If you’re suddenly breaking out during menopause and thinking, “Why am I dealing with zits now, not in my teen years?”—you’re not alone. I see menopausal acne all the time in the clinic. Sometimes it’s the first time a client has ever had persistent breakouts; other times, it’s a frustrating comeback after the teenage years. Either way, I want you to know this: there are effective treatments, and with a smart treatment plan, we can absolutely get you back to healthy skin.
Think of this as your friendly roadmap to understanding hormonal acne in this stage of life, plus the best ways to calm it down—at home and in-office.
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A Quick Personal Note From Me
Around 42, I noticed something I’d never seen on my body before: dry skin on my legs. As an acne-prone, oily person, I’d never needed body lotion—my skin was always dewy. Then 43 hit, and the menopausal transition introduced me to a new crowd: brain fog, night sweats, joint pain, and sheer exhaustion. That’s when I started hormone replacement therapy—first testosterone, then progesterone, and finally estrogen.
This past year, my skin changes stepped onto my face in a new way. I had to completely change my routine to a more hydrating one—think hyaluronic acid, barrier support, and gentler actives—to plump my skin back up from estrogen declines. Replacing the hormones has helped those menopause symptoms, but here’s the twist: I started breaking out again like I did in my teen years—mostly on my back, neck, and along the bottom of my hairline.
Fun fact (and something I see often in clinic): the shoulders, back, and chest tend to be highly androgen-responsive—there are lots of androgen receptors in those areas—so when you add androgenic hormone replacers like testosterone, they’re more likely to spark acne breakouts there. Luckily, I know exactly how to get rid of that acne, and I’ll show you how I approach it with clients, too.
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What’s Actually Causing These Breakouts?
Let’s start with the “why,” because when you understand that, everything else makes more sense.
During the menopausal transition (also called the menopause transition), estrogen declines. Your oestrogen levels—or levels of estrogen—dip, while male sex hormones (the male hormones like testosterone) don’t fall as quickly. That shift in androgen levels and testosterone levels plays a major role in your skin.
Here’s the chain reaction:
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Androgens signal your sebaceous glands (also called oil glands) to boost oil production—the production of sebum, an oily substance.
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More sebum production + dead skin cells inside hair follicles = clogs.
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Clogs invite acne-causing bacteria and inflammation.
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Result: acne breakouts that cluster on the lower face, jawline, and neck. Sometimes they’re deeper, tender nodules—hello, cystic acne.
This is still acne vulgaris (the same medical name used for teenage acne), but the type of acne you see now is driven more by hormonal changes, hormonal imbalances, and hormonal fluctuations than by the pore-clogging habits you might remember from your teen years.
Other pieces of the puzzle can include stress hormones (cortisol ramps up inflammation), health conditions like polycystic ovary syndrome, and lifestyle changes like weight gain or sleep disruption. Your immune system can also get a bit reactive when hormones are on a rollercoaster.
How Menopause Shows Up On Your Skin (Besides Pimples)
Many of you tell me your face feels both oily and parched—totally possible. Low estrogen often means dry skin and changes in texture, while androgens push excess oil. You might also notice fine lines, more pronounced skin conditions, or heightened sensitive skin. And of course, menopause symptoms (menopausal symptoms) like hot flashes, night sweats, mood swings, vaginal dryness, and hair loss can be traveling companions. This is why I take a whole-person approach—skin, hormones, stress, and habits.
Your First Step: A Calm, Consistent Home Routine
Before we talk “big guns,” let’s get your home base right. The first step is to build a simple skincare routine that lowers inflammation, clears pores, and supports barrier strength.
What I changed personally (and what I recommend often):
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I always use our Pro B5 Wash gel cleanser. If you are using an active cleanser, start by swapping out any stripping cleansers for a gentle cleanser—clean, not squeaky.
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I added a hydrating serum with hyaluronic acid and Peptides to support skin health.
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I rotated topical treatments more thoughtfully: salicylic acid (to decongest pores and whisk away dead skin cells), benzoyl peroxide (to target acne-causing bacteria), and azelaic acid (to calm redness and refine).
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I used alpha hydroxy acids like the CytoClear Serum for texture and fine lines, being careful not to overdo it while my barrier recalibrated from the menopausal period shifts.
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I committed to sunscreen daily (the non-negotiable).
Morning
Evening
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Pro B5 Wash (double cleanse if you wear makeup or sunscreen)
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Choose ONE main active, based on your skin type and type of acne: See my blog: A guide for Choosing the Best Acid for Acne Treatment
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Salicylic acid (BHA)
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Alpha hydroxy acids
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Retinol
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Apply a topical cream benzoyl peroxide as needed
A quick note on counter products and counter treatments (over-the-counter): more is not better. Layering five actives nightly is a fast track to irritation, especially for sensitive skin. We’ll choose the few that fit you best to get the best results.
When At-Home Isn’t Enough: In-Clinic Boosts
If your skin needs a nudge, I have professional treatment options that safely accelerate progress:
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Chemical peels (customized with AHAs/BHAs or mandelic/azelaic) to dissolve buildup, brighten, and reset texture without wrecking your barrier. Done properly, peels can be incredible for adult acne and tone.
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Blue/red light protocols to calm inflammation and target bacteria.
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Barrier-repair strategies to steady irritation so actives can actually do their job.
We’ll time these with your menopausal period patterns, because I often see flares alongside hormonal shifts (think: after clusters of hot flashes or weeks with more night sweats).
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Let’s Talk Hormone Replacement Therapy (HRT)
You deserve a clear, pressure-free explanation—plus my real-life experience.
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What HRT aims to do:
Ease menopause symptoms like hot flashes, night sweats, vaginal dryness, mood and sleep issues, and support long-term health. From a skin perspective, estrogen supports collagen, elasticity, and hydration—so some notice smoother texture and fewer lines once oestrogen levels are supported.
