Acne in perimenopause and menopause

What changes in these years

Perimenopause is the stretch before periods stop for good. It usually begins in your 30s or 40s, when estrogen made by the ovaries starts to rise and fall less predictably. The average age of menopause in the US is 51, according to the American College of Obstetricians and Gynecologists, and MedlinePlus notes that it most often happens between 45 and 55.

The AAD lists hormone swings around perimenopause and menopause among the reasons adults break out. That is as far as the evidence goes: the shift in hormones can lead to breakouts, and it explains why acne may appear in women who never had much of it before.

Where it shows and what it looks like

In adult women, inflamed spots tend to sit on the lower chin, jawline and neck, with more closed comedones (small whiteheads under the surface), according to a 2013 review in the Journal of the European Academy of Dermatology and Venereology. Most cases are mild to moderate, but they can be slow to respond. DermNet adds that large whiteheads on the chin, cheeks and forehead are more common in adults than in younger people.

Drier skin changes the plan

Dry and itchy skin is a common symptom of menopause, the NHS says, and the 2013 review notes that older skin is more prone to irritation. So start gently. The AAD suggests benzoyl peroxide at 2.5%, one product at a time for 6 to 8 weeks, spread in a thin layer over the whole area rather than dotted on single spots.

Because skin at this age is drier and quicker to sting, a gentle routine is half the job, and the basics of adult acne skincare keep irritation down.

Treatments that change with age

Hormonal treatment is still possible, but the options shift. At 35 or older, the pill may not be an option, and a dermatologist may prescribe spironolactone on its own, the AAD notes. The NHS does not recommend the combined pill from age 50.

Pregnancy is still possible until periods have stopped for long enough. If you could still become pregnant, spironolactone needs to be paired with birth control. The NHS says contraception is still needed for 2 years after the last period if it came between 40 and 49, and for 1 year if it came at 50 or older. Ask your doctor about any prescription medicine; this page gives no doses.

When it is not acne, or not only acne

• Rosacea: redness in the middle of the face and skin that stings can be rosacea rather than acne. A dermatologist can tell them apart.
• Perioral dermatitis: small bumps around the mouth, nose or eyes. It mostly affects young and middle-aged women, and steroid creams make it worse.
• New hair changes: acne with new facial hair or thinning hair on your scalp is a reason to see a doctor.
• A new medicine: if acne began after you started one, keep taking it and ask the doctor who prescribed it.

The bottom line

Acne in your forties and fifties is common, and hormone swings in perimenopause and menopause are a known trigger. Treat it gently because the skin is drier, give each product weeks to work, and check with a doctor when acne arrives with hair changes, a new medicine or stinging redness.