How do you recognize perimenopause acne?

You look in the mirror and think: these don't look at all like the pimples I used to have.

They are often not small pimples like in your teenage years. They are deeper, more painful, and always seem to reappear in the same places. Often on your chin or along your jawline.

Many women who get pimples again around their forties or forty-fives wonder if it has something to do with their hormones. And very often, that is indeed the case.

Menopausal acne, also known as hormonal acne, often arises in the years leading up to menopause. In the previous blog, I already explained why you can get pimples again around age 45. This usually has to do with hormonal fluctuations during perimenopause [1][7][9].

In this blog, we will look together at how to recognize menopausal acne. Because there are a few typical signs that many women share.

What is menopausal acne?

Menopausal acne is acne that arises during perimenopause, the phase before menopause.

During this period, hormones like estrogen and progesterone begin to fluctuate and slowly decline. As a result, androgens can relatively gain more influence on the skin. This can lead to increased sebum production and inflammation in the skin [5][7].

The result can be that women get pimples again, even though they had clear skin for years. This phenomenon is known in dermatological literature as adult female acne [1][2].

If you haven't read the previous blog yet, it might help to first understand why pimples can reappear around age 45. (Read more: Why do you suddenly get pimples again around age 45?) This makes it easier to recognize what is happening to your skin.

Pimples on the chin and jawline

One of the most recognizable signs of hormonal acne is the location where the pimples appear.

Many women get pimples on:

• the chin

• the jawline

• around the mouth

• sometimes also on the neck

Dermatologists often call this the U-zone of the face. The skin in this zone reacts more sensitively to hormonal changes [2][4]. That's why many women in this life stage primarily get pimples on their chin and jawline.

These are often pimples that keep coming back in the same spots. Sometimes they disappear for a while and then reappear.

This pattern is often seen in hormonal acne in adult women [1][2].

Subcutaneous pimples that hurt

A second typical characteristic of menopausal acne is subcutaneous pimples.

These are pimples that are deeper in the skin. They often feel like small hard bumps under the skin and can be sensitive or painful.

Unlike classic youth pimples, they often do not have a clear whitehead.

Many women describe them as:

• painful bumps under the skin

• pimples that linger

• pimples that are difficult to get rid of

Dermatological studies describe that adult hormonal acne more often consists of deeper inflammatory lesions than juvenile acne [1][4].

Pimples that keep coming back

Another typical sign of hormonal acne is that pimples keep returning.

You might feel that your skin calms down for a while, and then pimples reappear. Sometimes it seems like they come in waves.

Many women, for example, notice that their skin is calm for a while and then suddenly a few pimples reappear in the exact same spot.

This often has to do with hormonal fluctuations during the cycle or during perimenopause [7][9].

Pimples and drier skin at the same time

What many women also notice is that their skin feels drier than before. This can be confusing. You would expect dry skin to get fewer pimples.

Yet, we often see that women in this phase have both dry skin and pimples.

This is because the skin barrier changes when estrogen declines. At the same time, hormonal changes can affect sebum production [9][17].

In the next blog, I will delve deeper into this and explain why dry skin and pimples often occur together. (Read more: dry skin and pimples)

Your skin suddenly reacts more sensitively

Many women also notice in this phase that their skin reacts more sensitively than before.

Products they used without problems before can suddenly sting or cause redness.

This is because the skin barrier often becomes more fragile during perimenopause and the skin can thin [9][17].

As a result, the skin can react more quickly to:

• strong exfoliants

• aggressive acne products

• too many different products at once

That's why the approach that might have worked well for juvenile pimples before doesn't always work for menopausal acne anymore.

What is the difference from juvenile pimples?

Many women wonder if their acne is still the same as before.

However, there are a few clear differences between juvenile acne and hormonal acne in adults.

Juvenile pimples are often located on:

• the forehead

• the nose

• the cheeks

In hormonal acne, we more often see:

• pimples on the chin and jawline

• deeper inflammations

• recurring pimples

• more sensitive skin

These differences are also described in dermatological studies on adult female acne [1][2][4].

How do you know if you have hormonal pimples?

There are a few signs that often indicate hormonal acne.

Your pimples may be hormonal if:

• you are around forty or forty-five

• pimples are mainly on the chin or jawline

• they are often subcutaneous pimples

• they keep coming back in the same spot

• your skin feels simultaneously more sensitive or drier

This does not mean that hormones are always the sole cause. But in many women, hormonal changes do play a significant role [1][6].

What can help with premenopausal acne?

When you notice your skin changing, it can help to re-evaluate your skin routine. The skin in this phase of life often needs a gentler approach.

This means, for example:

• mild cleansing

• supporting the skin barrier

• not exfoliating too aggressively

• using products that soothe the skin

Want to know more? In this blog, we will look together at what can truly help to calm hormonal pimples. (Read more: What helps with hormonal acne)

Briefly summarized

Premenopausal acne often arises during perimenopause, when hormones begin to change.

Typical signs include:

• pimples on the chin and jawline

• subcutaneous pimples

• pimples that keep coming back

• skin that becomes simultaneously drier and more sensitive

Many women only truly understand their skin when they realize that hormones play a role. And once you know what's happening, it often becomes easier to give your skin some peace again.

Author: Sofie Dewitte

Sources

1. Harper JC, et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology, 2024.

2. Rocha M, Bagatin E. Adult female acne: Clinical characteristics and factors related to disease severity. Australasian Journal of Dermatology, 2018.

3. Del Rosso JQ, Kim G. Adult female acne: A guide to clinical practice. Journal of Clinical and Aesthetic Dermatology.

4. Preneau S, Dreno B. Female acne – a different subtype of teenager acne? Journal of the European Academy of Dermatology and Venereology.

5. Pappas A. Acne pathogenesis: from comedogenesis to inflammation. Clinics in Dermatology.

6. Carmina E et al. Female Adult Acne and Androgen Excess. Journal of the Endocrine Society, 2022.

7. Thiboutot D et al. Acne: hormonal concepts and therapy. Clinics in Dermatology.

8. Lucky AW et al. Hormonal treatment of acne in women. Journal of Clinical and Aesthetic Dermatology.

9. Newson L. Acne, perimenopause and menopause. Newson Health Menopause Society.

10. Dr Louise Newson. Clinical explanations on perimenopause, hormones and skin changes.