If you thought acne would disappear after your teenage years, developing spots in your 20s, 30s or 40s can be frustrating. You may notice painful spots around your chin, jawline or lower face, especially before your period.
Hormonal acne does not necessarily mean you have abnormal hormone levels. Your skin may simply be more sensitive to normal hormonal changes, while genetics, skincare, medications and conditions such as PCOS can also affect your breakouts.
What Do You Mean by Hormonal Acne?
Hormonal acne is a common term for acne that appears to be influenced by hormonal changes. You may notice breakouts around your menstrual cycle or persistent spots around your chin, jawline or lower face.
Hormones called androgens can increase sebum production and contribute to blocked follicles and inflammation. You do not necessarily have high hormone levels, as your skin may simply be more sensitive to normal hormonal changes.
Why Can Acne Continue After Your Teenage Years?
Acne can continue after your teenage years because your follicles may remain sensitive to androgens and continue producing excess sebum. You may also be affected by genetics, blocked pores and inflammation, even if your skin was clearer during adolescence.
Your menstrual cycle, pregnancy, contraception and hormonal conditions can also influence your skin. You should not blame yourself for persistent adult acne, as it is a common medical skin condition rather than a sign of poor skincare.
Why Does Hormonal Acne Often Appear Around Your Jawline?
You may notice hormonal acne around your jawline and chin, particularly with deeper, tender spots. However, you can also develop acne on your cheeks, forehead, neck, chest or back, so the location alone does not confirm a hormonal cause.
You may have blocked pores in one area and painful inflammatory spots in another. Your dermatologist will look at your acne pattern, symptoms and how your breakouts change over time rather than relying on a fixed “hormone map”.
Why Do Breakouts Often Get Worse Before Your Period?
You may notice your acne getting worse several days before your period, as hormonal fluctuations may influence sebum production and inflammation in acne-prone skin. You may find that tracking your breakouts for a few cycles helps you recognise this pattern.
A predictable premenstrual flare can suggest hormonal influence, but you do not necessarily have abnormal hormone levels. You also do not automatically need blood tests just because your acne worsens before your period.
Evidence Note
Adult women with acne can have androgen levels within the normal range, and increased sensitivity to androgen activity has been proposed as one factor that may contribute. Hormonal influence therefore does not automatically mean that a blood test will show a hormone abnormality.
What Role Do Androgens Play in Your Acne?
Androgens such as testosterone can stimulate your sebaceous glands to produce more sebum. You may develop blocked pores and inflammation when your skin is particularly sensitive to these hormonal signals.
You can have hormonally influenced acne even when your blood hormone levels are normal. Your acne therefore does not automatically mean you have a hormone imbalance.
Could Polycystic Ovary Syndrome Be Causing Your Acne?
Polycystic ovary syndrome (PCOS) can increase androgen activity and may contribute to acne. You may need further hormonal assessment if your adult acne develops alongside irregular periods, excess facial or body hair, scalp hair thinning or other signs of increased androgen activity.
Acne alone does not confirm that you have PCOS. Your doctor will consider your wider symptoms and, where appropriate, further investigations before making a diagnosis. If you notice changes in your periods, facial hair or scalp hair, tell your doctor or dermatologist so you can discuss whether further assessment or treatment may be appropriate.
Can Contraception Affect Your Skin?
Yes, hormonal contraception can affect your acne because changing hormone activity may influence sebum production and breakouts. You may notice changes in your skin when you start, switch or stop a hormonal contraceptive.
- Combined Pill: Some combined contraceptive pills may help reduce acne by decreasing the influence of androgens on your skin.
- Starting Contraception: Your skin may change after beginning hormonal contraception as your body adjusts to the new hormone pattern.
- Changing or Stopping: Switching or stopping contraception can sometimes be followed by changes in your acne or increased breakouts.
- Individual Suitability: Your medical history and contraceptive needs should be considered before using a combined pill as part of acne treatment.
Hormonal contraception will not be the right acne treatment for everyone. If you are considering it for your skin, you can discuss both your acne and contraceptive needs with an appropriate healthcare professional.
Can Pregnancy Cause Hormonal Acne?
Yes, pregnancy can change your skin because of major hormonal shifts. You may notice clearer skin or new and worsening acne, particularly during early pregnancy.
Your acne treatment may also need to change because some medicines are not suitable for use during pregnancy. If you are pregnant, planning pregnancy or could become pregnant, tell your clinician so that your acne treatment can be reviewed and options that are appropriate during pregnancy can be considered.
Which Acne Treatments Need Special Consideration During Pregnancy?
Your acne treatment should be reviewed if you are pregnant or planning a pregnancy because some commonly used medicines are not suitable during this time. Topical retinoids such as adapalene should not be used during pregnancy or when planning pregnancy, and oral tetracycline antibiotics also need to be avoided.
Other options may be considered depending on your acne severity and individual circumstances. Tell your doctor, dermatologist or pharmacist if you are pregnant, breastfeeding or planning pregnancy before starting or continuing acne treatment.
How Is Hormonal Acne Diagnosed?
