As if hot flashes, mood swings and weight gain weren’t enough, many women going through menopause experience a new or recurring bout of acne. Menopausal breakouts — a type of hormonal acne — are different from teenage and other adult acne in both cause and appearance. Because older women’s skin is more sensitive and slower to heal, those who experience menopausal acne have an increased risk of developing post-inflammatory hyperpigmentation and scarring — along with a greater psychological impact than their younger counterparts report.

According to Dr. Sandra Lee (aka Dr. Pimple Popper), there are ways to manage menopausal acne. Here’s what to look out for, and what to do if you start breaking out during middle age.

What is menopausal acne?

We’ve talked about the effect hormones have on breakouts before — and menopausal acne is no exception. Remember that during the teen years, a surge in hormones (and their fluctuations) leads to an increase in sebum production, which in turn spurs clogged pores and and sometimes, inflammatory acne.

In the years leading up to menopause (known as perimenopause), estrogen and progesterone levels begin to drop rapidly. This leads to a relative surplus of testosterone (which declines more gradually), that can remain after menopause is complete — a condition known as postmenopausal hyperandrogenism. The imbalance can lead to several conditions:

• Acne
• Hirsutism (aka excess hair around the mouth and chin)
• Alopecia (hair loss)

What does menopausal acne look like?

Although all acne begins with clogged pores, there are typically distinct differences between teen acne and hormonal acne. You may recall that teen and young adult acne tends to appear along the T-zone: the forehead, nose and chin, due to the preponderance of sebaceous glands there.

Menopausal acne, on the other hand, presents with some of the same characteristics as the acne associated with fluctuations from the menstrual cycle, including:

• Deep, cystic pimples
• Occurrence around the chin and jawline

Are some women more susceptible to menopausal acne?

Research shows that about 26% of women in their 40s, and 15% of women in their 50s (and beyond) experience acne. The exact reasons why some women get menopausal acne and some don’t have yet to be determined — though studies do suggest some factors at play.

• Ovary and adrenal activity: how much estrogen, progesterone and testosterone being secreted throughout perimenopause and menopause varies from woman to woman.
• Sensitivity to androgen receptors: some women may be more sensitive to androgens known as DHEAS, which can increase acne susceptibility.
• Lifestyle factors: stress, high glycemic index foods, cosmetics, smoking, lack of sleep and UV exposure have all been linked to increased risk of menopausal acne.
• Skin’s microbiome: new research suggests that breakouts occur when acne-causing bacteria isn’t kept in balance.
• Inflammatory activity: some women have a more powerful immune response, resulting in an increase in inflammatory acne.
• Underlying medical conditions: rarely, a disorder like polycystic ovary syndrome or androgen-secreting tumors can disrupt hormone balance.
• Genetics: a family history of menopausal acne increases a woman’s chances.

How do you treat menopausal acne?

Much like other types of acne, treating hormonal breakouts like menopausal acne centers around consistency and targeted solutions. Dr. Lee recommends SLMD Acne System, which contains powerful ingredients that manage both inflammatory and non-inflammatory acne. This regimen includes:

• Salicylic Acid Cleanser: exfoliates and penetrates into pores to clear out excess sebum and dead skin.
• Benzoyl Peroxide Acne Lotion: benzoyl peroxide kills acne-causing bacteria responsible for nodules and cysts.
• Retinol Resurfacing Serum: increases cell turnover which reduces the chances of dead skin clogging pores and also promotes more even skin tone.
• Facial Moisturizer: keeps delicate menopausal skin balanced, protecting it from the drying effects of acne treatment.

Because menopausal pimples tend to be deeper, they carry a greater risk of scarring. To help shrink pimples and protect skin, Dr. Lee favors a few SLMD Skincare spot treatments:

• Salicylic Acid Spot Treatment: a roll-on solution that penetrates into pores and helps calm inflammation.
• BP Acne Spot Treatment: a maximum-strength benzoyl peroxide treatment that targets acne-causing bacteria and quells redness.
• Salicylic Acid Pimple Patches: ultra-transparent salicylic acid patches that draw out pus and bacteria while keeping prying fingers away.

Do you need a prescription to treat menopausal acne?

Although menopausal acne can be difficult to treat, it typically responds well to topical retinoids and benzoyl peroxide. When over-the-counter versions of these ingredients don’t address the problem, stronger prescription versions are available.

Sometimes, these treatments don’t do the job. For perimenopausal and menopausal women who don’t respond to topical interventions, dermatologists can prescribe oral medication like spironolactone, which works by blocking androgen receptors. Many women report a reduction in acne within about six months while taking the drug.

Dr. Lee’s last word

I have a lot of patients who ask me about menopausal acne — most women aren’t expecting to have pimples again in their late 40s and early 50s. The good news is that with a consistent anti-acne routine, most women can manage their hormonal breakouts. For patients who don’t respond as well to over-the-counter solutions, there are some prescription options we can try.

—Dr. Sandra Lee