Breakouts in your 40s aren't in your head. As estrogen swings erratically through perimenopause while androgens hold steadier, oil glands shift into androgen-driven overdrive. Peer-reviewed research shows perimenopausal acne is common, often distinct from teenage acne, and generally improves after full menopause. This piece covers what diet studies actually support and which treatments — from dermocosmetics to spironolactone — have real evidence behind them.