Acne after your teens is common
Many women are surprised to break out more in adulthood than they did in high school. Adult female acne often shows up as tender, deep bumps along the jawline, chin and neck, and frequently flares before a period. It can be emotionally draining, especially when over-the-counter products and facials have not helped.
What makes acne "hormonal"
Androgens — hormones such as testosterone that all women make in small amounts — stimulate oil glands. Some women's skin is more sensitive to normal androgen levels, while others make more androgens than usual. Acne combined with irregular periods, unwanted hair growth on the face or body, or scalp hair thinning may point to polycystic ovary syndrome. The 2023 International PCOS Guideline recommends assessing for PCOS when these features occur together.
Other contributors include stopping hormonal birth control, perimenopausal hormone shifts, certain medications, stress and some hair and skin products.
Evaluation
A visit reviews your cycle history, skin history, previous treatments and goals. When PCOS or another hormonal cause is suspected, lab testing may be recommended. Photos taken before treatment help everyone see progress, since acne improves gradually over months.
Treatment options
The American Academy of Dermatology's 2024 acne guideline supports several medical treatments for women, often used in combination:
- Topical retinoids, benzoyl peroxide and topical antibiotics in combination
- Combined oral contraceptives, which lower androgen activity
- Spironolactone, an anti-androgen medication commonly used for adult female acne
- Short courses of oral antibiotics for inflammatory flares, paired with topicals
- Treating underlying PCOS or insulin resistance when present
Setting expectations
Most hormonal treatments take two to three months to show clear improvement, and the full benefit may take longer. Some medications, including spironolactone and retinoids, must be avoided during pregnancy, so your family-planning goals are part of the conversation. Gentle, non-comedogenic skincare supports any medical treatment.
Jennifer Neilan, WHNP, looks at acne as part of your overall hormone health and can coordinate care with a dermatologist when severe or scarring acne calls for it.
Preparing for your visit
Coming prepared helps you get the most from an appointment about adult acne. Take photos of your skin, list the products and prescriptions you've tried, and note your cycle pattern and pregnancy plans.
JennWell Women's Health is located at 11844 Standing Stone Dr., Suite 200 in Gretna, inside Skilled Touch Health and Healing, and welcomes women from Elkhorn, West Omaha, Millard, Papillion, La Vista, Bennington, Lincoln and across Eastern Nebraska. To schedule, call (402) 800-8595 or request an appointment online. If you are unsure whether this service is right for you, a consultation is a no-pressure place to start the conversation and learn your options.
Frequently asked questions
Clinical guidelines & references
This guide is informed by published consensus statements from these professional organizations. It is educational and not a substitute for individual medical advice.
- American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30.
- Monash University, ASRM, ESHRE & Endocrine Society (co-endorsed). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469.