This article is for educational and general wellness purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease. If you are noticing changes in your skin or have questions about your health, please consult a knowledgeable healthcare provider.

Ok, But What Actually IS Acne?

Acne is an inflammatory disorder of the skin and a common condition that happens when hair follicles under the skin become clogged and irritated. Sebum — oil that helps keep skin from drying out — and dead skin cells clog the pores, which leads to outbreaks of lesions, commonly called pimples or zits.

The skin has sebaceous (oil) glands that connect to the hair follicle through a pore. In healthy skin, the sebaceous glands make sebum that empties onto the skin surface through the pore. Keratinocytes, a type of skin cell, line the follicle. Normally as the body sheds skin cells, the keratinocytes rise to the surface of the skin and slough off. When someone has acne, the hair, sebum, and keratinocytes all stick together inside the pore. This prevents the keratinocytes from shedding and keeps the sebum from reaching the surface of the skin. The mush of oil and cells allows bacteria that live on the skin to grow in the plugged follicles and cause inflammation — swelling, redness, heat, and pain. When the wall of the plugged follicle breaks down, it spills bacteria, skin cells, and sebum into nearby skin, creating lesions or pimples. You can learn more about the science of acne here.

Hormonal Impact on Skin

Hormones play a huge role in keeping everything running smoothly in our bodies, including our skin. But sometimes, things change — and we're left wondering why pimples start popping up out of nowhere.

Let's take a look at the hormones that can impact our skin:

• Estrogen: This hormone is like the calming force for our skin. It helps keep oil production in check and promotes collagen production, which is associated with that plump, youthful appearance. When estrogen levels shift, skin may have a harder time retaining moisture, making it drier. Drier skin is more susceptible to irritation and may be more prone to pores clogging with oil and dead skin cells.
• Progesterone: Progesterone works alongside estrogen to help regulate menstrual cycles and is involved in managing skin inflammation. However, when women have anovulatory cycles — meaning they don't actually ovulate — progesterone levels will be low, and this can influence how the skin looks and feels. Women can have anovulatory cycles when eating a high-carb diet or during perimenopause, when the ovaries don't always release an egg each month.
• DHEA: Dehydroepiandrosterone (DHEA) is a hormone produced in our adrenal glands. DHEA levels naturally decrease as we age. While DHEA has many roles — including associations with mood and energy — it can also contribute to increased oil production, potentially affecting skin clarity. This is because some DHEA is converted to testosterone, and then on to another androgen called DHT.
• Testosterone: We all have testosterone, but women usually have much less than men. Some testosterone gets converted to DHT. Testosterone — and especially DHT — stimulate the oil glands in our skin. When women have high blood sugar (often related to a high-carb diet), testosterone levels may increase. As testosterone and DHT rise, so does sebum production, which can clog pores and contribute to breakouts, especially along the jawline and chin. Lower progesterone can compound this picture, since progesterone is involved in slowing the conversion of DHEA to testosterone.

Supporting balanced progesterone levels during perimenopause may help skin appear clearer and more comfortable. After menopause, many women find that supporting estrogen and progesterone levels helps skin feel more comfortable and appear more resilient.

Pesky Pimples?

Sadly, it's not just hormones we have to watch out for. Other factors can also play a role in adult acne:

• Stress: Feeling overwhelmed? That stress hormone, cortisol, can also contribute to breakouts. When we're stressed, our bodies go into fight-or-flight mode, which can lead to an increase in cortisol production. Cortisol can stimulate the oil glands in our skin and also affect the immune response, making us more susceptible to the bacteria that contribute to acne.
• Diet: Sugary treats and processed foods might be tasty, but they can be tough on our skin. Sugary foods cause spikes in blood sugar, which can contribute to inflammation throughout the body, including the skin. Processed foods are often high in unhealthy fats and refined carbohydrates, which can also play a role in breakouts.
• Skincare routine: Harsh scrubs and too many products can irritate skin, making things worse. Aggressive exfoliation can strip away the skin's natural oils, leading to dryness and irritation — which can actually prompt the skin to produce more oil to compensate. Using too many products can also clog pores and further irritate the skin.

Skin Support

Now, let's get down to the good stuff — what can we do?

• See a skin care professional: A dermatologist can be a helpful resource if you want professional guidance on skin care approaches that may suit your individual needs.
• Chill out: Easier said than done, but managing stress through exercise, meditation, or spending time in nature can work wonders for both your skin and your well-being.
• Eat clean: Focus on a balanced diet with plenty of vegetables, some fruit, protein, and whole grains. Limiting sugary and processed foods can also help.
• Simplify your skincare: Stick to gentle cleansers and moisturizers. Look for products that are non-comedogenic, meaning they won't clog your pores. There's a lot of good information out there on navigating skin care ingredients — a dermatologist or esthetician can point you in the right direction.
• Bioidentical hormones: Some women find that supporting estrogen and progesterone levels helps skin appear healthier and feel more supple. If you're curious about hormone options, a conversation with a knowledgeable provider is the best starting point.

It's Not Spots, It's Lines!

For some women, it's not adult acne that bothers them — it's the (often sudden) increase in fine lines and wrinkles that can occur during perimenopause.

During perimenopause, estrogen levels do start to shift, and this can contribute to drier, thinner-feeling skin. Decreased estrogen levels may contribute to increased skin sensitivity and irritation in some women. Another change during perimenopause is a reduction in collagen production, which is associated with the appearance of fine lines and wrinkles on the face as well as areas like the hands or neck.

If you're free from acne but noticing more fine lines, there are options. Topical skin care products formulated to support the appearance of aging skin are worth exploring — a dermatologist or skin care professional can help you find approaches suited to your skin's needs.