Understand this symptom
Acne in menopause
Written by
Uma Health
Medically verified by
Dr. William Declerck
Physician
Insight
The essentials
This symptom is caused by the hormonal shifts your body is going through. Understanding what's happening helps you better cope with what you're feeling.
The cause
In menopause the balance between your oestrogen and your male hormones shifts, and those male hormones gain relative weight. That shift makes your oil glands more active and slows down how quickly your skin renews itself, so pores clog more easily. How much you notice varies a great deal from woman to woman. Stress and broken sleep go hand in hand with skin that flares more.
What helps
Gentle care for mature skin, not the harsh products aimed at teenagers, and patience: give each treatment eight to twelve weeks. If that isn't enough, there are effective medical options. A care provider who knows menopause can look at what fits you.
Honest and transparent
The most frequently asked questions
Frustrating, just when you thought this chapter was closed. In menopause the balance between your oestrogen and male hormones such as testosterone shifts, and those male hormones gain relative weight. Your oil glands are sensitive to them: they start producing more sebum while your skin renews itself more slowly. Pores clog, and inflammation follows. How pronounced that shift is varies from woman to woman.
Good question, because it really is a different beast. Menopause acne typically sits along your jawline, chin and neck, and more often takes the form of deep, painful lumps that linger for weeks. That pattern is not absolute: other areas can join in. Your skin is also drier and more sensitive than it was at sixteen, so the harsh products of back then now do more harm than good.
That's what everyone hopes, and the honest answer is: often yes, but not always. For many women the skin settles once hormones find a new balance after the final period. It is not a guarantee, because the ratio of oestrogen to testosterone stays different from before. The good news: acne is treatable at any age.
It makes sense to hesitate, because most anti-acne products are built for teenage skin. Go for a gentle cleanser, a non-comedogenic moisturiser and daily sun protection. Avoid scrubs and high-alcohol products: they wear down your skin barrier and invite irritation. Give any new product eight to twelve weeks before you judge it.
Smart to pause on that, because not every breakout after 40 is hormonal acne. Rosacea is common at this age and looks similar, but needs a different treatment. Corticosteroids, certain other medications, a hormonal coil and PCOS can also trigger or worsen spots. If you are unsure, have it looked at by a doctor.
A fair question, and the answer needs some nuance. Hormone therapy is not prescribed to treat acne. It can still affect your skin: some progestogens can worsen acne, others are skin-neutral. If you are considering hormone therapy for other menopause symptoms, do mention your skin: your doctor can factor it into the choice of preparation.
You are 45 and standing at the mirror with a painful lump on your chin. Fine lines and spots at the same time: nobody warned you about that. Maybe you thought acne belonged to your teens. For many women it comes back in menopause, and sometimes it even shows up for the first time. On this page you will read why that happens, how this acne differs from teenage acne, what you can do yourself and when it is worth seeing a doctor.
How women describe it
"Spots and wrinkles at the same time. That just feels unfair."
"Always in the same place: my chin and my jawline."
"Deep, painful lumps that stay for weeks."
"I thought I'd left this behind at sixteen."
Sound familiar? You are in large company. In one big survey, around a quarter of women aged 40 to 49 reported acne.1 That figure comes from self-reporting and moves with the definition researchers use. Usually it is acne that returns or never fully went away, sometimes skin that flares for the first time. In both cases the cause is often the same: your hormones are shifting.
What happens in your skin
During perimenopause, the years before your final period, your oestrogen starts to fluctuate and fall. Your male hormones, such as testosterone, drop too, but at a different pace. So the balance between the two tips in favour of the male hormones. How strongly that happens varies a great deal from woman to woman.
For your skin that matters. Your oil glands are sensitive to male hormones: give those relatively more weight and the glands produce more sebum.1 At the same time, falling oestrogen means your skin renews itself more slowly. Dead skin cells linger, pores clog, and inflammation forms inside those blocked pores.
That is how you get the strange combination so many women trip over: skin that turns drier and thinner, and still breaks out. Both are the result of the same hormonal shift. Stress and short nights play a part too. They go hand in hand with skin that flares more, through several mechanisms at once.
Different from the acne of your teens
Compare menopause acne with teenage acne and three clear differences stand out.
The location differs. Teenage acne sits mainly on the forehead, nose and cheeks. Hormonal acne in adult women often picks the lower half of the face: jawline, chin and neck.2 Typical, though not a rule: overlap with the classic teenage zones happens.
The form differs. Fewer blackheads and surface spots, more deep, painful lumps under the skin that heal slowly and leave marks or small scars more easily.
