Hormonal Acne: How to Restore Clear Skin During Perimenopause

What is hormonal acne?

Hormonal acne, often referred to as “adult female acne,” is an inflammatory skin condition that differs from teenage acne in terms of its location and underlying cause. Unlike teenage acne, which often affects the T-zone (forehead, nose, and chin), hormonal acne in adulthood is generally concentrated in the “U-zone”: the lower face, jawline, chin, and sometimes the neck.

It is characterized by lesions that are often deeper, appearing as red, painful nodules or cysts that take a long time to heal. These flare-ups are closely linked to fluctuations in the hormones that regulate sebum production (skin oil). When this balance is disrupted, the sebaceous glands go into overdrive, the pores become clogged, and inflammation sets in.

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Why does hormonal acne occur during perimenopause?

Perimenopause is a period of “hormonal chaos” during which estrogen and progesterone levels fluctuate unpredictably before dropping. This phenomenon creates conditions conducive to acne for several reasons.

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Relative excess of androgens

A decrease in estrogen and, in some women, a decrease in SHBG (sex hormone-binding globulin), increases the proportion of biologically active androgens. These androgens further stimulate the sebaceous glands, promoting excessive sebum production and the development of inflammatory lesions.

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Changes in the Skin Microbiome

Hormonal changes alter the composition of sebum, the skin’s barrier function, and the balance of the skin microbiome. In some people, this promotes the proliferation of certain strains of Cutibacterium acnes that are involved in inflammation.

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Systemic Inflammation

The decline in estrogen, which has anti-inflammatory effects, makes the skin more sensitive to external aggressors and stress.

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Stress and Cortisol

Cortisol (the stress hormone) can stimulate the production of androgens by the adrenal glands, thereby worsening the acne cycle.

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Is it possible to reduce hormonal acne?

Treating hormonal acne requires patience. The goal is to reduce inflammation, regulate sebum production, support skin repair, and help maintain overall hormonal balance.

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Daily skincare to soothe the skin

You can follow these recommendations to reduce hormonal acne.

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Clean gently but thoroughly

Use a cleanser with a physiological pH (around 5.5) to avoid stripping the skin's barrier.

Avoid mechanical scrubs with grains, which can be harsh on the skin.

Exfoliating acids can be introduced gradually. AHAs improve skin texture, while salicylic acid (BHA), which is fat-soluble, penetrates the sebaceous follicle and is the gold standard for reducing blackheads. Azelaic acid is also an excellent option for adult women thanks to its anti-inflammatory and anti-dark-spot properties.

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💡 Double cleansing at night: worth trying

Double cleansing may be beneficial for people who wear makeup or water-resistant sunscreen every day. In other situations, gentle cleansing is usually sufficient.

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Moisturize to restore and protect the skin barrier

Moisturize daily with lightweight, non-comedogenic formulas containing ingredients such as niacinamide or hyaluronic acid. Niacinamide also helps reduce sebum production, minimize redness, and restore the skin’s barrier function.

A damaged lipid barrier contributes to inflammation and sensitivity; even acne-prone skin needs to be nourished.

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Protecting Your Skin from the Sun: Daily Sun Protection

Avoid direct sun exposure to the lesions and apply a non-comedogenic sunscreen (SPF 50).

Sun exposure causes post-inflammatory hyperpigmentation, which then takes several months to fade.

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💡 Silk pillowcases: a good idea or a myth?

Changing your pillowcase regularly helps maintain good skin hygiene. However, no particular material (such as silk or satin) has been shown to have a specific benefit on the progression of acne.

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Diet for Healthy Skin: What You Can Do

Diet can play a role in triggering or alleviating hormonal acne. Here are some ideas to explore.

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Cut back on refined sugars and ultra-processed foods.

Repeated spikes in insulin and IGF-1 (Insulin-like Growth Factor-1) directly stimulate the sebaceous glands and promote the proliferation of cells lining the hair follicles. A low-glycemic-load diet is currently one of the best-documented nutritional interventions for hormonal acne.

For some women, cutting back on dairy products—especially milk and whey protein—may also help reduce acne flare-ups. Several studies suggest that these foods can cause an increase in insulin and IGF-1 levels in susceptible individuals.

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Increase your intake of omega-3s (small fatty fish, nuts)

Choose high-quality fats rich in omega-3 (small fatty fish, nuts, ground flaxseed, canola or camelina oil), while limiting your intake of ultra-processed foods.

Small, fatty fish (sardines, mackerel) and fish oils are excellent sources. Here is a list of foods to prioritize:

• sardines
• mackerel
• nuts
• canola oil
• camelina oil
• flaxseed oil (no more than one teaspoon per day; store in a cool place and do not heat).

They help reduce skin inflammation.

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Supporting estrogen metabolism

A diet rich in vegetables, particularly cruciferous vegetables (broccoli, cabbage, cauliflower, arugula, etc.), provides glucosinolates and other bioactive compounds involved in the physiological metabolism of estrogens. These foods are part of a varied diet that supports overall hormonal balance.

