If you had acne as a teen or into your twenties and experienced a huge sigh of relief when it was over, or if you were one of those girls who sailed through those adolescence with barely an acne pimple and figured this was one thing you would never have to face, you might think again. Once some women reach perimenopause and menopause—in fact, about 26 percent of women in their 40s and 15 percent in their 50s--develop acne. Although these figures are much lower than the approximately 70 percent seen in teens, these are still significant percentages, and the physical and emotional impact can be just as real. 

Read about menopause and acne

Acne in perimenopause and menopause

Why does acne appear in some women in perimenopause and beyond? We can point a finger at several factors. One is declining estrogen levels, which have an impact on levels of collagen and elastin. The dropping levels of these two proteins results in thinner, drier skin. 

The declining levels of collagen and elastin in aging skin are also affected by sugar, specifically fructose and glucose. These sugars bind to collagen and elastin in the skin in a process called glycation and produce advanced glycation end products (AGEs). Too much sugar in the diet accelerates the production of AGEs. AGEs have been associated with various skin conditions and damage, including thinning and sagging skin, development of dark spots, poor skin healing, dry skin (unable to retain moisture), wrinkles, and advanced skin aging, all of which can affect acne. 

Glycation and AGEs also stimulate the inflammatory process. In a 2018 study, researchers reported that “dietary AGEs directly stimulate the inflammatory response of human innate immune cells and help us define the risk of regular consumption of AGE-rich food products on human health.” One of those risks is worsening acne and other skin conditions. 

We can also place some blame on androgen levels (e.g., testosterone) because they control the production of sebum, a waxy substance that is made by the sebaceous glands in the skin and hair. When these glands begin to make too much sebum, it combines with dead skin cells and plug up follicles in the skin, resulting in pimples and other skin eruptions of acne.

A few other factors, according to the author of an article in the New England Journal of Medicine, are chronic inflammation controlled by the immune system; and activity of Cutibacterium acnes, (formerly known as Propionibacterium acnes) bacteria associated with acne development.

Beyond these factors, it’s important to remember that acne is a complex condition in which dietary/nutritional, genetic, and environmental factors are also part of the picture along with hormones. Therefore, when we want to consider ways to naturally prevent, manage, and treat acne in menopause, we will need to take all of these factors into account.

Read about supplements to improve skin during menopause

How to Manage Perimenopausal/Menopausal Acne Naturally

Here are a wide range of natural ways to help prevent, manage, and treat perimenopausal and menopausal acne.

Consider allergies

Certain food allergies are often associated with acne. In a 2022 study of individuals aged 11 to 46 who had moderately severe acne, investigators tested for food, fungal, and pollen allergens. They found the most significant food allergens to be whole chicken eggs (66.7%), chicken egg protein (61.4%), and chicken meat (52.9%). Next were cow’s milk protein (43.9%) and beef (44.2%) of participants. Pollen allergens were culprits in 64.8% (meadow grasses) and 62.5% (cereal grasses). Alternaria alternate, a common fungus found on leaves, was involved in 67.9% of cases. 

Other research has shown a link between dairy consumption and acne, such as a 2018 meta-analysis that involved nearly 72,000 participants. If you do not know what you may be allergic to or you have never been tested for allergens, you may want to discuss this with your healthcare provider. Reducing or eliminating the offensive foods may be helpful not only for skin health but digestive health as well.

Try berberine 

An herb that may help with management of acne is berberine. This compound has been shown to restore blood sugar imbalance by supporting healthy blood sugar metabolism and insulin sensitivity. It also has anti-inflammatory properties. Check with your physician before taking berberine, especially if you have diabetes. 

Read about menopause and stress

Reduce stress

Stress and the accompanying high levels of the stress hormone cortisol are factors that contribute to the development of acne. Every woman should practice stress-reducing techniques on a daily basis, whether it be exercise, meditation, yoga, visualization, massage, journaling, affirmations, tai chi, or other activities that work for you. Among those activities is adequate sleep, which means 7 to 8 hours per night. One supplement can help with both reducing stress and sleep: Sleepus. It contains ingredients formulated to achieve these goals: 

• Lactium, which helps to regulate cortisol levels
• L-theanine, which helps you relax and fall asleep faster
• Magnesium bisglycinate chelate, which improves quality of sleep, promotes relaxation, and increases heart rate variability, a factor that supports better sleep
• Melatonin, in a micronized sustained-release form that is highly absorbable and is released over six hours to support sleep

Prevent constipation

When your intestinal tract is not eliminating properly, you are holding in the toxins in your stool, allowing them to be reabsorbed into your blood stream and contributing to skin issues such as acne. One way to help prevent constipation is eating adequate fiber. Women should consume at least 25 to 30 grams daily. To help prevent constipation and help ensure elimination of harmful toxins, include Fiberus in your daily routine. This supplement provides 6.5 grams of unflavored soluble prebiotic fiber per serving. 

