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Breakouts aren’t just for teenagers. Plenty of people start seeing pimples and blemishes popping up again well into their 30s or 40s. One major culprit is perimenopause, the phase leading up to menopause. Perimenopause is characterized by irregular ovarian function, with bigger peaks and valleys of estrogen and progesterone, which can trigger blemishes — even for those who never dealt with acne in the past.
Why am I suddenly getting acne on my face in my 40s?
Hormones often hold the biggest clue to midlife breakouts. During perimenopause, irregular ovarian function leads to larger fluctuations in estrogen and progesterone levels, and often higher circulating androgens (like testosterone and DHEAS). This imbalance can lead to acne around the chin, jawline, and lower cheeks. Relatively lower estrogen and higher androgens can affect how much oil (sebum) the skin produces. Sebum is important for that healthy glow, but too much of it — especially when pores are clogged — can lead to flare-ups.
Stress is another key factor. Many individuals in their 40s juggle career pressures, family responsibilities, or big personal goals, and higher stress can lead to elevated cortisol. Cortisol, commonly called the stress hormone, can impact skin factors like sebum production, making breakouts worse or more stubborn.
It also helps to know that cell turnover and collagen production naturally slow down with age. This means the skin doesn’t bounce back from blemishes as quickly, and pimples might stick around longer or leave dark spots. Throw in limited sleep, a hectic schedule, or poor hydration habits, and these bumps can become a bigger issue. While this can be frustrating, it’s good to remember that midlife acne can be managed with the right approach.
Is acne common during perimenopause?
Adult acne is more widespread than many people realize. Around one-third of women experience breakouts as adults, and that number can rise during perimenopause. Hormone swings don’t affect everyone the same way, but it’s not unusual for someone in their late 30s or 40s to suddenly deal with whiteheads, blackheads, or deeper cystic bumps.
Perimenopausal acne can also show up alongside other symptoms like irregular periods and hot flashes. Because hormone levels can shift dramatically from month to month, clear-skin phases might be followed by sudden flare-ups. Research suggests that when estrogen levels drop, androgens can dominate, setting the stage for extra oil production. Stress or other triggers might add to the perfect storm, making it tough to predict when a breakout will strike.
It’s also important to realize that adult acne is not just “leftover” teenage acne. Adult stressors, hormones, and slower cell turnover mean perimenopausal acne has its own characteristics. Thankfully, more healthcare providers recognize how common this is, so there are better treatment plans these days.
What does perimenopausal acne look like?
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Perimenopausal acne tends to show up along the jawline, lower cheeks, chin, and sometimes the neck. These spots may be red, inflamed, or even painful. Often, they’re deeper than regular whiteheads — some may become cysts that feel larger and more sensitive. Hormonal changes can make pores more prone to blockage and trapped oil, leading to flare-ups.
Dark marks or hyperpigmentation can also appear after pimples heal, especially since skin renewal slows with age. It’s normal for these marks to hang around longer in the 40s than they would have in the teen years. Sensitivity, redness, or tenderness around active breakouts can be a signal to handle skin gently — picking or popping pimples can leave scars or worsen inflammation.
Hot flashes, another well-known symptom of perimenopause, can bring more blood flow to the face, which sometimes makes blemishes more visible. For those still experiencing menstrual cycles, breakouts might spike around certain times of the month. Pinpointing patterns can help when creating a skincare routine that targets hormonal fluctuations.
How do you treat perimenopausal acne?
A good plan for tackling perimenopausal acne usually looks at both what’s happening on the skin’s surface and what’s going on inside the body. Here are some common approaches:
- Gentle cleansing and topical treatments: A mild cleanser can help get rid of extra oil without stripping the skin. Salicylic acid or benzoyl peroxide products can also help clear pores and keep bacteria under control. Studies show these ingredients can be good for mild to moderate acne, though it’s best not to overdo it or irritate the skin.