Your dermatologist can usually diagnose acne by examining your skin and asking about your symptoms. You may be asked whether your breakouts worsen around your period, whether you use hormonal contraception and whether you have irregular periods or excess facial hair.
Blood tests are not automatically required just because you have adult acne. If your symptoms suggest a hormonal condition, your doctor may recommend further tests to understand what is affecting your skin.
Do You Need Hormone Blood Tests?
Hormone blood tests are not automatically required for every woman with adult acne. Your doctor may consider testing if your history or symptoms suggest androgen excess or another hormonal condition, particularly if you have irregular periods, increased facial or body hair, scalp hair thinning or sudden-onset severe acne.
The specific tests you need should be guided by your symptoms, medical history and clinical assessment rather than using a broad hormone panel without a clear reason.
When Hormonal Assessment May Be Useful
| What you notice | What it may suggest |
| Acne that flares before periods | Hormonal influence may contribute |
| Irregular or absent periods | Further hormonal assessment may be useful |
| Increased facial/body hair | Possible androgen excess |
| Scalp hair thinning | May occur with androgen-related conditions |
| Sudden severe adult acne | May justify further assessment |
| Regular periods with no androgen symptoms | Routine hormone testing may not be necessary |
Which Topical Treatments Can Help?
Topical treatments can help you manage hormonal acne by reducing blocked pores and inflammation. You may be prescribed options such as adapalene, benzoyl peroxide or azelaic acid, depending on your acne severity, skin type and whether pregnancy is relevant to your treatment choices.
You should not expect results straight away, as your skin may take several weeks to improve. If you have sensitive skin, you can start some treatments gradually to reduce irritation and help you continue using them consistently.
Clinical Tip
Acne treatments often need several weeks before improvement becomes noticeable. Introduce potentially irritating topical treatments gradually when advised and use them consistently rather than changing products frequently.
Can Spironolactone Help Hormonal Acne?
Spironolactone may help some women with persistent hormonally influenced acne by reducing the effects of androgens on the skin. You may see improvement gradually over several months, particularly when topical treatments have not controlled recurring breakouts.
Spironolactone is not suitable for everyone and can cause side effects such as menstrual changes, breast tenderness or dizziness. You should discuss your medical history and medicines with your clinician, and spironolactone should not be continued during pregnancy. Tell your clinician if you are pregnant, think you may be pregnant or are planning pregnancy so that your treatment can be reviewed.
Research Insight
The SAFA trial found that spironolactone improved acne outcomes in adult women compared with placebo, with greater differences seen at 24 weeks than at 12 weeks. This supports its use as an off-label option for persistent acne in selected women.
Do Oral Antibiotics Still Have a Role?
Yes, oral antibiotics can help you manage moderate to severe inflammatory acne when topical treatment alone is not enough. You may be prescribed them alongside topical treatment, rather than using antibiotics on their own.
You should not normally use oral antibiotics long term because of antibiotic resistance. If your acne keeps returning, your dermatologist may discuss maintenance treatment or other longer-term options, including hormonal treatment where this is appropriate for you.
When Might Isotretinoin Be Considered?
Isotretinoin may be considered for severe acne that has not responded adequately to appropriate standard treatments, or when your acne places you at risk of permanent scarring. You may also be assessed based on your previous treatments, scarring and how acne affects your wellbeing.
You need specialist supervision while taking isotretinoin because it has important risks and side effects. Pregnancy must be strictly avoided during treatment, and your dermatologist may discuss maintenance treatment if your acne later returns.
Your mental health should be considered before starting isotretinoin and reviewed during treatment. You should tell your healthcare team about any new or worsening mental-health concerns or other troublesome side effects while taking it.
UK Guidance Note
Isotretinoin can seriously harm an unborn baby, so strict pregnancy prevention is required if you could become pregnant. Pregnancy must be avoided during treatment and for one month after stopping isotretinoin.
Can Skincare and Diet Make Hormonal Acne Better?
A simple skincare routine can support your acne treatment without needing lots of products. You can use a gentle cleanser and non-comedogenic moisturiser, while avoiding harsh scrubbing or squeezing spots that can increase irritation, pigmentation and scarring.
Diet may also influence acne for some people, but there is no single food you need to avoid. You can mention any foods or supplements that appear to be associated with changes in your breakouts, rather than following restrictive diets without medical advice.
When Should You See a Dermatologist About Adult Acne?
You should consider seeing a dermatologist if your acne is painful, persistent, leaving scars or keeps returning despite treatment. You may also benefit from specialist advice if your acne is affecting your confidence or emotional wellbeing.
You can also seek help if you are unsure whether your spots are actually acne. A dermatologist can assess your skin and help you find the most suitable treatment for your needs.
