For most of her life, Donna Sy never worried too much about acne. As a teenager, she was one of the lucky ones: an occasional pimple here and there, but nothing major. Throughout her 20s and 30s, her skin remained smooth and mostly trouble-free. But when persistent breakouts began appearing in her 40s, she found herself bewildered, frustrated, and searching for answers.

“When I started to break out [in my 40s], I got so confused,” Sy, a former salon manager, recalls. Desperate for an explanation, she scoured her routine for the culprit. “My skin was so clear and smooth before, so I thought [it was] something I ate or the makeup I used or [it was because] I was not properly washing my face.”

Unlike teenage acne, often driven by excess oil and clogged pores, adult acne is more insidious. It is frequently fueled by hormonal fluctuations. Experts say this is especially true for women in their 40s, when hormonal shifts become more pronounced. “Adult acne in women over 40 is more common than people realize,” says board-certified dermatologist Corrine Sison-De Jesus, MD, who practices at the Quirino Memorial Medical Center, Our Lady of Lourdes Memorial Hospital, and Skin and Cancer Foundation. “Up to 25 percent of women in this age group experience persistent or late-onset acne.”

Board-certified dermatologist Raissa Francisco-Pasion, MD, a Philippine Dermatological Society fellow with 16 years of experience in the field, agrees: “Adult acne in women has grown increasingly common,” she says. “There is even a scientific term for this– AFA or Adult Female Acne.”

For Sy, who is now a full-time 46-year-old homemaker, years of clear skin made the sudden resurgence of acne feel like she was losing control over her own body. And she had a few suspicions about what was behind it.

The role of perimenopause

One possible culprit on top of her mind? Perimenopause—the transitional phase before menopause.

She was on to something. According to Dr. Sison-De Jesus, hormonal shifts during perimenopause and menopause can significantly impact the skin. As estrogen levels decline, oil production becomes harder to regulate. “Estrogen plays a key role in regulating oil production, so as it declines, the skin can become drier yet still prone to breakouts,” she explains.

During perimenopause, testosterone and other androgens become more dominant, Dr. Sison-De Jesus says. This hormonal imbalance can lead to increased oil production and inflammation—two key triggers of adult acne.

Perimenopause is already a challenging transition, bringing hot flashes, mood swings, and sleep disturbances. Adding adult acne to the mix feels like an especially cruel twist of fate.

Endometriosis and acne: Is there a link?

Another factor Sy suspected was her endometriosis. She was diagnosed with the condition—a disorder where cells similar to the uterine lining grow outside the uterus, often causing chronic pain and hormonal imbalances.

For women with endometriosis, the situation is even more complex, Dr. Sison-De Jesus says. “Endometriosis is linked to chronic inflammation and estrogen dominance,” she explains. “Inflammation makes acne lesions more persistent, while excess estrogen can lead to increased skin cell turnover, potentially clogging pores.”

Dr. Francisco-Pasion further explains: “In endometriosis there is an existing hormonal imbalance that can stimulate oil glands, leading to clogged pores especially around the chin and jawline.”

But is endometriosis directly responsible for acne? Not necessarily, says OB-GYN Lyra Ruth Clemente Chua who practices at The Medical City, where she heads the Women’s Health Care Center. “It can be due to the hormonal milieu of these patients and to a similar genetic predisposition to both conditions,” she says. In many cases, it’s not endometriosis itself but co-existing conditions like polycystic ovary syndrome (PCOS) that contribute to acne, she adds.

Dr. Chua emphasizes that acne during perimenopause is primarily due to shifting testosterone levels as estrogen declines. “If endometriosis is left unmanaged, its symptoms may worsen as a woman enters perimenopause,” she says. “But acne during this time is not related to endometriosis—it is due to the rising effects of testosterone as estrogen levels decrease.”

The good news is that the symptoms often subside after menopause when hormone fluctuations stabilize. However, Dr. Chua warns that some women may continue to experience persistent breakouts even after menopause.

More than skin deep

For Sy, understanding the possible reasons behind her acne didn’t necessarily make coping with it any easier. The breakouts weren’t just a cosmetic issue. They impacted her confidence, mood, and even her willingness to socialize. “It took a toll on me. It made me irritable, and at times I would not want to go out and show my face or put makeup on it so that it [would] not get worse,” she shares.

