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Acne is a common symptom of the menopause transition. Yes, really. It can suddenly rear its ugly head (pun intended) in your 40s during perimenopause. It usually affects those of us that had acne back in adolescence, but even the acne-free among us may experience it at some point during the menopausal transition.

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    The science

    Unfortunately, there’s a chance that we may have to face the indignity of pimples once again as we move through the menopause transition.

    And as you might guess, it’s the hormonal kind, which is most likely to appear around the mouth, chin and jawline. It tends to occur cyclically along with our period, usually about a week before and during, and is often inflamed. For many, it also involves cystic acne, those really horrible, painful blemishes that develop deep beneath the skin. The “regular” non-hormonal acne, on the other hand, is less inflamed and instead marked by white and blackheads.

    The science behind why hormonal acne appears (or, for the lucky among us, reappears) during menopause is multi-faceted, spanning everything from hormones to endocrine disorders, genetics to lifestyle factors. Below, we break it all down.



    During the menopause transition, we are in a state of androgen excess relative to dropping estrogen levels. Androgens are a group of hormones that include testosterone. With more testosterone, we’re more prone to acne, hirsutism (male-pattern hair growth on the face, chest, and back), and male-pattern hair loss. And because of this relative increase of testosterone, women with polycystic ovarian syndrome are also at higher risk of acne.

    To be clear, acne in this time period does not mean that one’s testosterone or overall androgen level is too high. Testosterone, for example, starts to gradually decline in our late 20s. Rather, it is the relationship of androgens to the other hormones that may be responsible.

    Thyroid abnormalities

    Although the connection is unclear, hypothyroidism caused by autoimmunity (Hashimoto’s) is associated with adult acne, perhaps because of an effect on sebum production (sebum is the oil that’s produced by glands in your skin for lubrication). Factors related to chronic inflammation may also be at play.

    Insulin resistance

    Insulin resistance is correlated with acne, and is thought to be an effect of insulin on sebum production.


    Diet plays a huge role in acne, with dairy and sugar/refined carbohydrates as the primary culprits.


    Proteins found in dairy can be an inflammatory food for many, and the proteins themselves can vary from cow to cow, based on how they’re raised and what they eat. And remember, inflammation is something to avoid if you’re concerned about acne.

    When we say “inflammation,” we’re referring to our body’s normal response to infection or injury. It’s what causes damaged tissues to release chemicals that signal to white blood cells that it’s time to start repairing — which is totally a good thing and exactly what we want to happen when there’s an injury. What we DON’T want, however, is for the inflammation to become chronic and spread throughout the body, because then it can cause damage to your skin, in addition to increasing your risk of heart disease, stroke, cancers, diabetes, and more.

    Sugar/refined carbohydrates

    Eating sugar and refined carbs leads to insulin spikes, and we know there’s a correlation between insulin and acne. These types of foods also contribute to inflammation.


    Stress can significantly impact acne. Through its effect on our adrenal glands and stress hormone production, inflammation throughout the body is increased, which can lead to acne. So more stress = more stress hormones = more acne.

    Other factors

    Outside of diet and stress, other lifestyle considerations are lack of sleep and exercise, obesity, ultraviolet radiation (yes, sunlight can actually contribute to a particular form of acne called acne aestivalis – wear sunscreen!), cosmetics and skin care products, and smoking.

    So you may be asking the question: At what point do I see a doctor about acne? And the answer really depends on you. If acne is bothering you, then go see a dermatologist. There are a lot of very effective over-the-counter and prescription medications available to help manage acne, and a dermatologist is the one to help you navigate through. You can find one in your area here.

    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

    Because skin health is so personal, treatment options are, too. Factors such as the cause and severity of acne must be considered, as well as skin type (dry & sensitive vs thick and oily) and response to any previous treatment.


    Nutrition & Diet

    As we mentioned, food that we eat affects inflammation which, in turn, affects our skin health.

    There are certain tried-and-true nutritional tenets that our founding physician, Dr. Anna Barbieri, MD recommends to keep inflammation at bay and help mitigate the symptoms of acne during menopause. As a first step, she recommends focusing on sugar and dairy:

    • Eliminate sugar as much as you can, including sweeteners like high fructose corn syrup and refined carbs (i.e. things made with white flour) that quickly convert to sugar in your body.
    • Dairy is another major dietary culprit associated with acne. It’s worth a trial of omitting dairy for several weeks to see if there is any improvement.
    • Hydrate, hydrate, hydrate! When our urine is pale and clear, that’s a sign we’re properly hydrating our skin from the inside.

    If you’re interested in addressing inflammatory foods even more, you can also try removing conventionally raised meat, unhealthy fats (trans fats & processed vegetable oils), and gluten.

