Most people associate acne with adolescence. It is often viewed as a rite of passage during the teenage years, disappearing as hormones settle into adulthood. However, for many women, breakouts can return decades later during perimenopause and menopause, often at a time when they expected their main skin concerns to be wrinkles, dryness and loss of firmness.

Yes, menopausal acne is a thing! And it is different from teenage acne.

Why Does Menopause Cause Acne?

The short answer is hormonal imbalance. They play a central role in the development of menopausal acne.

Throughout much of adult life, oestrogen and androgen hormones exist in a relatively balanced relationship. During perimenopause and menopause, levels of both hormones begin to decline. However, oestrogen tends to fall more rapidly than androgens, creating a shift in the body's hormonal environment.

As oestrogen levels decrease, androgens can exert a greater influence on the skin. One of their key effects is stimulating the sebaceous glands, which produce the skin's natural oils. This can lead to an increase in sebum production, making pores more likely to become clogged. When excess oil mixes with dead skin cells and other debris, it creates an environment where inflammation and breakouts can develop.

Hormonal fluctuations are not the only factor here. Women experience increased stress, disrupted sleep and changes in overall wellbeing during menopause. These factors can contribute to inflammation within the body and may further influence the skin's behaviour.

As a result, many women notice acne appearing or returning during their 40s and 50s, even if they have not experienced significant breakouts for years.

How Is Menopausal Acne Different From Teenage Acne?

Although both forms of acne involve blocked pores and inflammation, menopausal acne develops in skin that has changed significantly over time.

Teenage skin is typically characterised by higher oil production and a stronger skin barrier. In contrast, menopausal skin often experiences reduced collagen production, increased dryness and greater sensitivity.

Unlike teenage acne, menopausal acne often appears alongside age-related skin changes. That’s why, menopausal acne requires a different treatment approach from the one used for treating teenage acne. Common skin ageing concerns often seen alongside menopausal acne include:

1. Fine lines and wrinkles
2. Loss of elasticity and firmness
3. Dryness and dehydration
4. Increased sensitivity
5. Uneven skin tone

Where Does Menopausal Acne Tend To Appear?

The location of breakouts can often provide clues about their underlying cause.

Teenage acne commonly appears across the forehead, nose and upper cheeks.

Menopausal acne, on the other hand, tends to affect the lower face. The most common areas include:

1. The chin
2. The jawline
3. Around the mouth
4. The neck

These breakouts are often deeper and more inflamed than the whiteheads and blackheads associated with adolescent acne. Many women describe painful, tender spots beneath the skin that can take weeks to fully resolve.

Because mature skin generally heals more slowly, breakouts may also leave lingering redness or post-inflammatory pigmentation.