- Prescription medications: Sometimes, a dermatologist might recommend prescription retinoids or antibiotics to reduce inflammation. Retinoids speed up skin cell turnover, helping prevent clogged pores. Antibiotic creams or lotions can fight the bacteria that lead to breakouts. In severe cases, doctors may prescribe spironolactone to help block androgens. Research shows spironolactone can help with persistent hormonal acne.
- Lifestyle adjustments: A balanced diet with lean protein, whole grains, fresh produce, and healthy fats supports overall hormone health. While there isn’t a single “anti-acne diet,” limiting high-glycemic foods (like sugary snacks) may help. High-glycemic foods can spike insulin levels, which sometimes correlate with increased oil production. Staying hydrated and finding ways to handle stress (like meditation, yoga, or journaling) can also keep cortisol levels from spiking too high. Adequate sleep is huge — lack of rest can mess with hormone function.
- Skincare routine and moisturizers: Contrary to what some think, even oily or acne-prone skin needs moisture. Lightweight moisturizers that won’t clog pores help maintain the skin’s barrier. Try not to pick at blemishes, and consider gentle chemical exfoliators, like alpha hydroxy acids (AHAs), to encourage healthy cell turnover.
- Professional treatments: If at-home methods aren’t cutting it, dermatologists can offer options like chemical peels, laser treatments, or blue light therapy. These can be effective but need careful consideration, especially if the skin is sensitive or if there are other health issues.
Will HRT help my hormonal acne?
Hormone Replacement Therapy (HRT) can be used for several perimenopausal symptoms, like hot flashes or mood changes. It might also help with hormonal acne by replacing estrogen, which can combat androgen excess, but results vary from person to person. Some HRT formulas might reduce breakouts, while others — including those with androgens or certain progestins — could make acne worse.
Research shows that combined hormone therapy (estrogen plus progesterone) may help stabilize the ups and downs that cause midlife breakouts. Still, it’s important to remember there’s no universal outcome. A healthcare provider will look at someone’s overall health and hormone levels before suggesting HRT as a solution for acne.
In many cases, HRT is more about treating multiple perimenopausal symptoms, with skin improvements as a possible bonus. But if acne is the primary concern, a specialist might recommend other treatments first. Connecting with a primary care doctor, a dermatologist, or an endocrinologist can give a well-rounded view of which approach makes the most sense.
Self-esteem goes a long way
Hormonal acne can really shake self-confidence. It’s understandable to feel overwhelmed or down about new or worsening pimples. Stress management, therapy, or support groups can be a big help — not just for overall well-being but also for healthier-looking skin, since stress can spark extra inflammation.
Be mindful of skincare ingredients
Skin in your 40s can be drier or more sensitive, so look for gentle, non-comedogenic options. Retinol or retinoid-based formulas can encourage cell turnover, and niacinamide is known for soothing redness and calming inflammation. As always, patch testing is wise before fully committing to a new product.
When to seek professional help
Over-the-counter products can take care of mild or moderate acne, but serious or persistent breakouts may call for an expert. Deep cystic blemishes or severe redness that just won’t quit should be looked at by a dermatologist. They can prescribe stronger treatments or discuss other therapies, like lasers. Seeing an endocrinologist might be helpful too, especially if there’s any suspicion of a bigger hormonal condition.
Love the skin you’re in
Perimenopause can spark big changes, and acne is only one of them. Hormone swings, stress, and an evolving skincare routine can all play a part in these midlife breakouts. Realizing you’re not the only one going through this can be a big relief.
From gentle cleansing to prescription meds to emotional support, there are multiple ways to tackle perimenopausal acne. Results might take a while, but consistent care and a plan tailored to individual needs can lead to calmer, clearer skin — and a boost in confidence, too.
Hormonal changes aren’t all doom and gloom. With the right knowledge and approach, it’s totally possible to manage perimenopause acne and still feel great about stepping into this new stage of life. Healthcare professionals can offer support and help sort out treatment options, so no one has to face this journey alone.
Tassia O'Callaghan is an experienced content writer and strategist, having written about a vast range of topics from chemical regulations to parenting, for brands like Peanut App Ltd, Scary Mommy, Tally Workspace, and Fertility Mapper. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.