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💡 The Ainoha app makes tracking easier

Keeping track of when breakouts occur, as well as the associated factors (stress, diet, sleep), helps you identify any recurring patterns and objectively assess the effect of the changes you’ve made.

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Supplements and Active Ingredients to Explore

Diet alone can't do everything, and taking supplements can help reduce your acne. 

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Zinc

A trace element with anti-inflammatory and antibacterial properties, it helps regulate sebum production and plays a recognized role in wound healing: a benefit for minimizing the marks left by inflammatory lesions.

Food sources: oysters, pumpkin seeds, legumes.

You should consult a healthcare professional before taking any supplements.

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Vitamin A

Essential for skin regeneration and proper wound healing.

It is best to obtain it primarily through your diet—either from beta-carotene (carrots, sweet potatoes, squash, and dark green leafy vegetables), which the body converts as needed, or from organic liver, in moderation.

Supplementation with preformed vitamin A (retinol) must be supervised by a doctor and is contraindicated during pregnancy.

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Targeted Aromatherapy

Tea tree essential oil, when properly diluted, can be applied topically to an inflamed area to take advantage of its purifying properties. However, it should not be used undiluted on large areas of skin due to the risk of irritation or skin sensitization.

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Wound Healing and Scar Prevention

Another challenge is making sure your skin doesn't get marked. Here are our tips. 

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Do not touch the lesions

Popping or picking at an inflamed pimple increases the risk of scarring and permanent pigmentation.

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Support skin repair

Once the inflammatory phase has subsided, soothing and restorative ingredients (niacinamide, Centella asiatica (“cica”), topical zinc) help restore the skin and reduce the appearance of marks.

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Note: Daily sun protection is also a good habit to develop.

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General Prevention (Excluding Diet)

Hormonal acne has many causes, and you may also want to consider the following. 

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The Impact of Sleep and Physical Activity

Adequate sleep and regular physical activity help improve insulin sensitivity, reduce low-grade chronic inflammation, and support hormonal balance. These two key factors can help limit hormonal acne flare-ups over the long term.

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Measures to Reduce Endocrine Disruptors

Limit exposure to substances that may interfere with hormonal balance:

• Choose cosmetics with simple ingredient lists;
• Avoid heating food in plastic containers;
• Ventilate living areas regularly;
• limit the use of synthetic home fragrances.

💡 Please note: “natural” does not mean “without precautions.” Before incorporating a plant, essential oil, or supplement into your routine, consult your doctor or pharmacist, especially if you are taking medication, are pregnant, are breastfeeding, or have a known medical condition.

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When should you talk to a professional about it?

It is recommended that you see a dermatologist or a gynecologist if:

• acne has a significant psychological impact or affects your quality of life;
• the pimples leave scars or persistent pigmentation marks;
• acne persists despite changes in lifestyle after three months;
• you have other signs of excess androgens (excessive hair growth, hair loss).

Topical dermatological treatments (benzoyl peroxide, adapalene, or azelaic acid) are generally the first-line treatments. They may be combined, when necessary, with appropriate hormonal therapy.

There are also medical options available, such as certain specific hormonal treatments (spironolactone, certain birth control pills) or topical retinoids. These should be discussed in detail with your doctor to assess the risk-benefit balance in the context of perimenopause.

When lifestyle changes are not enough, micronutrient supplementation or expert advice on hormonal balance can be a useful addition to dermatological care.

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Symptoms Often Associated With This Condition

• Period-Related Buttons
• Dry skin
• Hair Loss

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Please note:

Hormonal acne is a multifactorial condition. Hormonal fluctuations play a central role, but they interact with genetics, inflammation, insulin sensitivity, the skin microbiome, stress, sleep, and lifestyle habits. A comprehensive treatment approach often yields more lasting results than an approach focused exclusively on skin lesions.

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Frequently Asked Questions

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- Why do I always get pimples on my chin?

The jaw and chin area is particularly rich in hormone receptors. This is why fluctuations in androgen levels primarily manifest as skin inflammation in this area.

- Can stopping the birth control pill make my acne worse during perimenopause?

Yes. Stopping hormonal birth control can cause a “rebound effect” while the body gradually returns to its natural hormonal balance, often in a situation where estrogen levels are already beginning to fluctuate.

- Does chocolate really cause pimples?

Current scientific evidence suggests that pure cocoa is likely not the main culprit. However, chocolate products high in added sugars or milk may trigger acne flare-ups in some sensitive individuals, particularly through their effects on insulin and IGF-1.

- Can I use the same products as my teenager?

This is not recommended.

During perimenopause, the skin is often thinner, drier, and more sensitive than that of a teenager. Acne treatments designed for teenagers can sometimes be too harsh and may further damage the skin barrier.