaves more androgen active in the body. The review calls this state postmenopausal hyperandrogenism, meaning a relative excess of male-type hormones, and says it can bring acne, extra hair growth and hair thinning.

A 2024 review in the same journal, prepared with editorial help paid for by the skin care company Pierre Fabre, adds that during perimenopause acne can get worse because of the imbalance between estrogen and androgens.

Other factors play a part. The 2019 review lists genetics, stress, diet changes, lack of sleep and too little exercise as triggers. The AAD also names stress, family history, skin and hair products, medicine side effects and undiagnosed medical conditions as causes of adult acne.

Most women with this acne have normal hormone tests. The 2019 review says most menopausal women with a few acne spots have normal androgen levels and do not need extensive tests. It suggests basic tests, including total testosterone, and a full check when there are other signs.

What menopause acne looks like

The two reviews describe these patterns:

Pattern	What the reviews describe
Lower face	Red bumps on the cheeks, around the mouth and on the chin and jawline
Deep spots around the mouth	Deep, inflamed bumps or lumps that leave redness, dark marks or scars and resist treatment
Many small closed bumps	Many closed comedones, visible when the skin is stretched, with large pores on the nose and cheeks
Body	After age 60, acne more often sits on the trunk

The 2024 review says collagen loss after menopause makes the skin thinner and more likely to scar from acne. The 2019 review says women at this age have more sensitive skin, so redness, dark marks and scars are more common after a spot heals.

When acne after menopause needs a doctor

The 2019 review says acne after menopause can rarely point to a hormone disorder, including, rarely, a tumor that makes androgens. It lists other causes to rule out: polycystic ovary syndrome, a rare inherited adrenal gland condition, and medicines such as corticosteroids, androgens, hormone replacement therapy, anabolic steroids, lithium and some antidepressants. It also says rosacea can look like acne at this age. See rosacea vs acne.

See a doctor soon if acne after menopause comes with:

• New hair growth on the face, chest or belly
• Hair thinning on the head
• A deeper voice or other male-type changes
• Dark, velvety patches of skin
• Acne that started suddenly and severely

How menopause acne is treated

Products on the skin come first

The 2019 review says long-term treatment on the skin is the main treatment for mild menopausal acne. It names:

• Retinoids, such as adapalene, which it says clear pores, calm inflamed bumps and help with signs of aging. It advises starting slowly, for short periods every other day, to limit irritation.
• Azelaic acid, which it says also fades dark marks.
• Benzoyl peroxide, used with care because it can dry and irritate older skin. It prefers a low 2.5% strength in a cream.

It says a cream or gel antibiotic should not be used alone, and recommends combining treatments as the first step. The AAD's own list for adult acne is adapalene, azelaic acid, benzoyl peroxide and salicylic acid, used for 6 to 8 weeks before judging.

Pills, when needed

• Spironolactone. The 2019 review calls it the first choice when a woman needs a hormone-blocking pill, especially with extra hair growth or hair thinning. The AAD says women 35 or older may be prescribed spironolactone without a birth control pill. See spironolactone for acne.
• Birth control pills. The review says combined pills are usually avoided after menopause, because the risks of blood clots and heart disease are higher. The FDA labels for combined pills say women over 35 who smoke should not use them. See birth control for acne.
• Isotretinoin for severe acne that does not respond. See the Accutane guide.

Procedures

The 2019 review says treatments done in a clinic, such as chemical peels and lasers, can help at this age because they also treat acne scars and signs of skin aging. See chemical peels for acne scars and laser treatment for acne scars.

Hormone therapy for menopause symptoms

ACOG says hormone therapy is the best treatment for hot flashes and night sweats, and lists its risks, including a small rise in the risk of blood clots, stroke and breast cancer. Neither ACOG nor the reviews list acne as a reason to take it. The 2019 review lists hormone replacement therapy among the medicines a doctor asks about when acne appears, so mention it if acne began after starting.

Questions to ask your doctor

• Could my acne be linked to a medicine, including hormone therapy?
• Do my other symptoms, such as hair growth or thinning, need blood tests?
• Is this acne, or could it be rosacea?
• Which acne product suits dry or sensitive skin?
• Is spironolactone safe with my blood pressure and kidney health?

Caring for dry, acne-prone skin

The NIA says skin can become thinner and drier around menopause. The 2024 review says the skin barrier weakens and loses more water, which may start the inflammation behind acne. The 2019 review adds that most acne products are designed for oily teenage skin, with fewer made for sensitive, mature skin. So older skin needs acne treatment and moisture at the same time:

• Wash with a gentle cleanser, without scrubbing.
• Use a moisturizer labeled "non-comedogenic," meaning it does not clog pores.
• Start acne treatment every other day if your skin is dry, and build up.
• Use sunscreen every day, especially with a retinoid.

The moisturizer for acne-prone skin guide covers product choice. Skinli's free acne plan builds a starting routine from a photo, which you can adjust for dry skin.