A very common yet often surprising effect of perimenopause and menopause is spots and acne breakouts. Women often say to me, “I’m too old for spots!” or “I didn’t even have spots as a teenager – why am I suddenly being plagued with them now?”

Sound familiar?

Having spots at any age is no fun, but menopause is a time when you may already be feeling low in confidence and really could do without yet another skin complaint to contend with.

And while hormonal acne can crop up at any age, it’s particularly common in puberty, pregnancy, and perimenopause when major hormonal changes happen in a woman’s body.

What is hormonal acne?

Hormonal changes in the body stimulate hormonal acne or breakouts. It’s often caused by an imbalance, such as a hormonal disorder, declining oestrogen, or coming on and off the pill. Shifts in progesterone and oestrogen levels can stimulate the production of sebum and acne-causing bacteria, which causes skin inflammation. What’s more, during menopause, you may also be battling sleep issues, sugar cravings, stress and mood changes, all of which can exacerbate problematic skin.

Hormonal acne tends to appear on the lower part of the face, including the bottom of the cheeks and around the jawline, but it may also affect the back, chest, and shoulders. Hormonal acne tends to take the form of painful cystic bumps under the skin, but it can also form painful red papules or pustules on the surface.

Hormonal acne often reappears in the same area due to oil production patterns, so if you’re noticing a breakout continually reappearing in the same area, it’s likely to be hormonal.

What’s happening to my hormones during perimenopause?

During perimenopause, your body is starting to prepare itself for menopause, which can lead to hormonal fluctuations.

Firstly, a natural skin and mood calmer, progesterone may decline, leading to inflammation. Testosterone levels are likely to rise, resulting in slow cell turnover and cystic acne. And thanks to low oestrogen, you may notice that you scar more easily from spots, plus the reduced collagen and elastin also means that pores may become larger and more prominent.

How to effectively tackle spots in menopausal skin

Reduce inflammation

A good adult acne treatment is to reduce inflammation in breakouts and skin in general. Calming spots and pimples down will reduce redness, size, and pain. Look for ingredients such as niacinamide, ceramides, green tea and aloe vera.

Strengthen your skin barrier

This will reduce your skin’s reaction to products and external triggers, so it maintains moisture, stays hydrated and is more resilient.

Look out for ingredients such as hyaluronic acid, ceramides, and vitamin E.

Choose the right cleanser

Gentle, nourishing cleansers are the way to go when dealing with menopausal skin. Choose a formulation that contains hydrating ingredients like ceramides and fatty acids, and avoid washing your skin too often, as this may strip it of its natural oils.

Minimise sebum production

The acne-busting benefits of retinoids are well documented. They work on a cellular level to help kickstart your cell turnover rate, reduce inflammation, and decrease oil production – all key functions for keeping pores clear and breakout-free.

I’m a big fan of the SkinBetterScience AlphaRet Overnight Cream, which is excellent for skin regeneration and is made up of a retinoid combined with an alpha hydroxy acid.

Chemical exfoliants such as BHAs (salicylic acid) are also very effective. They travel inside the pore lining to eliminate the build-up of oil and dead skin cells in the pores as well as on the surface of the skin.

Optimise your hormones

The most effective way to tackle any symptom of menopause is to optimise your hormone levels. During perimenopause, acne occurs due to plummeting levels of oestrogen and progesterone and an increase in testosterone. Once you’ve ruled out other causes, Bio-identical Hormone Replacement Therapy (BHRT) could be a very effective option.