perimenostage
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Last checked September 2026 against 7 sources · Editorial policy

Menopause acne: pimples in your 40s and 50s

Menopause acne is real: pimples can return in perimenopause and after menopause, not only in adolescence. As estrogen falls, androgens have relatively more effect, and spots often cluster on the jaw and chin. The same shift can bring extra facial hair or thinning scalp hair. Most women with a few menopausal spots have normal androgen levels. Long-term topical treatment is the mainstay; spironolactone is the usual tablet if more is needed.

Hormonal acne along the jaw and chin is common in perimenopause. Why it happens, skincare that works on older skin, and prescription options.

Find your stage · 2 min7 sources

Menopause acne: expectation vs reality

What people often expect

“Acne is a teenage problem, and something else must be wrong”

What the evidence shows

Acne is increasingly seen in adult life, including around menopause. Most women with a few spots have normal androgen levels in their blood and don't need extensive testing, though a baseline total testosterone can be useful. Stress, sleep, diet, medicines and related conditions such as obesity or diabetes can still trigger flares. Menopausal acne is now recognized as its own subtype of acne.

Why menopause causes acne and pimples

Falling estrogen gives androgens more effect

Menopausal acne has several causes, but the main one is hormonal imbalance: less estrogen means androgens have more relative effect on the skin. That shows up as oilier skin and clogged pores, often on the jaw and chin, and it can come with hirsutism and pattern hair loss from the same shift. You don't need high androgen levels for this to happen; the balance between hormones is what changes.

Stress, sleep and lifestyle trigger breakouts

Genetics, stress, poor sleep, changes in diet and lack of exercise can all trigger breakouts, and several of these tend to worsen in perimenopause. Night sweats break sleep, stress often peaks in midlife, and routines change. These triggers don't cause menopausal acne on their own, but they make flares more likely and treatment harder. Tackling sleep and stress alongside skin treatment gives the best chance of clear skin.

HRT and other medicines can cause pimples

Progestogens in HRT are among the medicines that may worsen acne, and the NHS lists acne as a side effect of progestogen. Testosterone, used by some women for low libido, also increases acne in trials. If spots started when you began or changed hormone treatment, the type or dose may be the reason, and your prescriber can adjust it. Do not stop HRT suddenly because of spots; side effects often settle within a few months, and there are alternatives.

Other hormone conditions behind adult acne

Thyroid disease, high prolactin and insulin resistance can play a role when other symptoms point that way. When acne is more than a few spots, doctors also look for obesity, diabetes, high blood pressure and abnormal cholesterol, and a detailed history can rule out PCOS, a rare adrenal condition or a medicine as the cause. Acne with sudden hair growth or a deeper voice needs urgent tests.

Why menopausal skin needs a gentler approach

Skin after menopause is thinner and drier than teenage skin, so harsh acne products that strip oil can cause irritation. The NHS advises washing twice a day with a gentle cleanser, using non-comedogenic products that won't clog pores, and not scrubbing, which irritates skin and makes acne worse. Retinoids treat both acne and sun damage, which makes them a good fit at this age.

How common is acne in menopause?

There are no reliable figures for how many women get acne around menopause. Reviews describe it as increasingly common in adult women and treat menopausal acne as a distinct subtype.

Spots that aren't menopause acne

Not every breakout in your 40s and 50s is hormonal acne. Rosacea in particular looks similar and needs different treatment.

  • Rosacea

    Flushing and redness across the cheeks and nose, sometimes with small bumps, but no blackheads.

    Test: Doctor or dermatologist

  • PCOS

    Acne with irregular periods and extra hair going back years.

    Test: Hormone blood tests

  • HRT or testosterone side effect

    Check →

    Spots started with HRT, especially progestogen, or with testosterone.

    Test: Talk to your prescriber

  • Other hormone conditions

    Check →

    Thyroid problems, high prolactin or insulin resistance, usually with other symptoms.

    Test: Blood tests if other symptoms

  • Skin infection

    Hot, swollen, red or painful skin around spots.

    Test: Doctor's assessment

Treating perimenopause and menopause acne

  • Topical treatment for menopause acne

    Strong evidence

    For mild acne without signs of excess androgens, prolonged topical therapy is the mainstay. Over the counter, salicylic acid or benzoyl peroxide help; a doctor can prescribe retinoids such as tretinoin or adapalene, which reduce inflammation and oiliness and also improve sun-damaged skin. A steady routine matters more than switching products every few weeks.

  • Spironolactone for hormonal acne

    Strong evidence

    When oral anti-androgen treatment is needed, spironolactone is the first choice for menopausal acne. It blocks the effect of androgens on the skin. Doctors usually check your blood pressure and kidney function before and during treatment. It can take a few months to see the full effect.