Read about menopause and blood sugar dysregulation

Cut sugar

We have already mentioned the effect of sugar, glycation, and AGEs on skin health and acne. Sugar is an inflammatory substance, and inflammation is part of the acne experience. It’s also wise to avoid added sugar as it can lead to high blood sugar and diabetes and contribute to inflammation and pain throughout the body. 

Try herbal teas

According to naturopath Dr. Amelia Patillo, several herbal teas may help ease the inflammation and stress associated with acne. She notes that preparing the teas is a stress-reducing process, which can help with acne, and that the teas themselves have anti-inflammatory properties. Plus tea is a great way to hydrate. We're big fans of Bigelow Botanicals which are infusions you can add to water to give it flavor and herbal benefits.

The following teas are suggested, one to two cups daily or as recommended by your healthcare provider. 

• Chamomile: This tea is often suggested to help with sleep because of its calming qualities. It also fights inflammation and is easy on the gut.
• Dandelion root: Known for its ability to help detoxify the body, dandelion root may help stimulate digestive enzymes in the digestive system and improve the elimination of toxins that can contribute to skin irritation. 
• Hibiscus: One of the best properties of this tea is its high levels of antioxidants, including the anti-inflammatory beta-carotene and vitamin C. Several recent studies, including a 2021 systematic review, have also shown that hibiscus can be helpful in lowering blood glucose levels and improving insulin sensitivity. High levels of sugar and insulin can result in excessive production of sebum and promote inflammation. 
• Holy basil: This Ayurvedic herb is considered to be an adaptogen, which means it can help the body adapt to the impact of stress. Since stress is a factor in the development of acne, drinking holy basil tea may help establish a sense of calm and balance cortisol levels. In a 2023 animal study, researchers reported that use of holy basil inhibited the release of cortisol and was found to be effective in relieving stress in rodents. Holy basil also may fight the bacteria that are involved in acne (Cutibacterium acnes). 
• Spearmint: Several studies have shown that spearmint has anti-androgen properties, which means it may help lower elevated testosterone levels, including a report in the International Journal of Endocrinology and Metabolism. Since high testosterone levels are a factor in the development of acne in perimenopausal and menopausal women, adding this tea to your diet may be helpful. Limit yourself to two cups per day to avoid any possible stomach upset. 

Take omega-3 fatty acids

One of the many benefits of omega-3 fatty acids may be its ability to reduce acne. The results of a study released at the European Academy of Dermatology and Venereology meeting in 2022 noted that omega-3s reduce inflammation by prompting the body to make anti-inflammatory substances. One of those substances is insulin-like growth factor (IGF-1), which is involved in causing acne.  

According to the study’s lead author, Dr. Anne Gurtler, when they analyzed the blood samples of the 100 study participants, they found that people who had lower levels of omega-3 fatty acids had higher levels of IGF-1. Individuals who had severely low omega-3 levels had even higher levels of IGF-1. Dermatologist Dr. Sandra Johnson, who was not involved in the study, commented that “Although there are not a lot of clinical trials to support their [omega-3s] use, one can consider eating foods high in omega-3 as well as supplement as an adjunct or a natural alternative for the treatment of acne.” A high-quality omega-3 supplement can help you achieve better skin health and prevent acne. 

Try tea tree oil

Research supports the use of topical tea tree oil (Melaleuca alternifolia) to relieve symptoms of mild to moderate acne. In a 2023 review of studies of tea tree oil in the management of acne, the authors noted that tea tree oil has “known antibacterial, anti-inflammatory, and antioxidant properties, making it a candidate for the treatment of acne.” Use of the oil can result in fewer inflammatory papules and pustules. 

When using tea tree oil, it is necessary to dilute it with a carrier oil such as almond, olive, coconut, or jojoba. A common mixture is one to two drops of tea tree essential oil added to 12 drops of carrier oil. If you have never used tea tree oil before, do a skin patch test first. Apply the diluted oil to the inside of your forearm and wait 24 hours. If no inflammation occurs, you can use the oil safely for acne.

Other Tips

Some other lifestyle tips can help in the prevention and management of acne. 

• Stop smoking, as it reduces blood circulation and is harmful for skin health
• Stay well hydrated to prevent drying skin and support overall skin health
• Use gentle facial cleansers that have low levels of salicylic acid. Do not use soap.
• Use a natural moisturizer, such as coconut oil or almond oil
• Avoid using oil-based cosmetics, which can contribute to plugged pores
• Use sunscreen (SPF 30 or higher) whenever you are outside. Non-comedogenic, mineral based sunscreens free of preservatives, fragrances, and other chemicals are recommended.

Bottom line

We know: you didn’t count on having to deal with acne in perimenopause and menopause. But if it does happen, there are many natural remedies you can try to help you prevent, manage, and eliminate this skin issue. Note that if you are taking hormone replacement therapy (HRT) for your perimenopause or menopause symptoms, you may still get acne. The use of progestin in some HRTs may cause skin eruptions such as acne.