Acne and menopause

Hormonal fluctuations and lifestyle factors can contribute to this skin condition – but it can be treated

During the menopause, acne can return in those who had it as a teen or be experienced for the first time
You may need to simplify your skincare routine if you’re experiencing acne and sensitive skin
Over-the-counter treatments and dermatologist care can help bring it under control

Just as puberty’s hormonal turbulence can contribute to acne, so too can the perimenopause and menopause. One survey found just over a quarter of women aged 40-49 suffered with the skin condition (decreasing to 15% of those aged 50 and older [1].

Dr Anjali Mahto, a consultant dermatologist and founder of dermatology clinic Self London, says: ‘Fluctuations in hormone levels, particularly declining oestrogen levels and increased androgen activity, can contribute to acne development in some women during this period.’

If you experienced acne as a teen or young adult, you may be more likely to have a flare-up of acne during perimenopause or menopause compared to those who have never experienced it before. ‘This is because the hormonal fluctuations associated with perimenopause and menopause can exacerbate existing acne or reactivate dormant acne tendencies. However, women who have never experienced acne before may also develop the condition due to hormonal changes and other factors such as genetics, lifestyle and underlying health conditions,’ says Dr Anjali.

Why do hormones affect acne?

Oestrogen plays an important role in your skin’s health, promoting hydration, reducing oil production and helping to stimulate collagen and elastin production. ‘As oestrogen levels decline during perimenopause, the relative increase in androgens [commonly known as male hormones present in both men and women] can lead to an imbalance,’ explains Dr Anjali. ‘Androgens stimulate the sebaceous glands to produce more oil, which can clog pores and contribute to acne development. Specifically, an increase in testosterone levels relative to oestrogen levels can exacerbate acne symptoms.’

Progesterone is anti-inflammatory and levels of this hormone can fluctuate during perimenopause and reduce during menopause. The imbalance of hormones can trigger inflammation, excess oil production, and changes in skin cell turnover, all of which contribute to the formation of acne.

It’s worth noting that while acne can occur during both the perimenopause and menopause, it tends to be more prevalent or pronounced during perimenopause due to the fluctuating hormone levels. Dr Anjali also says stress and other factors associated with the perimenopausal transition can further contribute to acne development.

For some women, acne may gradually improve as menopause progresses and hormone levels stabilise at lower levels, but others may continue to get acne even after menopause.

‘Factors such as genetics, lifestyle, skincare habits, and underlying health conditions can influence acne persistence during and after menopause,’ confirms Dr Anajli.

How should I look after my skin?

If you need help managing your acne, Dr Anjali recommends consulting a dermatologist for personalised guidance and treatment options.

She also suggests adopting a simple skincare routine.

A gentle cleanser: looks for ones including ingredients such as glycerin and hyaluronic acid.
Moisturiser: choose one that contains hydrating ingredients such as hyaluronic acid, ceramides, niacinamide, peptides, and antioxidants such as vitamin C and E.
Sunscreen: choose a broad-spectrum SPF30 or higher formula with zinc oxide or titanium dioxide for physical protection and additional antioxidants for added defence.

While there is no need to buy products that are “menopause specific” there are some considerations to keep in mind at this stage of life, especially if you are experiencing dryness and acne simultaneously. Dr Anjali says: ‘Acne products formulated for younger skin may be too drying or harsh, particularly if your skin is also sensitive due to hormonal changes. If that’s the case, opt for gentle yet effective formulations, so those labelled as suitable for sensitive skin and containing hydrating and soothing ingredients such as hyaluronic acid, ceramides, niacinamide, and gentle exfoliants like lactic acid or PHAs (polyhydroxy acids). Always do a patch test too, just to be on the safe side.’

Can make-up help?

Make-up may help you feel more confident with your skin, and Dr Anjali recommends products that prioritise your skin health. ‘Start with a moisturising primer to smooth and hydrate. Opt for lightweight foundations or BB creams that are enriched with skincare ingredients such as antioxidants, peptides, and SPF. Avoid heavy or matte formulas that can settle into fine lines. Finally, always remove make-up gently and follow with a gentle skincare routine to maintain skin health.’

Can I take HRT?

If you are experiencing menopausal symptoms, HRT is the first-line treatment for these. It’s not prescribed solely for skin conditions, although some women may find their skin improves after replacing oestrogen. Other women may find their acne continues to be a problem.

It’s worth seeking advice from your healthcare professional to ensure your hormones are balanced and at optimal levels as HRT can help to stabilise the hormones.

What are the treatment options?

Treatments vary according to the severity and type of spots but the over-the-counter options for acne include topical creams and gels such as retinoids (vitamin A based products), benzoyl peroxide (which can reduce bacteria in the skin) and azelaic acid.

If acne persists despite over-the-counter treatments, consult a dermatologist for a personalised treatment plan. Dr Anjali advises: ‘The best approach may involve prescription medications tailored to your specific acne type, severity and skin sensitivity. These may include topical treatments such as retinoids, benzoyl peroxide, or topical antibiotics, oral medications or isotretinoin for severe or resistant acne. We also have laser options available now too. AviClear is a new to the UK treatment that is less invasive compared to medication, yet has been shown to deliver similar results.’

During the menopause, hormonal changes may affect your skin’s ability to heal. If you experience acne scarring, treatments include topical retinoids, vitamin C, or alpha hydroxy acids for mild scarring. ‘Professional procedures like chemical peels, microneedling and laser can address moderate to severe scarring by stimulating collagen or resurfacing the skin. Consulting a dermatologist for a personalised recommendation.’

Dr Anjali Mahto is a consultant dermatologist and founder of dermatology clinic Self London: www.selflondon.com

References

Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56–59. doi: 10.1016/j.jaad.2007.06.045