It’s a common misconception that acne is at its worst during your teenage years. The reality is that roughly 25% of women in their 40s and 15% of women in their 50s experience acne — even if they didn’t have many breakouts when they were younger.
While there are many reasons you might develop acne later in life — such as stress, dietary and environmental factors, sleep deprivation, and genetics — the hormonal changes associated with perimenopause are often the culprit for particularly stubborn and painful cystic acne.
But before you reach for the Clearasil to zap those bumps back to the ‘90s, it's important to understand what’s happening with your skin during perimenopause and what it really needs during this phase of life.
What does hormonal acne look like?
Hormonal adult acne typically forms on the lower part of your face. This includes the bottom of your cheeks, chin, and around your jawline, though it can happen anywhere on your body.
Hormonal acne usually shows up as cystic bumps. These bumps form deep under the skin and don’t come to a head on the surface. They’re often tender to the touch and out of reach of most topical medications. Cystic acne bumps can last long and often leave scars or red marks.
How do hormones impact your skin?
With millions of hormone receptors in our skin, our reproductive hormones, such as estrogen, progesterone, and testosterone, play a vital role in keeping our skin healthy. In particular, the powerhouse hormone estrogen promotes hydration by enhancing our skin's ability to retain moisture. Estrogen also stimulates collagen production, which gives skin its firmness and elasticity and encourages cell turnover.
Your skin is covered in sebaceous glands, which produce an oily substance called sebum. Sebum helps moisturize and protect your skin from infection. Testosterone and progesterone both influence the production of sebum and the size of your pores. If you have too much sebum or an overabundance of dead skin cells, it can block the opening of your pores and create a space for bacteria to thrive.
How does menopause affect acne?
During perimenopause — which can last anywhere from 4-10 years before your final period — your levels of estrogen, progesterone, and testosterone will start to change.
As estrogen declines, it causes your skin to become thinner, drier, and less elastic. More wrinkles will appear as the production of collagen decreases. You may also notice that scars or marks stay longer as your skin’s cell regeneration slows. Your testosterone level will also diminish — just not as quickly as estrogen.
The imbalance of these hormones is one of the major triggers of adult acne. Testosterone influences the size of your sebaceous gland, causing it to get bigger and produce more sebum. It also makes the size of your pores smaller. At the same time, lower estrogen levels make it more challenging for your skin to shed dead skin cells as efficiently. This combination is the perfect formula for clogged pores and means bacteria have a higher chance of getting trapped in your skin.
While we often associate oily skin with acne, the fact is that many women going through perimenopause actually experience dry skin and acne. The remedies you might have reached for as a teenager are likely too harsh for your skin now and may even make the problem worse.
It’s also worth noting that many women going through menopause have high levels of stress. Stress can cause your body to produce more androgens, like testosterone. In one study, daily stress was shown to exacerbate acne in a third of adult female patients.
How do you care for hormonal acne during menopause?
Treating hormone-related acne isn’t easy. You often need to address the root cause and repair damage on the outside if you want to see results. If you can, visiting a dermatologist at this stage of life, one who can recommend the right over-the-counter treatments and possibly prescribe medications is best.
However, we also recommend finding a healthcare provider who is knowledgeable about menopause to help you better understand what’s happening in your body to address the root cause of your acne.
Establish the right skincare routine
The first step to treating menopause-related acne is to find the right skincare routine for your skin type. Remember, many women will find their skin drier than it used to be because sebum production slows down as we age.
If you’ve always had oily skin, you might notice that your skin is now combination or even normal. Or your skin might feel dehydrated and flakey when you’ve always had combination skin.
To determine your skin type, wash your face with a gentle cleanser, then gently pat it dry. Wait 30 minutes. If your skin appears shiny all over, it’s a good indication that you have oily skin. You probably have combination skin if the shine is only in your T-zone. And if it feels tight or looks flaky, you likely have dry skin.
Skincare routine for menopausal acne
Use a gentle cleanser
Wash your face with a gentle cleanser with a low salicylic acid level. Salicylic acid will help unclog your pores without drying out your skin. Avoid scrubs as they can be overly abrasive, leading to inflammation and potential scarring.
