What Causes Acne During Perimenopause
Perimenopause is the time leading up to menopause, often starting in a woman’s 40s, when hormone levels begin to shift unpredictably. These changes can bring back acne that many thought was left behind in the teenage years. The main culprit is a drop in estrogen and progesterone, which throws off the balance with other hormones like testosterone.
Estrogen helps keep skin smooth and controls oil production. As it declines during perimenopause, the skin’s oil glands, called sebaceous glands, can overproduce sebum, that thick oil that clogs pores and leads to pimples. At the same time, progesterone levels fluctuate wildly, making breakouts come and go in cycles, much like during menstrual periods but more intense for some women.
Testosterone, known as an androgen, plays a big role too. Women naturally have some testosterone from the adrenal glands, but after estrogen dips, its effects become stronger. This relative increase stimulates more sebum and can turn it into a more potent form called DHT, which inflames hair follicles and causes stubborn acne. You might notice this as deep, painful cysts on the chin, jawline, or forehead, areas typical for hormonal acne in this stage.
Stress adds fuel to the fire. Perimenopause often brings sleep issues and anxiety, raising cortisol levels. High cortisol worsens insulin resistance and boosts oil production, leading to more breakouts. Poor gut health can contribute as well. Declining estrogen slows digestion, disrupting gut bacteria, which affects hormone processing and triggers inflammation that shows up on the skin as acne, often with bloating or irregular bowels.
Foods high in sugar or dairy can spike insulin, mimicking androgen effects and worsening the problem. Skincare products with heavy creams or gels might clog pores further during this sensitive time. Sun damage from earlier years weakens the skin barrier, making it prone to irritation and spots that look like acne.
These factors combine in perimenopause because the body is adjusting to lower overall hormone levels, unmasking sensitivities that were balanced before. Acne here tends to be episodic, painful, and located lower on the face, setting it apart from teenage breakouts.
Sources
https://www.restartmed.com/menopause-acne/
https://news.umiamihealth.org/en/how-to-care-for-your-skin-during-perimenopause-menopause/
https://www.marieclaire.co.uk/beauty/hormonal-acne
https://www.youtube.com/watch?v=lMpW2srUQPQ
https://northtexasmedspa.com/hormonal-skin-changes/
https://conscious-skincare.com/blogs/news/hormonal-acne-in-adults-natural-solutions-skincare-that-works
