Understanding Acne in Menopause
Menopause often brings to mind hot flashes and mood swings, but lesser-known symptoms, like changes in skin, can also emerge. In fact, many women begin to notice skin issues as they age, sometimes experiencing problems they thought were long behind them from their teenage years.
Dr. Amy Wexler, a dual board-certified dermatologist and psychiatrist based in Manhattan, works with women in their menopausal years who, unexpectedly, find themselves dealing with acne. It’s, well, a bit unsettling—many have never faced this issue before. “For them, it feels foreign and frightening,” Dr. Wexler explained. “Acne can lower self-esteem and create anxiety or even depression.”
The Midlife Paradox
According to Dr. Wexler, women experience two primary “acne peaks”: during adolescence and again during menopause. “It’s not uncommon for someone to be acne-free for decades only to find that, around 40, those pesky breakouts return,” she noted. This time, though, they typically show up on the lower half of the face—most often the chin and jawline, where hormonal acne tends to thrive.
Women aged 35 to 55 frequently come in expressing confusion—too young to worry about wrinkles but too mature to be struggling with acne. Meanwhile, some men who are genetically predisposed to acne might continue experiencing it into adulthood, but for women, certain hormonal changes during perimenopause and menopause often trigger these skin issues. Notably, breakouts usually taper off after menopause.
Some conflicting studies suggest that weight reduction from GLP-1 medications or certain antidiabetic drugs could possibly lead to an increase in acne, though this isn’t universally acknowledged. “If there was a clear link, I think I would have noticed it by now, given how many patients I treat who are on GLP-1,” Dr. Wexler remarked.
Treatments for Adult Acne
Addressing age-related acne often involves hormone-related treatments. Dr. Wexler highlighted that spironolactone can be particularly effective, as it helps block testosterone from binding to receptors in the lower part of the face. Hormone replacement therapy or oral contraceptives might also be beneficial, though any treatment plan should be tailored to individual needs.
“Some people come to me with just a few blackheads or whiteheads. They might not require oral medications,” she explained. Instead, topical treatments—often retinoids like Differin, Retin-A, or Tretinoin—can be quite effective. Not only do they help with acne, but they also have anti-aging benefits by promoting collagen production.
In some cases, she may prescribe low doses of doxycycline, which serves a dual purpose as both an antibiotic and anti-inflammatory. For more severe cases, a lower dose of Accutane might be recommended based on the individual’s experience with acne.
Maintaining Healthy Skin
Stress, in addition to genetics and hormones, can significantly impact the skin, according to Dr. Wexler. One of the best defenses? Getting quality sleep, which she describes as an “anti-inflammatory” period for the body. “Regrettably, many don’t get sufficient rest,” Wexler noted, stressing that adults typically need about seven-and-a-half to eight hours of sleep. During this time, stress-related cortisol levels diminish, while healing hormones peak.
Alongside proper sleep, experts suggest managing stress through exercise, spending time outdoors, social interactions, stretching, and practicing deep breathing. These strategies can help lower cortisol levels throughout the day.
Wexler stressed the importance of using the right skincare products for those susceptible to acne. “Make sure everything is non-comedogenic or oil-free,” she advised—indicating that companies should have tested products to ensure they won’t clog pores. Regular skin care routines, like washing the face post-exercise and avoiding overnight makeup, are crucial, too.
If acne persists beyond the efficacy of over-the-counter products after a couple of months, Dr. Wexler encourages seeking advice from a dermatologist.