    Eliminating sugar, by far, is the single most effective way to control acne.

    For more on what foods raise the risk of inflammation and impact complexion, refer to our comprehensive nutrition guide.

    Holistic Practices

    Healthy skin starts with a basic (but effective!) skincare regimen that’s, above all, sustainable. Here’s what we recommend:

    • Wash your face once or twice daily with a mild soap cleanser or benzoyl peroxide face wash. Resist the urge to over-wash since it can dry out the skin and cause further irritation. Those of us with thick, oily skin should consider a glycolic or salicylic acid-based face wash, which is more aggressive against breakouts. The classic Cetaphil cleanser is frequently recommended by dermatologists.
    • Use water-based cosmetics and remove 100% of your makeup before bed, every night.
    • Use a moisturizer that’s non-comedogenic (so it won’t clog pores), non-acnegenic (so it won’t aggravate acne-prone skin), and hypoallergenic (so it won’t contain potential allergens). This option from CeraVe is a good place to start.
    • Always, always, always use sunscreen!

    Skincare aside, it’s important to focus on sleep health and stress management for optimal skin health. Too little sleep can cause stress, and stress causes inflammation, and inflammation can lead to acne.

    Supplements & Over-the-Counter Solutions

    Supplements and over-the-counter solutions may be effective in supporting your skin health…if you choose wisely. We recommend consulting with your healthcare provider first to ensure you’re using something with optimal efficacy and safety (i.e. backed by clinical research) or consulting with Elektra’s providers. Here’s a quick primer from our team on how to go about selecting high-quality supplements.

    Topical therapies are a go-to line of defense against acne, but they must be selected carefully. During the menopausal transition, we’re already susceptive to dry, itchy skin (more on that here), so the last thing we want is something to cause even MORE dryness and irritation. Our skin is no longer like teenage skin, so many of the products made for teens may be too harsh for us now. Listed below are Dr. Barbieri’s go-tos.

    Topical retinoids

    Retinoids are a family of chemical compounds closely related to vitamin A — and they come with the added benefit of addressing signs of aging like fine lines and wrinkles. Examples include tretinoin, tazarotene, isotretinoin, adapalene, and retinol. Some retinoids, like retinol and adapalene, are available over-the-counter. They can cause skin irritation, redness, and peeling at first, so ease into it by applying every second or third night for the first week or so. Retinoids increase skin photosensitivity — aka it’s easier to get a sunburn — so wear sunscreen!

    Benzoyl peroxide

    This comedolytic, antimicrobial topical treatment is effective but should be used with caution since it can cause irritation and dryness for those of us with sensitive skin.

    Azelaic acid

    Azelaic acid is an anti-inflammatory, comedolytic, antimicrobial product that is used for mild acne.

    Vitamin C (Ascorbic Acid)

    This potent antioxidant protects the skin from free radicals, which break down the skin cells and cause fine lines and wrinkles. It also acts as a shield to protect the skin from sun damage.


    Curcumin is a spice derived from the boiled, dried, and ground root of the Curcuma longa plant. It’s what constitutes turmeric, the anti-inflammatory, antioxidant-rich spice that’s fittingly referred to as “Indian gold.” Studies show that it may help reduce the signs of aging and ease the symptoms of acne.



    One hormonal treatment for acne is actually not related to estrogen or progesterone. Antiandrogens such as spironolactone are effective and well-tolerated for acne as well as hirsutism (growth of male-pattern facial hair along the face, chest, and back). It may also help with water retention and bloating too…a win-win!

    For women in perimenopause, low-dose birth control may be an option to manage acne. Interested in learning more about hormone replacement therapy (HRT)? We’ve got you covered with a complete guide.


    There are some non-hormonal prescription options for acne as well, both topical and oral. Talk to your dermatologist about the best option for you.


    Tretinoin is a topical retinoid available by prescription only. It’s used to both control acne and reduce fine lines and wrinkles.


    Dapsone is a topical gel with antimicrobial and anti-inflammatory properties. It’s effective and well-tolerated when used twice daily.


    Isotretinoin is an oral medication used for the treatment of severe, nodulocystic acne (in other words, acne affecting the face, chest, and back with both inflated and uninflamed nodules and scars). It can also be prescribed to those with moderate acne that’s resistant to conventional treatment. Isotretinoin is often referred to as Accutane, a brand name for the drug, which is no longer available in the US.

    While highly effective, it does come with side effects including photosensitivity, skin/mouth/eye dryness, muscle aches, and has been associated with feelings of depression. Isotretinoin can cause birth defects, so if you haven’t hit menopause yet, you have to use two reliable forms of birth control (some doctors may accept abstinence, some not) and pregnancy tests must be done monthly during treatment, which usually lasts around 5 months.

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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