Menopause Triggers Unwelcome Skin Changes, Including Return of Acne

While hot flashes and mood swings are commonly associated with menopause, many women face a less discussed symptom that can be psychologically distressing: the return of acne, often decades after they thought they’d left breakouts behind.

Studies show that most women report skin problems as they age, with acne emerging as a particularly troublesome issue that can affect mental wellbeing alongside physical appearance.

Dr. Amy Wechsler, a Manhattan-based physician with dual board certification in dermatology and psychiatry, specializes in treating women experiencing acne during perimenopause and menopause.

“For them, it’s just horrible because they’ve never had it — it’s so foreign to them,” Dr. Wechsler explained. “There’s so much psychological overlap and effects of acne on people in terms of lowering self-esteem and self-confidence, and causing anxiety and sometimes depression.”

Medical experts identify two primary “peaks of acne” in women’s lives: during adolescence and again during the perimenopausal and menopausal transition. This creates what Dr. Wechsler describes as a midlife paradox.

“Women often come to see me, age 35 to 55, complaining about wrinkles and pimples, and they feel too young for their wrinkles and too old for their pimples,” she noted.

The pattern of breakouts also differs from teenage acne. Women who had clear skin for decades suddenly find themselves battling breakouts again around age 40, but with a distinctive pattern.

“This time it’s centered around their lower face, chin and jawline, which is where hormonal acne tends to occur,” Dr. Wechsler said. The acne typically resolves once a woman completes menopause.

While some research has suggested a potential connection between GLP-1 medications (used for weight loss and diabetes) and increased acne, Dr. Wechsler hasn’t observed a clear link in her practice despite seeing many patients taking these medications.

The treatment approach for menopausal acne primarily targets hormonal factors. Spironolactone, a medication that “blocks testosterone from binding to the testosterone receptors in the lower face,” is specifically designed for hormonal acne in women. Hormone replacement therapy and birth control pills can also provide relief.

For milder cases with primarily blackheads and whiteheads, topical treatments may be sufficient. Dr. Wechsler often prescribes retinoids, sold under brand names like Differin, Retin-A, or Tretinoin, which offer the dual benefit of treating acne and stimulating collagen production to address age-related skin changes.

Other treatment options include low-dose doxycycline, which works as both an antibiotic and anti-inflammatory, or low-dose Accutane for more widespread or severe cases. “It really depends on the individual and how bad the acne is,” Dr. Wechsler emphasized.

Beyond medication, managing stress plays a crucial role in skin health. Optimal sleep—seven and a half to eight hours per night—provides essential “anti-inflammatory” time when the body heals. During sleep, cortisol (the stress hormone) reaches its lowest levels while healing compounds like beta-endorphins, growth hormones, and oxytocin peak.

Dr. Wechsler also recommends stress-reduction activities throughout the day, such as exercise, spending time outdoors, social connection, stretching, and deep breathing techniques to lower cortisol levels.

Product selection matters significantly for acne-prone skin. “It’s really important that all products are non-comedogenic, or oil-free,” Dr. Wechsler advised. “That means the company has tested the product and that it will not clog your pores and cause pimples.”

Basic skincare practices remain essential: washing your face after exercise and before bedtime, and never sleeping in makeup.

For women struggling with persistent acne that doesn’t respond to over-the-counter treatments within two months, Dr. Wechsler recommends consulting a dermatologist for personalized treatment options. With professional guidance, this unexpected and unwelcome side effect of the menopausal transition can be effectively managed.