Menopause acne: why you're getting spots again and what can help
By Softer Mind · Updated 15 October 2026 · 7 min read · Based on NHS guidance and published research
You thought spots were behind you. Now there are sore lumps around your mouth and chin, or clusters of blackheads you haven't seen since school. And it's happening just as the rest of your skin is getting drier. It can feel deeply unfair.
Yes, menopause acne is real. The NHS says hormone changes during puberty, periods, pregnancy and menopause can all play a part in acne. Doctors use the term "menopausal acne" for acne that starts or comes back around perimenopause or menopause, usually from about 45 onwards (a 2019 review).
So perimenopause acne isn't a sign you're doing something wrong. But now and then, new acne in midlife is a sign of something else going on. Please read the box below first.
Get an urgent GP appointment if you have acne and also:
- thick, dark hair suddenly starts growing on your face or body
- your voice is getting deeper
- your muscles are getting bigger
These can be signs that your body is making too many male-type hormones. The NHS says a tumour affecting hormone levels is a rare cause, and these signs need checking quickly.
See your GP if your skin is hot, swollen and red, which can be a sign of infection, or if acne is affecting your mental health (NHS).
What does menopause acne look like?
It can look a bit different from teenage acne. The 2019 review describes:
- deep, sore spots or lumps, mostly around the mouth and chin
- lots of blackheads and whiteheads, sometimes large ones on the forehead and the sides of the face, especially in women over 40 and in smokers
- spots on the chest, back or upper arms, which become more common in women over 60
Acne can be persistent (it never really went away), recurrent (it's come back after years) or brand new. All three happen in midlife.
The tricky part is that your skin is changing in other ways too. The review says women with menopausal acne tend to have more sensitive skin. So they're more likely to be left with red or dark marks and scars after spots heal.
Why does menopause cause acne?
It comes down to the balance of hormones.
- Oestrogen falls fast. After menopause, oestrogen drops sharply.
- Androgens fall slowly. Androgens are the "male-type" hormones, such as testosterone, that all women make too. They fall much more gradually.
- So androgens have more effect. A protein in your blood that normally mops up androgens also falls, leaving more of them free to act on your skin.
A 2022 review of menopause and skin says this "relative" excess of androgens is thought to be behind menopausal acne, though the exact cause isn't clear.
Most women with menopause acne have normal hormone levels in a blood test. The British Association of Dermatologists explains that in acne, the skin's oil glands can be extra sensitive to these hormones, even when levels are normal. They make too much oil. Oil and dead skin cells block the pores, and bacteria then cause inflammation.
The 2019 review also lists other things that may play a part, including stress, smoking, poor sleep, being overweight and some cosmetics.
Can HRT or testosterone cause acne?
Sometimes, yes.
- HRT. The NHS lists acne as a possible side effect of progestogen, the second hormone in most HRT. It says side effects like this usually go away after a few weeks. The 2022 skin review notes that combined oestrogen and progestogen HRT increases oil in the skin, while oestrogen alone reduces it.
- Testosterone. Some women are prescribed testosterone after menopause for low sex drive. A University Hospital Southampton leaflet lists acne and greasy skin as rare side effects. It says a deeper voice is a very rare side effect, only seen when more than the recommended dose is used.
If you think a medicine is behind your spots, talk to your GP or pharmacist. Don't stop or change HRT or any other medicine without talking to them first.
Other causes of acne in midlife
Before putting it all down to menopause, it's worth thinking about what else could be going on.
- PMOS. Polyendocrine metabolic ovarian syndrome is the new name for polycystic ovary syndrome (PCOS). The NHS lists oily skin and acne, extra hair growth or hair loss, and irregular periods among its symptoms.
- Other medicines. The British Association of Dermatologists says some medicines can bring on acne, including steroids and some hormonal contraceptives.
- Greasy products. Oily skincare, heavy moisturisers and hair products can make acne worse.
- Other hormone problems. The 2019 review says doctors may check your thyroid and other hormones. Rarely, too many androgens are caused by a growth (tumour).
- Rosacea. The NHS lists rosacea as a linked condition, and it can look like acne. It causes redness and flushing across the middle of the face. Our page on menopause skin changes covers it.
What you can do yourself
These tips come from the NHS, the British Association of Dermatologists and the 2019 review.
Washing
- Wash your face once or twice a day with a gentle cleanser. Try not to wash it more often than that.
- Don't scrub. It irritates the skin and can make acne worse.
- Take your make-up off before bed.
Products
- Look for products labelled "non-comedogenic" or "oil-free". These are less likely to block pores.
- Use a light, non-comedogenic moisturiser. Your skin may be dry and spotty at the same time, and it still needs moisture.
- Throw out old make-up and skincare.
Hands off
- Try not to pick or squeeze spots. The NHS says this can cause scars.
Clothes
- For spots on your chest or back, wear loose, breathable clothes, especially when you're likely to sweat.
Day to day
- The 2019 review lists sleep, stress, smoking, exercise and weight as everyday things worth looking at alongside other care.
- There isn't enough evidence to say any special diet helps acne. The British Association of Dermatologists suggests a healthy, balanced diet.
What a pharmacist can offer
A pharmacist can talk you through acne creams and gels you can buy without a prescription. The NHS and the British Association of Dermatologists mention ingredients such as benzoyl peroxide, salicylic acid, azelaic acid and nicotinamide.
Tell the pharmacist your age and that your skin is drier than it used to be. The 2019 review warns that some acne treatments can dry out and irritate older skin.
Be patient. The British Association of Dermatologists says most creams take 2 to 4 months to work fully, and you should expect to use a treatment for at least 12 weeks before you see much change.
What your GP or a dermatologist can offer
Tests. Your GP may ask about your periods, any new hair growth and your medicines. They may suggest blood tests, for example to check your hormones or thyroid.
Prescription treatments. Depending on how bad your acne is, these are options to discuss:
- creams and gels, such as retinoids or antibiotic creams. The British Association of Dermatologists says acne can get a little worse for a few weeks after starting a retinoid before it improves
- antibiotic tablets, usually used alongside a cream
- spironolactone, a tablet that blocks the effect of androgens. The British Association of Dermatologists says it's used "off-licence" for acne in women
- isotretinoin, for severe acne, prescribed only by a skin specialist (dermatologist)
The combined pill is often used for acne in younger women. But the 2019 review says it's usually not suitable after menopause.
Scars and marks. The British Association of Dermatologists says getting acne under control early is the best way to avoid permanent scars. If you already have scars, ask your GP about seeing a dermatologist.
How acne can feel
Acne in your 40s and 50s can hit hard. You might feel embarrassed, or cross that you're dealing with spots and wrinkles at once. The NHS says acne can affect your mental health and may be linked to anxiety, depression and low self-esteem. The 2019 review says acne can cause real distress for women at this age.
That's a real reason to see your GP. It isn't vanity.
When to see a GP about acne
The NHS says to see a GP if:
- treating it yourself isn't helping
- you have lots of spots, or deep or painful ones
- your spots are leaving scars
- your skin looks infected (hot, swollen and red, which can be harder to see on brown and black skin)
- acne is affecting your mental health
And use the box at the top of this page for anything urgent. Our symptoms checklist lets you tick off everything you've noticed and print a list for your GP.
Related
Acne often comes with other skin changes in menopause, new facial hair and hair loss, and you can see them all in our list of perimenopause symptoms.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