My personal HRT journey:
At 43, I started testosterone first, then progesterone, and finally estrogen. My mood swings, foggy focus, and exhaustion improved, and sleep got better. Skin-wise, estrogen support helped with hydration and those fine lines, but I also noticed acne breakouts popping up—especially on the back, neck, and bottom of my hairline. That pattern matches what I see with clients on androgenic therapy: those areas (plus the shoulders and chest) are very androgen-responsive because of abundant androgen receptors. If you’re using testosterone, excess oil can show up there first.
How I manage this—for me and for clientsÂ
Exactly what I did for my back/shoulders and lower neck–hairline acne:
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In-shower “leave-on-then-rinse” step: I switched to a benzoyl peroxide body wash and let it sit on the shoulders and back for a couple of minutes before rinsing. That brief contact time knocks down acne-causing bacteria without over-scrubbing.
Tip: Rinse well and be mindful that BP can bleach towels/fabrics. -
Post-shower serum: On clean, dry skin I apply AHA 15% Back & Body Serum across the back, shoulders, and along the bottom of my hairline. The alpha hydroxy acids smooth dead skin cells and help keep pores clear while supporting overall skin health.
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Targeted peel rhythm: Every other week, I use BetaRX peel pads as a body treatment. This adds a controlled chemical peel effect (BHA/AHA) to further decongest and refine texture—especially helpful where androgen receptors are dense and sebum production/ excess oil ramps up.
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We pick the right topical treatments (body salicylic acid or benzoyl peroxide based on your skin type, type of acne, and pattern of acne breakouts (face vs. back/shoulders/chest).
How I sync your skin plan with HRT timing
I help you coordinate in-clinic treatments and your at-home product routine around your hormone replacement therapy so we can stay ahead of acne breakouts.
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We pick the right topical treatments (body salicylic acid or benzoyl peroxide based on your skin type, type of acne, and pattern of acne breakouts (face vs. back/shoulders/chest).
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Pellets: We pre-book a treatment right after insertion to anticipate a testosterone surge (those androgen receptors on the shoulders, back, and chest love a spike). I lean on a brief contact benzoyl peroxide wash in the shower, then AHA 15% Back & Body Serum post-shower, and add BetaRX peel pads every other week. In-clinic, we time gentle chemical peels and anti-inflammatory protocols to blunt excess sebum production and calm hair follicle congestion.
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Injections (set days each month): We align peels and body “spot cleansers” (salicylic acid or benzoyl peroxide washes) for the 3–7 days after each shot when androgen levels tend to peak, then pivot to barrier and hydration (hello, hyaluronic acid) as levels stabilize. If the lower face flares, I rotate azelaic acid or a targeted topical cream.
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Transdermal (patch/gel): Because dosing is steadier, we keep a consistent routine with periodic check-ins to dial actives up or down based on your skin changes, menopause symptoms, and any hormonal fluctuations.
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Oral therapy (with a progestin): We watch for pattern flares on the lower face. A smart rotation of salicylic acid, azelaic acid, and occasional alpha hydroxy acids helps keep dead skin cells moving while protecting a sensitive barrier.
When it’s helpful, I’ll coordinate with your healthcare provider so your treatment plan and your hormone plan work together—for the best options and best results.
Food, Stress, and Daily Rhythms (Yes, They Count)
This is not about perfection or a rigid lifestyle. Small lifestyle changes add up.
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Food: Some of you notice flares with dairy products. If that’s you, a short trial off dairy can be illuminating. Focus on steady protein, fiber, and colorful plants—for stable energy and calmer skin.
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Stress: We can’t remove it, but we can buffer it. Gentle movement, breath work, and regular sleep dial down stress hormones, which your skin loves.
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Hydration & sleep: Under-sleeping and under-drinking amplify skin issues. Simple, not glamorous, but powerful.
Your Personalized Plan: How We’ll Work Together
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Assessment & mapping
We’ll look at your skin type, flare timing, menopause symptoms, and any health conditions. If needed, we’ll loop in your healthcare provider about HRT, oral contraceptives, or other medical treatments—particularly if there’s high blood pressure or other considerations. -
Foundational routine
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Gentle cleanser morning and night.
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Smart actives: salicylic acid, benzoyl peroxide, or azelaic acid, chosen intentionally (not all at once).
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Hydration with hyaluronic acid; antioxidants like vitamin C in the morning.
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Sunscreen daily, no exceptions.
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Targeted upgrades
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Periodic chemical peels aligned with your skin calendar.
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Lifestyle fine-tuning
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Gentle lifestyle changes around sleep, stress buffering, and possibly testing a no-dairy products window.
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Mind the connections with mood swings, hot flashes, night sweats, and vaginal dryness—they can sync with flares.
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Review & adapt
Skin is dynamic. We’ll watch for patterns in hormonal shifts and adjust so you feel supported in this stage of life.
The Good News
There is good news: menopause acne is very treatable. Whether we keep it simple with topical treatments, add in-clinic support like chemical peels, or coordinate medical treatments with your provider, you don’t have to “wait it out.” This is your skin, your comfort, your confidence—and you have choices.
If you’re ready, let’s start with a skin consult. We’ll map what’s happening, choose the right skincare products, and begin your personalized acne treatment plan. You don’t have to figure this out alone.
Disclaimer: I’m not a medical doctor. The information on this site is for educational purposes only and isn’t medical advice. It shouldn’t be used to diagnose, treat, cure, or prevent any disease or skin condition, and it doesn’t create a provider–patient relationship. Always talk with your licensed healthcare provider about your specific health concerns, medications, or before starting new treatments or skincare products. If you’re experiencing a medical emergency, call 911 (or your local emergency number).
