Pimples? Really? After surviving breakouts in your teen years, it’s hard to believe you’re dealing with blemishes at this stage of your life.

Acne is the number one complaint I get from patients going through menopause,” says New York City dermatologist Francesca Fusco, M.D.

“Estrogen opposes testosterone, so when your ovaries stop producing estrogen, your relative testosterone levels rise,” she explains. This can cause many women to suddenly develop severe acne, particularly around the jaw and chin.

READ MORE: Acne, Decoded

Treatment: “Menopausal acne is very different from what you may have experienced as a teen,” Dr. Fusco says. Back then, your zits were probably accompanied by excess oil and shine, whereas mature skin tends to be dry with or without pimples.

“If you’re seeing whiteheads, salicylic acid and benzoyl peroxide are good place to start.” Be sure not to overdo it with acne treatments, which can irritate dry skin and make the problem worse.

If your acne doesn’t clear or if you develop deep cysts, head to a dermatologist. Spironolactone, a mild prescription diuretic that has an anti-androgen effect (it’s also used to treat menopausal hair loss) is particularly effective in treating cysts and inflamed bumps. Retinoids like Retin-A, which treat acne, sun damage and wrinkles, are also a good option. Depending on your medical history, your derm may even prescribe antibiotics or birth control pills to clear your complexion.