  • Gentle skincare for adult acne

    First step

    Wash twice a day with a gentle cleanser, remove makeup at the end of the day, and use non-comedogenic skincare and makeup. Don't pick, squeeze or scrub, which can cause scars and irritation. A pharmacist can recommend products and supplements such as zinc or niacinamide.

  • Lifestyle changes that support treatment

    First step

    Reduce stress where you can, aim for regular sleep and exercise, eat a balanced diet and keep a simple skin routine. The review on menopausal acne lists these as part of treatment, alongside controlling weight. They support medical treatment rather than replace it. Controlling weight also matters, since obesity and insulin resistance are linked with menopausal acne.

  • Combined pill for acne

    Limited evidence

    Combined oral contraceptives can clear acne but are relatively contraindicated after menopause, so they're rarely the right fit in this age group. In perimenopause, if you still need contraception, it may be an option to discuss. For most postmenopausal women, topical treatment and spironolactone are the better options.

    Related guide →

  • Procedures for acne scars and aging skin

    Some evidence

    Procedural treatments can help with acne scars and age-related skin changes at the same time. They're usually added once active acne is under control, and a dermatologist can advise which suits your skin. Options range from chemical peels to laser treatments, and they can also improve fine lines and uneven skin tone.

When acne needs a doctor

  • Urgent: Acne with rapid new hair growth or a deeper voice

    Ask for an urgent doctor's appointment. Sudden changes like these need prompt hormone tests.

  • Deep, painful lumps or scarring

    See a doctor. Early treatment for nodular acne lowers the risk of permanent scars.

  • Pharmacy treatments haven't worked

    See a doctor for prescription creams or tablets, or a dermatology referral.

  • Acne is affecting your mood

    Acne can fuel anxiety, depression and low self-esteem. Medical treatment and support both help.

Menopause acne: questions women ask

Why am I getting acne in my 40s and 50s?

Falling estrogen lets androgens affect the skin more, which drives menopausal acne. Stress, sleep loss, lifestyle changes and some medicines, including progestogens in HRT, can add to it. Most women with a few spots have normal hormone levels.

Can menopause cause pimples?

Yes. Menopausal acne is a recognized subtype of adult acne, driven mainly by the relative increase in androgens as estrogen falls. Spots tend to appear on the lower face, jaw and chin, sometimes with oilier skin.

Does HRT help or cause acne?

It can go either way. Progestogens can cause acne as a side effect, and testosterone increases it in trials. If spots start when you begin HRT, talk to your prescriber about switching formulation or dose.

What's the best treatment for menopausal acne?

Prolonged topical therapy for mild acne without other signs of excess androgens. Spironolactone is the first choice when you need a tablet. Most women with a few spots don't need extensive hormone testing. Give any new treatment at least a few months before judging it, and keep using it once acne clears to stop it returning.

Why do I get pimples on my chin in menopause?

Chin and jaw spots are typical of hormonal acne, because the relative rise in androgens affects oil glands in the lower face most. The same shift can bring chin hair. Topical retinoids and, if needed, spironolactone target this pattern.

Related →

Does estrogen cause pimples?

Estrogen itself doesn't usually cause acne. It's the fall in estrogen, relative to androgens, that drives menopausal acne. Progestogens and testosterone in hormone treatment are the parts more likely to cause spots. If you notice spots after starting HRT, ask whether a different progestogen or route would suit you better.

Can you get back acne in perimenopause?

Yes. Acne usually affects the face, chest and back, and hormonal acne in perimenopause can too. Loose, breathable clothing, especially when exercising, helps, along with the same treatments used for facial acne. If back acne is deep or painful, see a doctor, as tablets may work better than creams for large areas.

How do I treat perimenopause acne?

Start with a gentle routine: wash twice a day with a mild cleanser, use non-comedogenic products and try salicylic acid or benzoyl peroxide. If that is not enough, a doctor can prescribe a retinoid such as tretinoin or adapalene, and spironolactone if hormonal acne needs a tablet. In perimenopause, the combined pill is also an option if you need contraception.

Sources

  1. Khunger N, Mehrotra K. Menopausal Acne - Challenges And Solutions. Int J Womens Health. 2019;11:555-567.
  2. NHS. Side effects of hormone replacement therapy (HRT).
  3. Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
  4. NHS. Excessive hair growth (hirsutism).
  5. NHS. Acne.
  6. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264-70.
  7. Sitohang IBS, Makes WI, Sandora N, et al. Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials. Int J Womens Dermatol. 2022;8(1):e003.

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