Breakouts and acne in menopause might seem strange as this problem is more often associated with teenage years, but it is more common than you think. Some women suffer with acne in midlife, even if they didn’t when they were younger.
We spoke to medical and aesthetic specialist Dr Sophie Shotter to discuss why menopause acne and breakouts can be an issue during menopause – and the best ways to deal with spots, pimples, and blemishes.
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Can acne during menopause affect your mental health?
A lot of people can feel quite depressed. Acne and depression can be a vicious circle. The acne makes the sufferer feel unhappy and can cause social anxiety which increases isolation, impacting mood and increasing stress hormones that can make acne worse.
Like teenage acne, adult acne can have a really negative effect. But there are different reasons for this. In your teens, spots are perceived as normal, whereas in adulthood acne is rarer, but it can have a profound effect on mental health, confidence, and well-being. Having to adjust to menopause as well as having acne at 50 years old can be a difficult process. Treatment should focus on minimizing the impact of menopausal acne on your life, as well as treating the underlying cause.
Is there a difference between hormonal breakouts and acne and other types of breakouts?
The main cause of breakouts and acne is similar, whether in teens or in adults during menopause. The skin doesn’t exfoliate effectively which means that dead skin cells clog the pores rather than being shed. This leads to a build-up of sebum in the pores, which is a perfect breeding ground for bacteria. Adult breakouts and acne can be triggered by a wide range of issues but can present particularly during menopause.
Why does bad skin happen in menopause?
During menopause, estrogen levels drop and your rate of skin exfoliation slows down. Hormonal changes can also lead to imbalances between estrogen and testosterone.
If testosterone levels become higher in relation to estrogen, sebum production in the skin can increase. This can result in acne during menopause or breakouts producing a surge of whiteheads, or more cystic under-the-skin type spots. Other factors such as dietary changes, medication side effects, and stress can also be triggers.
What is the difference between acne and rosacea?
People with rosacea, sometimes called acne rosacea, are often misdiagnosed as having ‘just acne’. Unfortunately, the treatment for the two conditions is very different.
Rosacea is a skin barrier problem that happens when your skin becomes impaired and doesn’t function properly, whereas acne is a disease of skin that is usually oily and more resilient. If you know what to look for it is easy to distinguish between the two conditions.
Rosacea will most commonly affect the cheeks and nose, whereas acne can affect the whole face as well as other body areas. Small inflamed bumps can appear in rosacea alongside other symptoms such as redness, sensitivity, and dilated blood vessels. In acne, the skin contains a variety of different blemishes such as blackheads, whiteheads, and red bumps.
Topical treatments for acne typically involve ingredients like salicylic acid or benzoyl peroxide. Unfortunately, using these on rosacea will increase the flare-up rather than improve it. Rosacea needs products aimed at barrier repair that contain gentler ingredients such as polyhydroxy acids (known as PHAs) – some rosacea will also need antibiotics topically and/or orally.
Treatment tips for menopause acne
Each case of menopausal acne is different, and you should visit your healthcare provider to establish what will work best for you. Whatever you are dealing with, there is a solution. Try these skincare tips.
1. Choose your cleanser carefully
A good cleanser is key – ideally one with not too many active ingredients. Powerful ingredients such as Vitamin C can often cause a reaction. If you have acne with no rosacea present, try a cleanser with some salicylic acid.
2. Look for a moisturizer with alpha hydroxy acids (AHAs)
With any breakouts try to stay away from moisturizers that contain rich ceramides as this may make the problem worse. Instead, look for moisturizers with alpha hydroxy acids (AHAs) to boost exfoliation and cell turnover.
3. Use retinol
Topical retinoid creams can be a very good option for treating acne and will leave your skin glowing and smooth too. They work on a cellular level to help kickstart cell turnover, reduce inflammation, and reduce oil production – all critical for keeping pores clear and skin free of breakouts. They can also help fade stubborn acne scars and marks that linger after a breakout.
When using any retinol product for the first time, start by applying a pea-sized amount of product:
- Once a week at night for one week
- Twice a week for two weeks
- Three times a week at night for three weeks
- The goal is to work your way up to nightly use without irritation.
You must be sure you are not pregnant before using retinols. While there is no evidence that over-the-counter retinol products can cause birth defects, they are related to chemicals that clearly do.
4. Consider benzoyl peroxide
Benzoyl peroxide has been used for many years for treating acne, and you can get it in a prescription form. For anyone with mild to moderate acne, there are many over-the-counter products that you can try, all with varied strengths of the ingredient.
It works by killing c. acnes (the harmful bacteria on your skin responsible for breakouts) and helps minimize oil production, sheds pore-clogging dead skin cells, and reduces the redness and swelling associated with inflammatory pimples.
Benzoyl peroxide can be quite drying, so see your healthcare provider for advice before you try it.
5. Steroids for very persistent or extreme breakouts
Occasionally breakouts – particularly nodules and cysts – can be large and painful or just won’t get better, no matter what you try. In this case, steroid injections may be a good option. The steroid acts as a powerful anti-inflammatory, stopping the inflammation and helping the skin to heal faster.
Can diet changes help?
Dietary changes are not evidence-based treatments for acne, but some people report that they help.
Consider adding phytoestrogens – things like tofu, miso, and soybeans – to your diet. Phytoestrogens have a weak estrogen-like effect on the body that may help rebalance the effects of an elevated testosterone-to-estrogen ratio.
Find out more about menopause on our blog or in our symptoms library.
