Menopausal Acne: Why It Happens and Proven Solutions for Clearer Skin

March 25, 2025

Just when you thought breakouts were a distant memory of your teenage years, perimenopause and menopause arrive—often bringing unexpected and frustrating acne along with them. If you’ve been wondering why you’re suddenly dealing with pimples and blemishes in your 40s or 50s, you’re not alone.

For many Australian women, menopausal acne comes as an unwelcome surprise during an already challenging transition. This type of adult acne can be confusing because it often appears alongside other contradictory skin changes like increasing dryness and sensitivity.

Today, we’re exploring why hormonal shifts trigger these breakouts and sharing evidence-based strategies to help you achieve clearer skin during this transitional time.

Understanding the Hormonal Triggers Behind Menopausal Acne

The Androgen Connection

During perimenopause and menopause, hormones undergo significant fluctuations. While estrogen and progesterone levels generally decline, androgens (male hormones like testosterone) often decrease more slowly, creating a relative androgen dominance—even though their absolute levels may not increase.

This hormonal imbalance affects your skin in several key ways:

Androgens stimulate sebaceous glands to produce more oil, creating an environment where acne-causing bacteria thrive. This explains why many women notice increased oiliness in the T-zone despite overall drier skin elsewhere.

Androgens trigger hyperkeratinisation—a process where skin cells reproduce more quickly and don’t shed properly. These cells can then block pores, creating the perfect environment for acne formation.

The changing estrogen-to-estrogen ratio increases inflammation, making skin reactive and breakouts more persistent and inflamed.

The Cortisol Factor

Stress plays a significant role in menopausal acne. During perimenopause and menopause, many women experience increased stress due to hormonal fluctuations, sleep disruption, and life changes. This elevates cortisol levels, which can:

Stimulate additional oil production, compounding the effects of androgen dominance. Impair skin barrier function, making skin more vulnerable to bacteria and irritants. Slow wound healing causes acne lesions to linger longer than they would have in your younger years.

Distinct Characteristics of Menopausal Acne

Menopausal acne typically differs from teenage acne in several important ways:

Location: Rather than appearing primarily on the forehead and nose, menopausal acne concentrates along the jawline, chin, and neck—hallmark signs of hormonal breakouts.

Type: The breakouts are often more profound, more cystic, and more inflamed than teenage acne, making them both more painful and slower to heal.

Persistence: Without proper treatment, these hormonal breakouts can be remarkably persistent, often not responding to the same therapies that worked in your younger years.

Proven Solutions for Clearer Skin: Skincare Strategies That Work

Several targeted approaches have shown significant efficacy for menopausal acne:

Gentle, balanced cleansing is essential, as harsh, stripping cleansers can trigger excess oil production and increased dryness. Look for sulphate-free cleansers with a pH between 4.5 and 5.5 that remove excess oil without compromising your skin barrier.

Retinoids address multiple aspects of menopausal acne by normalising, preventing pore blockage, and reducing inflammation. Start with gentler forms like retinaldehyde or retinyl esters 2-3 times weekly, gradually increasing frequency as tolerance builds.

Salicylic acid (BHA) works particularly well for hormonal acne because it’s oil-soluble, allowing it to penetrate pores, dissolve excess sebum, and remove dead skin cells. Lower concentrations (0.5-2%) used regularly often produce better results than more potent, more irritating formulations.

Niacinamide (vitamin B3) at 5% concentration helps regulate oil production, strengthen the skin barrier, and reduce inflammation—addressing multiple aspects of menopausal acne simultaneously. Research shows it can reduce sebum production by up to 50% after four weeks of consistent use.

Azelaic acid offers multiple benefits for menopausal skin with acne—it reduces inflammation, kills acne-causing bacteria, and helps fade the post-inflammatory hyperpigmentation that often accompanies hormonal breakouts. Studies show that 15-20% of concentrations can be as effective as prescription treatments for many women.

Internal Approaches for Hormone Balance

Addressing menopausal acne from within can produce significant improvements:

Anti-inflammatory diets, which focus on omega-3-rich foods, colorful fruits and vegetables, and minimising sugar, and processed foods, can help modulate the inflammatory response that drives hormonal acne. Research indicates that women who consume more omega-3s and antioxidant-rich foods show lower incidences of adult acne.

Stress management practices like meditation, yoga, or regular exercise can help reduce cortisol levels that contribute to breakouts. Studies show that women who engage in regular stress-reduction activities experience fewer hormone-related skin flares.

Targeted supplements like zinc (30-50mg daily), omega-3 fatty acids (1000-2000mg daily), and vitamin D can help support skin health and hormone balance. Always consult your healthcare provider before starting new supplements, especially if taking any medications.

Professional Treatment Options

For more persistent menopausal acne, several professional approaches have shown excellent results:

Prescription treatments like spironolactone block androgen receptors, directly addressing the hormonal drivers of menopausal acne. Studies show improvement in up to 85% of women with hormonal acne after 3-6 months of treatment.

Light and laser therapies that target acne-causing bacteria and reduce inflammation can provide significant clearance for many women. Blue light therapy kills P. acnes bacteria, while specific laser treatments minimise production and improve skin texture.

Chemical peels using salicylic acid, glycolic acid, or mandelic acid help clear pores, reduce oil production, and fade post-acne marks. For menopausal skin, gentler peels yield better results than a single aggressive treatment.

Your Menopausal Acne Action Plan

Quick Tips for Immediate Improvement

Avoid over-cleansing, which can trigger increased oil production. Twice-daily gentle cleansing is sufficient for most women.
Be strategic with active ingredients. Rather than layering multiple potentially irritating treatments, focus on one or two effective ingredients used consistently.
Prioritize, proactively alongside acne treatment. Use hydrating, non-comedogenic moisturizers to moisturise and improve skin function.
Consider your makeup choices. Opt for mineral-based foundations and non-comedogenic products that won’t exacerbate breakouts.
Practice hands-off policy. Touching or picking at acne lesions increases inflammation and can lead to scarring—a concern for menopausal skin with slower healing capacity.

Creating Your Balanced Routine

Morning: Use a gentle cleanser, hydrating toner, vitamin C serum (which helps with both acne and the hyperpigmentation it leaves behind), lightweight non-comedogenic moisturizer, and moisturiser, which is critical as many acne treatments increase sun sensitivity.

Evening: Thorough but gentle cleansing, treatment product (retinoid, azelaic acid, or BHA—rotated rather than used simultaneously), and barrier-supporting moisturiser.

Weemoisturiser exfoliation 1-2 times weekly with either a low-concentration chemical exfoliant or enzyme mask to remove dead skin cells without irritation.

Embracing Your Skin’s Journey

While menopausal acne can be frustrating, it’s essential to approach treatment with patience and consistency. Most women see significant improvement within 8-12 weeks of implementing appropriate care strategies.

Remember that your skin’s needs during this transition are unique—what worked in your teens or 20s may no longer be appropriate. By understanding the hormonal drivers behind these changes and implementing targeted, science-backed solutions, you can successfully navigate this challenging aspect of menopause while supporting your skin’s overall health.

What strategies have you found most helpful for managing hormonal breakouts during menopause? Share your experiences in the comments below—our community of Australian women navigating similar changes has wisdom to share.