Dealing with Acne from Menopause? Here’s Why It Happens & What to Do About It

Whereas menopause used to be something of a taboo subject, in recent years we’ve seen more women share their experiences about this transitional time. From Naomi Watts, who started Stripes, a wellness brand that includes products targeted towards menopausal skin to the former first lady Michelle Obama opening up about using hormone replacement therapy to treat her hot flashes, I'm grateful for the discourse that’s happening around the topic, including ways to treat other common symptoms of menopause and perimenopause like inflammatory acne. If you’re noticing an increase in painful, deeply seated bumps along the middle and lower part of your face, read on for some clarity on why it’s happening and what you can do about it.

• Dr. Kerry-Anne Perkins is an actively practicing board-certified obstetrician and gynecologist, expert medical reviewer, coach and scientific researcher. She is a holistic health, wellness and lifestyle expert who also currently serves as a Major in the United States Army Reserves.
• Dr. Dawn Ericsson is a board-certified obstetrician and gynecologist who has been serving the Tampa community since 2006. Voted Tampa’s Best Obstetrician/Gynecologist in 2016, she holds a bachelor’s degree in history of science and medicine from Yale University and a medical degree from the State University of New York at Stony Brook Health Sciences Center. Dr. Ericsson completed her residency at Saint Barnabas Medical Center (now Cooperman Barnabas Medical Center) in New Jersey, becoming the program's first female African American graduate. Dr. Ericsson is dedicated to enhancing patients' health through hormonal balance and advanced treatments, aiming to improve their overall quality of life.
• Dr. Karan Lal, DO, MS, FAAD is a double board-certified dermatologist, who specializes in pediatrics and adult dermatology, laser surgery, soft tissue filler augmentation, body sculpting and pigmentary abnormalities of the skin. He completed his internal medicine internship at the University of Connecticut Medical Center and completed a three-year dermatology residency at the University of Massachusetts, where he was elected chief resident and completed a pediatric dermatology fellowship. He is the only board-certified pediatric and fellowship-trained cosmetic dermatologist in the country.

“Acne occurs during menopause due to the ongoing hormonal shifts at this time,” says Dr. Lal. As women go through menopause, estrogen and progesterone levels decrease, while androgen levels increase. “Androgens can stimulate the sebaceous glands in the skin, leading to increased oil production. This excess oil, also known as sebum, along with dead skin cells and bacteria on your skin, can clog pores and result in breakouts,” explains Dr. Ericsson.

For starters, all the experts we interviewed want to make it clear that everyone is different. “Hormonal changes during menopause can vary in timing and intensity for each person, so it's best to consult with a healthcare professional for a more accurate assessment of your specific situation,” advises Dr. Ericsson. That said, acne can happen at any phase of the menopause process, but more women report breakouts during perimenopause, which usually occurs around the ages of 45 to the early 50s (aka when there is the greatest fluctuations in hormones).

“Acne from menopause may present in the lower face, particularly the chin and jawline,” shares Dr. Perkins, who adds that these breakouts “can be severe and may hang around longer, as the hormones responsible for their presence increase throughout the postmenopausal years.”

Menopausal acne tends to appear as “deep, inflamed and painful cystic acne lesions rather than the smaller, more superficial pimples commonly seen in teenage acne,” explains Dr. Ericsson. “These cystic lesions are often larger and may take longer to heal. Additionally, menopausal acne may be more concentrated around the chin, jawline and neck area, whereas teenage acne can be more widespread across the face.”

Treating acne during menopause is similar to how you might approach acne at other stages of your life, in that it’s ideally a comprehensive plan that includes lifestyle changes, topical treatments and prescription medications or oral supplements, depending on the individual.

Here are some lifestyle changes that Dr. Ericsson recommends trying first:

• Keep your skin clean: Wash your face with a gentle cleanser to remove excess oil, dirt and bacteria.
• Avoid harsh products: Use non-comedogenic and oil-free skincare products to prevent clogging of pores.
• Moisturize: Use a lightweight, oil-free moisturizer to keep your skin hydrated without adding excess oil.
• Don't pick or squeeze: Avoid picking or squeezing acne lesions, as it can worsen inflammation and lead to scarring.
• Manage stress: Stress can contribute to hormonal imbalances, so practicing stress management techniques like exercise, meditation, yoga and adequate sleep and sunlight may help.
• Maintain a healthy diet:  Eat a balanced diet rich in fruits, vegetables, whole grains and lean proteins. Limit processed foods and sugary snacks, as they can potentially worsen acne.

Dr. Perkins agrees, adding, “Holistic lifestyle changes are often the first recommended conservative approach to treating menopausal acne, as they may offer benefits without significant risks. Lifestyle changes include eating a diet that is full of fiber, getting adequate water intake, incorporating regular physical activity and strength training and taking supplements to support the body's cellular processes such as Rael’s Hormone Balance, which helps address imbalances that can occur during menstrual cycles or menopause.”

If these lifestyle changes don’t help clear up the acne, here are some skincare products and medical treatments you can look into:

• Over-the-counter creams or gels containing ingredients like benzoyl peroxide, salicylic acid or retinoids can help reduce acne breakouts.
• In some cases, a dermatologist may prescribe topical or oral medications such as antibiotics, hormones (like hormone replacement or balancing therapy) or isotretinoin (aka Accutane) for severe cases of menopausal acne. Other prescriptions, like spironolactone, can be used to decrease the effect of DHT, a potent androgen which, when elevated, can also cause acne. Dr. Lal notes, “Spironolactone can help reduce male hormones in the skin, but it takes up to three months to take effect.”
• All of the above treatments can be used alone or in combination with light and laser treatments, which can help hasten the results of other topicals. Dr. Lal recommends “Sciton’s Broadband Light (BBL), which uses various filters of light to kill acne-causing bacteria and reduce inflammation.” He just cautions that, “this treatment cannot be done if patients are on isotretinoin.”
• Acne can also be a manifestation of imbalances in the gut bacteria or microbiome. Pre/probiotic therapy can sometimes be used to help balance the microbiome, as can supplements like zinc, folic acid, inositol, saw palmetto and stinging nettle, which can decrease the production of DHT hormones.

Again, as it bears repeating: It's important to consult with a dermatologist or other healthcare professional to determine the most suitable treatment(s) based on the severity and specific characteristics of your acne during menopause. Together, you can come up with personalized plan and monitor your progress to ensure the best outcome.