Myth vs Fact
| Myth | Fact |
| Hormonal acne always means abnormal hormones. | Your skin can be sensitive to normal hormonal changes. |
| Jawline acne proves you have a hormone problem. | Location alone cannot confirm a hormonal disorder. |
| Adult acne means you have PCOS. | PCOS is only one possible cause. |
| You always need hormone blood tests. | Testing is usually targeted to additional symptoms. |
| Antibiotics are the best long-term solution. | Long-term antibiotic use should be limited. |
| You must wait for scarring before seeing a dermatologist. | Earlier effective treatment may reduce further inflammation and scarring risk. |
Key Takeaways
- Hormonal acne can occur even when your hormone levels are normal.
- Premenstrual flares may suggest hormonal influence.
- Irregular periods, increased facial hair or scalp thinning may justify hormonal assessment.
- Topical treatments remain useful even when hormones contribute to acne.
- Spironolactone can be considered for selected adult women under medical supervision.
- You do not need to wait until significant scarring develops before seeking effective treatment.
Frequently Asked Questions
1. What is hormonal acne in women?
Hormonal acne is acne that is strongly influenced by hormonal activity, particularly the effects of androgens on your sebaceous glands. You may notice recurring breakouts around your chin, jawline or lower face, especially before your period.
2. Why does hormonal acne happen in adulthood?
Adult acne may be influenced by your skin’s sensitivity to androgen signals, which can contribute to increased sebum production and blocked follicles. Your menstrual cycle, genetics, pregnancy, contraception and certain medical conditions can also influence your breakouts.
3. Does hormonal acne mean your hormone levels are abnormal?
No, hormonal acne does not necessarily mean that you have unusually high hormone levels. Your skin can be particularly sensitive to normal hormonal fluctuations even when your measured hormone levels are within the normal range.
4. Why does acne get worse before your period?
Hormonal changes throughout your menstrual cycle can affect sebum production, inflammation and the likelihood of blocked follicles. If you notice breakouts regularly appearing before your period, this pattern may suggest that hormonal fluctuations are contributing to your acne.
5. Could PCOS be causing your hormonal acne?
PCOS can be associated with increased androgen activity and acne, but having acne alone does not mean that you have PCOS. You may need further assessment if your acne occurs alongside irregular periods, increased facial or body hair or scalp hair thinning.
6. Can hormonal contraception improve acne?
Some combined oral contraceptive pills can improve acne by reducing the influence of androgens on your skin. However, contraception is not suitable for everyone, so you should discuss your medical history and skin concerns with an appropriate healthcare professional.
7. Can spironolactone help hormonal acne?
Spironolactone may improve persistent acne in some adult women because of its anti-androgen effects. It is used off-label for acne in the UK and requires medical assessment because it is not suitable for everyone and should not be used during pregnancy.
8. Can topical treatments help hormonal acne?
Yes, topical treatments such as adapalene, benzoyl peroxide and azelaic acid can help control acne even when hormones contribute to your breakouts. You usually need to use treatment consistently for several weeks, and introducing irritating products gradually can help your skin tolerate them.
9. Do you need hormone blood tests for hormonal acne?
Hormone blood tests are not automatically required for every woman with adult acne. Testing may be considered if you have irregular periods, increased facial or body hair, scalp hair thinning, sudden severe acne or other symptoms suggesting an underlying hormonal condition.
10. When should you see a dermatologist about hormonal acne?
You should consider seeing a dermatologist if your acne is painful, persistent, scarring or repeatedly returns despite appropriate treatment. Specialist assessment can also help if your acne has a significant emotional impact or occurs alongside symptoms that could indicate an underlying hormonal condition.
Final Thoughts: Understanding Hormonal Acne in Women
Hormonally influenced acne can continue into adulthood even when your measured hormone levels are within the normal range, as your skin may be particularly sensitive to hormonal fluctuations and androgen activity. If you notice recurring breakouts around your period, persistent acne, painful spots or increasing scarring, you can benefit from understanding the underlying pattern rather than relying only on skincare changes.
If you’d like to see a dermatologist in London, you can contact our team at the London Dermatology Centre to arrange a consultation.
References:
- Amuzescu, A., Tampa, M., Matei, C. and Georgescu, S.R. (2024) ‘Adult Female Acne: Recent Advances in Pathophysiology and Therapeutic Approaches’, Cosmetics, 11(3), article 74. Available at: https://www.mdpi.com/2079-9284/11/3/74
- Bagatin, E. et al. (2019) ‘Adult female acne: a guide to clinical practice’, Anais Brasileiros de Dermatologia, 94(1), pp. 62–75. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6360964
- Tan, A.U., Schlosser, B.J. and Paller, A.S. (2018) ‘A review of diagnosis and treatment of acne in adult female patients’, International Journal of Women’s Dermatology, 4(2), pp. 56–71. Available at: https://www.sciencedirect.com/science/article/pii/S2352647517300862
- Santer, M. et al. (2023) ‘Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial’, BMJ, 381, article e074349. Available at: https://pubmed.ncbi.nlm.nih.gov/37192767
- Damoulaki, E. et al. (2025) ‘Polycystic Ovary Syndrome-Associated Acne: The Interplay of Hyperandrogenism, Insulin Resistance, and Therapeutic Strategies’, Cureus, 17(11), article e98103. Available at: https://pubmed.ncbi.nlm.nih.gov/41473651