Breakouts aren’t just a teenage problem. For many adults, especially women, acne can show up well into their 20s, 30s, 40s and beyond. And when it does, hormones are often to blame.

Hormonal acne is triggered by internal shifts that can happen during perimenopause, postpartum recovery, or even when starting or stopping birth control. These changes can affect your skin’s oil production, leading to frustrating and sometimes painful breakouts that don’t always respond to typical over-the-counter treatments.

Here’s what you need to know about what causes hormonal acne, how to recognize it, and what you can do to treat it effectively.

Why Hormonal Acne Happens

Your hormones play a major role in regulating your skin’s oil production. A key player? Androgens, a group of hormones (including testosterone) that can ramp up sebum production. While androgens are present in all genders, people assigned female at birth may be more sensitive to even slight hormonal shifts, making them more prone to hormonal acne.

Here’s when hormonal acne often strikes:

• Perimenopause & Menopause: Fluctuating or declining estrogen levels and imbalances in other hormones can kickstart oil production, leading to new or returning breakouts well into your 40s, 50s, or beyond.
• Postpartum: After you give birth, your hormones re-adjust. For some, acne fades quickly, but for many, postpartum breakouts can linger for months as estrogen drops and stress increases, both of which spike oil-production and the chances of clogged pores.
• Birth Control Changes: Starting, stopping, or switching hormonal contraceptives can trigger breakouts. Progestin-only methods sometimes worsen acne, while combined estrogen/progestin pills may help calm skin by balancing hormonal surges. Coming off birth control often leads to a temporary “androgen rebound,” fueling more oil and clogged pores.

How to Spot Hormonal Acne vs. Other Breakouts

While only a dermatologist can give you a definitive diagnosis, the American Academy of Dermatology notes that hormonal acne has a few telltale signs:

• Location: Often clusters along the jawline, chin, neck, and lower cheeks (contrasted with “regular” acne, which favors the forehead and nose).
• Appearance: Deep, tender cysts and nodules under the skin — these can be painful and tend to resist over-the-counter treatments.
• Timing: Often flares in sync with your menstrual cycle, during major hormonal shifts, or after stressful life events.

If this sounds familiar, it may be time to look at your hormones—not just your cleanser.

What You Can Do About It

You don’t have to live with frustrating breakouts. Here are some ways to manage hormonal acne:

Start with skincare that supports your skin barrier.

Look for gentle, non-comedogenic (won’t clog pores) products. Ingredients like:

• Niacinamide (helps with inflammation and oil control)
• Azelaic acid (targets redness, pigmentation and bacteria)
• Retinoids (can help regulate cell turnover, but may need to be used carefully if your skin is sensitive)

Avoid over-washing or harsh scrubs; these can irritate your skin and worsen inflammation.

Talk to your doctor or dermatologist.

If breakouts persist, it’s time to reach out to your primary care provider, OB/GYN or a dermatologist. Depending on the cause, they might recommend:

• Topical or oral prescription medications (like spironolactone, a medication that blocks androgens)
• Hormonal birth control (some types are FDA-approved to treat acne)
• Lifestyle changes (like managing stress or tweaking your diet)

In some cases, hormonal acne can signal an underlying condition like polycystic ovary syndrome (PCOS), a medical condition where hormone imbalance leads to acne, irregular periods, and sometimes unwanted hair growth or fertility issues. Your primary care provider can do more testing to determine if this is the cause of your acne.

During pregnancy or while breastfeeding, it’s important to talk with your doctor before adding anything new to your skincare routine, as some ingredients may not be safe to use during this time.

The Bottom Line

If your acne is affecting your confidence, causing pain or scarring, or simply won’t respond to over-the-counter treatments, don’t wait to get help. Your doctor can help you get to the root cause and guide you toward long-term solutions.

You deserve to feel good in your skin, and that starts with having the right information and support.

Need help managing adult acne or hormonal changes? Texas Health offers primary care and women’s health services close to home. Find a provider near you at TexasHealth.org/Doctors.