Menopausal acne treatment

Why acne starts around menopause

Acne that starts for the first time in adult life is most common in women going through menopause, according to the American Academy of Dermatology, which lists hormone swings around perimenopause and menopause among the reasons adults break out. Perimenopause is the run-up to the last period: from your 30s and 40s, the 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.

It is not rare. In a US survey of adults, 26.3% of women aged 40 to 49 and 15.3% of women aged 50 and older said they had acne, about twice the rate of men the same age. Those numbers are self-reported, so read them as a rough picture.

What menopausal acne 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 adult acne often has many large closed whiteheads.

Menopausal acne treatment you can start at home

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 the AAD's advice for treating adult acne at home makes a good first menopausal acne treatment:

• One active ingredient at a time: adapalene for blackheads, whiteheads and pimples; azelaic acid, which also fades dark spots after acne; benzoyl peroxide for mild pimples, starting with 2.5% to avoid dry, burning skin; or salicylic acid for whiteheads and blackheads.
• A thin layer over the whole area, not dotted on single spots, so you treat the next breakout too.
• 6 to 8 weeks before judging it, without adding or dropping products in between.

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.

Prescription menopausal acne treatment

Hormonal treatment is still possible, but the options shift. If you are 35 or older, the pill may not be an option, and a dermatologist may prescribe spironolactone on its own, the AAD notes. Spironolactone can treat deep, tender acne on the lower face, jawline or neck when other treatments have not worked, and many women notice fewer breakouts and less oiliness within a few weeks. It needs blood tests before you start and follow-up visits while the dose is raised.

Other options a dermatologist may use include clascoterone cream, which works on the hormonal causes of acne, and prescription retinoids. DermNet notes that oral isotretinoin can be very effective for adult acne and is often well tolerated in low doses, though it has important risks.

Pregnancy is still possible until periods have stopped for long enough. Spironolactone can cause serious birth defects, so the AAD says birth control is essential while taking it if you could become pregnant. Ask your doctor about any prescription medicine; this page gives no doses.

Acne after starting HRT

Hormone therapy can relieve menopause symptoms, and for women who still have a uterus it includes a progestin as well as estrogen, ACOG explains. The NHS lists acne among the possible side effects of this hormone (progestogen) and says these side effects usually go away after a few weeks. If breakouts began after you started HRT or another new medicine, keep taking it and talk with the doctor who prescribed it, the AAD advises; there may be a different option.

When it is not acne, or not only acne

• Rosacea: acne-like bumps where the face is red, on skin that stings or burns, point to rosacea rather than acne. A dermatologist can tell them apart.
• Perioral dermatitis: a rash of small bumps around the mouth, nose or eyes. Many people get it after putting a corticosteroid cream on the skin for too long, and those creams have to stop for it to clear.
• New hair changes: acne with noticeable new facial hair or hair loss on your scalp is a reason to see a doctor.

What to expect from treatment

If a product works for you, the AAD says to expect fewer breakouts in 4 to 8 weeks and clearing at about 16 weeks. If you are not seeing clearer skin within a few months, or dark spots are appearing as acne clears, it is time for a dermatologist. Any menopausal acne treatment is easier to stick with when the routine is short and gentle.