And your skin itself differs. At sixteen it was oily and resilient, now it is drier and more sensitive. That is why the old approach no longer works: aggressive cleansing and drying only makes mature skin angrier.
What you can do yourself
Care that suits mature skin already gets you a long way.
Cleanse your face twice a day with a gentle, soap-free cleanser. Follow with a non-comedogenic, hydrating moisturiser. It keeps your skin barrier intact and limits irritation, so your skin is less likely to answer with extra sebum. During the day sun protection matters, especially because some acne treatments make your skin more sensitive to the sun.
What to leave alone: scrubs, high-alcohol products and the harsh teenage ranges from the supermarket. Don't pick or squeeze deep lumps either. They sit too deep to push out, and you mainly raise the risk of marks and scars.
If you want to try something yourself, low-strength benzoyl peroxide is available without a prescription at the pharmacy. Start carefully, because it can irritate and dry out mature skin.
Two more things. Give any new approach eight to twelve weeks: skin doesn't change faster than that. And look at your habits too: enough sleep, stress kept in check, no smoking. For diet the evidence is weaker, though a diet high in fast sugars seems to worsen acne in some women.2
Which medical treatments exist?
If care alone doesn't get you there, that need not be the end of the road. For hormonal acne there are well-supported treatments, at this age too.
A doctor can start with prescription creams or gels, such as a topical retinoid or azelaic acid. These tackle clogged pores and inflammation and, dosed well, suit mature skin.
For stubborn hormonal acne, medication that slows the effect of male hormones on the oil glands can help, such as spironolactone.3 In Belgium it is prescribed off-label for acne, usually by a dermatologist.
And hormones themselves? The contraceptive pill can improve acne, but after 40 it is only started after a careful weighing of the risks. Hormone therapy for menopause is not prescribed to treat acne.4,5,6 It does affect your skin: some progestogens can worsen acne, others are skin-neutral. So mention your skin when hormone therapy comes up, and your doctor can take it into account when choosing the preparation.
For severe acne with scarring there is isotretinoin, a thorough treatment that runs through the dermatologist.
Could it be something other than menopause?
Not every unsettled complexion after 40 is hormonal acne, and that distinction matters because the treatment differs.
Rosacea is common at this age: red bumps on the cheeks and nose, often with flushing and heat, but without blackheads. It looks like acne yet needs a very different approach. Medication can trigger spots too, including corticosteroids, lithium and certain anti-epileptics, as can progestogen-only contraception such as a hormonal coil. And if you have had irregular cycles, extra hair growth and acne since you were young, PCOS may play a part.
One situation deserves a prompt visit to the doctor: acne that comes on suddenly and severely, together with more hair growth on your face or body, a deeper voice or hair loss at the crown. Then a doctor should check whether another hormonal problem is at play. That is rare, but too important to miss.
Either way, make an appointment when deep, painful inflammation keeps coming back, when scars form or when your skin starts to weigh on your confidence. That last reason is valid too.
Where to go for help
Your GP (huisarts) is a good first point of contact. They can make the diagnosis, start a first treatment and rule out other causes. For severe, scarring or stubborn acne you will be referred to a dermatologist.
Does your acne come alongside other menopause symptoms, such as hot flushes, poor sleep or thinning hair? Then look at it as one whole rather than treating each complaint separately. A gynaecologist or a hospital menopause clinic can help with that.
Want to talk straight away to someone who works on menopause every day? On Uma you will find care providers who specialise in (peri)menopause. Your consultation takes place online, you discuss all your symptoms together, including your skin, and you leave with a concrete plan. Uma is active mainly in Belgium, the Netherlands, Luxembourg and France, but any woman in Europe can consult a care provider on Uma. Prescriptions are valid across Europe.
Sources
- Khunger, N. & Mehrotra, K. (2019). Menopausal Acne – Challenges and Solutions. International Journal of Women's Health, 11, 555–567.
- Bagatin, E. et al. (2019). Adult female acne: a guide to clinical practice. Anais Brasileiros de Dermatologia, 94(1), 62–75.
- National Institute for Health and Care Excellence (2023). Acne vulgaris: management. NICE Guideline NG198.
- Rozenberg, S. et al. (2026). Guidelines Menopause. Belgian Menopause Society.
- National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE Guideline NG23.
- BCFI (2025). Hormone therapy during perimenopause: benefits and drawbacks.
The content on this page is intended for informational purposes and does not replace medical advice. Please consult a physician for a personal assessment.