Acne is often dismissed as a superficial concern, but for many women, it runs much deeper. It can undermine self-esteem and change the way they present themselves to the world. Sy found herself withdrawing, and second-guessing her appearance in ways she never had to before.

Determined not to let acne dictate her life, Sy made significant lifestyle changes and sought professional guidance. Today, she stresses the importance of consistent skin care and mindful daily habits.

“First, watch what you eat. Drink a lot of fluids, a lot of water. Protect your skin when you go out. Sunscreen—never forget it. Moisturize,” Sy advises. “I think I took for granted moisturizing my face in my 20s and in my 30s. I didn’t do that much moisturizing. So don’t forget your moisturizer.” She also urges other women to consult a dermatologist. “Go to a dermatologist. See what they say about your acne because it depends on the type of person, it depends on the skin,” she emphasizes.

Her journey is a powerful reminder that acne isn’t just a teenage problem. It can resurface during significant life changes—pregnancy, postpartum, perimenopause—bringing both physical and emotional challenges. But if you’re facing the same struggle, know this: You are not powerless.

How to fight it

When acne is driven by hormonal imbalances, Dr. Sison-De Jesus stresses that a multi-pronged approach works best. While topical treatments are essential, internal treatments can provide long-term stability. Oral contraceptives, she says, help regulate hormone fluctuations, while spironolactone, a medication that blocks androgens, can reduce oil production and inflammation. For severe cases, isotretinoin remains a powerful option.

 Usually, hormonal treatments are combined with topical treatments like retinoid creams, benzoyl peroxide, topical antibiotics, and/or azelaic acid, Dr. Francisco-Pasion notes.

However, Dr. Sison-De Jesus also emphasizes the importance of lifestyle adjustments. Reducing high-glycemic foods, cutting back on dairy, managing stress, and prioritizing sleep can all help keep breakouts at bay. “Stress is another major trigger, as elevated cortisol levels can stimulate oil glands,” she explains. 

In general and on the skin care front, balance is key. “By balancing acne treatments with hydration and barrier support, women in their 40s can maintain clear, healthy skin without compromising on anti-aging benefits,” Dr. Sison-De Jesus says. A well-rounded skin care routine can help manage breakouts while keeping the skin resilient and youthful.

A day-to-night skincare routine for adult acne

For her, a morning routine of a 40-something woman who’s experiencing acne should include:

  • A gentle, non-stripping cleanser. Look for one with salicylic acid or niacinamide to clear pores without stripping moisture.
  • An antioxidant serum with Vitamin C and niacinamide, which helps boost collagen, brighten skin, and reduce inflammation.
  • A lightweight moisturizer maintains hydration without clogging pores. Choose a gel or water-based formula with ceramides or hyaluronic acid.
  • A sunscreen with broad-spectrum SPF 30+ protects against sun damage and post-acne hyperpigmentation. Choose an oil-free, non-comedogenic option.

At night, Dr. Sison-De Jesus recommends:

  • Double cleansing. Start with a cleansing oil or micellar water, followed by a gentle foaming or cream cleanser to remove impurities without over-drying.
  • A retinoid treatment like tretinoin, adapalene, or retinaldehyde. It helps fight acne, boost skin renewal, and reduce fine lines.
  • A moisturizer with barrier-repair ingredients like peptides, ceramides, or niacinamide. These support the skin barrier and lock in hydration.
  • Spot treatments as needed. Benzoyl peroxide, sulfur, or hydrocolloid patches target active breakouts, reducing inflammation and promoting healing.

Before you treat, investigate

But remember: before diving into treatments, it’s crucial to understand what’s triggering acne in your 40s. Whether it’s PCOS, perimenopause, stress, or other hormonal imbalances, identifying the root cause is key to finding an effective solution. Consulting a dermatologist, OB-GYN, or family physician can help you get the right diagnosis and tailored treatment plan. 

“Treatment for adult acne must be targeted to each individual patient, with careful consideration of the patient’s acne severity and duration, response to previous treatments, skin type and color, lifestyle, diet, family history and past medical history,” Dr. Francisco-Pasion stresses.

With the right approach—balancing skin care, lifestyle adjustments, and professional guidance—you can regain control over your skin and confidence, proving that acne at any age is manageable with the right support.

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