If you have dry skin: Rather than reaching for a cleaner for acne that includes benzoyl peroxide or salicylic acid, choose a hydrating cream cleanser that won’t strip your skin of its natural oils.
Spot treat with an antimicrobial
Benzoyl peroxide is an antimicrobial that helps eliminate the bacteria that cause acne, but it can be extremely drying to your skin. Spot treating will help get rid of your acne and reduce the amount of dryness and irritation.
Use a topical retinoid
Retinol unclogs pores by sloughing away dead skin cells, helping your complexion stay clear. It also helps prevent inflammation, boosts collagen, and improves skin elasticity. Retinol can be potentially irritating, causing dryness and flaking, so start slow and increase use only as your skin tolerates.
If you have dry skin: Hold off on using products with alpha-hydroxy acids (like glycolic or lactic acid) or beta-hydroxy acids (salicylic acid) while starting retinoids, and add them in once a week only when your skin is already tolerating the retinoids.
Choose the right moisturizer
Moisturizing is crucial, even for oily skin. Opt for formulas that include dimethicone, glycerin, hyaluronic acid, or sodium pyrrolidone carboxylic acid. These ingredients help retain moisture without clogging pores.
If you have dry skin: One of the most common causes of acne with dry skin is a damaged skin barrier. A healthy skin barrier can reduce your skin’s reaction to products and external triggers. Look for moisturizers with ceramides or squalane to boost and repair your skin barrier.
Apply sunscreen daily
Sun protection is a must, especially as hormonal changes can increase sensitivity to UV rays. Select a non-comedogenic sunscreen (won't block pores), hypoallergenic, and formulated not to trigger acne.
There are many ways you can be proactive about preventing acne from forming. We recommend:
Reducing your sugar and dairy intake
Sugar and dairy can contribute to acne by spiking insulin levels and the hormone androgen. This, in turn, can increase sebum production and inflammation. Consider going on a low-glycemic diet that focuses on keeping your blood sugar levels on track or a Mediterranean diet, which has been shown to help reduce acne.
Phytoestrogens are plant-based compounds that mimic the effects of estrogen in the body but with a milder impact. Foods rich in phytoestrogens — such as soy products, flaxseeds, and various nuts and seeds — can help balance hormones by providing a buffer against the fluctuating levels of estrogen that contribute to acne during menopause.
Adding skin health-promoting supplements to your routine
Vitamins A, B, C, D, and E provide a spectrum of skin-supporting benefits that promote repair and regeneration. Omega-3 fatty acids can help manage inflammation, a key player in acne outbreaks. Zinc is known for its wound-healing and antibacterial properties, which can be particularly useful in combating acne. Echinacea can also reduce bacterial-induced inflammation. Be sure to discuss any supplements you’re adding to your diet with your healthcare provider.
If your skin isn’t responding to your new skincare routine and lifestyle changes, oral medications can clear your skin from the inside out. We recommend working with a dermatologist to determine your next steps. A dermatologist may prescribe a short-term use antibiotic such as Doxycycline, androgen blockers such as Spironolactone, or topical treatments like Clindamycin.
Hormone replacement therapy
If hormones are the driving cause of your acne, then one of the most effective ways you can treat menopausal symptoms is by balancing your hormones.
Hormone replacement therapy (HRT) can help restore hormonal equilibrium within your body, targeting the imbalances that might be contributing to your skin concerns. At FemGevity, our approach to HRT is to tailor your prescription to your individual needs, aiming not only to alleviate the symptoms of hormonal acne but to enhance your overall sense of wellness.
Get rid of menopause acne for good
While hormonal acne at this stage of life might feel like an unwelcome reminder from your teenage years, there are thankfully more effective methods to manage it now. The right blend of skincare and lifestyle changes can pave the way to clearer skin. Coupled with guidance from the right dermatologist and a menopause-savvy healthcare provider, you can develop a personalized strategy and access the medical interventions you need to feel radiant inside and out.
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