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What You Need to Know About Those Pesky Monthly Breakouts

There's more to breakouts than your hormones.
what causes hormone related acne and how to get rid of it skincare advice

Photo Credit: Shannon Lee Miller

When it comes to the body’s natural processes, women know all about hormonal changes. We even get a monthly reminder about the amazing things our bodies can do. The byproducts of such cycles, however, can be downright irritating—that’s right, we’re looking at you, acne.

You might be surprised to learn that there’s more to breakouts than just periods. Here’s the lowdown on hormonal acne.


Hormonal acne develops when your body’s hormone balance goes through a big change—like the changes that signal to your body when it’s time to have your period. Imbalances create the perfect environment for irksome pimples and breakouts. Dr. Michele Green, MD, a dermatologist in New York City, says this can manifest in different ways, from pus-filled cysts to small whiteheads caused by bacteria, oil, and dead skin cells. It’s important to note that hormones aren’t the direct cause of flare-ups; they just produce the ideal setting.

The most common interval for skin flare-ups is the time before menstruation. It’s so common that a study in the Journal of the American Academy of Dermatology found that more than half of all women have premenstrual acne.

The American Academy of Dermatology lists oil production, sticky skin cells, clogged pores, an increase in acne-causing bacteria, and skin inflammation as side effects of hormone changes that can trigger acne. According to Dr. Green, here’s what happens: Right before menstruation begins, your female sex hormones (estrogen and progesterone) decrease, and testosterone rises. All women produce some testosterone, but these increased levels stimulate oily skin. The result: an acne outbreak.

Menopause is another cause for breakouts. Most women go through menopause in their early fifties. But some women start as early as their thirties or forties. During this transition, hormonal levels are in prime fluctuation mode. The National Institute of Aging says that estrogen and progesterone levels vary. Testosterone steals the spotlight when estrogen and progesterone levels are low. Cue the hormonal acne.

Special Situations: PCOS & Hypoglycemia

Menstruation isn’t the only thing that causes a shuffle in our endocrine glands. Conditions such as polycystic ovarian syndrome (PCOS), a common endocrine disorder, can also spike testosterone levels. Enlarged ovaries with many fluid-filled sacs, or cysts, on each ovary characterize PCOS. Aside from acne, Mayo Clinic lists irregular periods, fertility problems, and weight gain as PCOS symptoms.

Hypoglycemia is a condition in which the body has surplus insulin—a hormone that uses glucose for energy. Excess insulin can increase androgen levels and lead to breakouts. Some causes of hypoglycemia include taking certain medications, drinking too much alcohol, skipping meals or fasting, and hormone deficiencies.


Relieve Stress

“Stress can aggravate any medical condition,” Dr. Green says. When it comes to hormonal acne, stress affects you through—you guessed it—estrogen. Feeling stressed causes temporary estrogen dips, throwing off your testosterone balance. If you’re feeling burned out, take it easy, and carve out some much-needed “you” time. Focus on doing the things you love with the people you adore. Resist unhealthy habits such as emotional eating, excessive drinking, and barely sleeping. Think you’re too busy to de-stress? There are ways to fix that, even at your desk.

Leave It Alone

Whatever you do, do not pick at your face. “Picking your pimples is never a good idea,” Dr. Green cautions. While it’s tempting, touching a zit can only intensify the problem. Your hands and fingers come into contact with so much—money, phones, door knobs, etc. Even with regular washing, our hands are home to millions of bacteria. Instead of picking at pimples, let the acne run its course. Otherwise, according to Dr. Green, squeezing your blemishes can lead to scarring or an even worse infection.

Drink Water

Acne or no acne, drinking enough H2O is vital for overall wellness. “It’s essential for transporting nutrients and flushing out toxins from our body,” says Natalie Robertello, MS, RD, CDN from Catholic Medical Partners in Buffalo, New York. Such toxins include bacteria on our skin that can eventually accumulate, clog our pores, and cause acne. The U.S. Department of Agriculture recommends that women aim for nine cups (72 ounces) of fluid each day. While any type of liquid counts as fluid, you really can’t go wrong with pure water, free of empty calories and sugar.

So, how does H2O help your skin? A study by Wound Repair and Regeneration found that adequate water intake decreases wound infection and encourages healing. Because pimples are technically small infections, staying well-hydrated works in your favor. The study also found that adequate hydration facilitates blood flow, which benefits a glowing complexion. “Remember, water isn’t the cure for acne,” Robertello says. “But it can help minimize the factors that may contribute to more breakouts.”

Visit Your Dermatologist

If there’s anyone who knows how skin-deep acne is, it’s your dermatologist. He or she can pinpoint the root of the problem and design a regimen that fits your lifestyle and needs. The recommended routine dermatologist visit is once a year, but you can make an appointment if your acne is really bothering you. “We’ll start off with a blood test to check that it’s definitely hormonal,” Dr. Green says. Then medicine options can be discussed. “This depends on the extent [of treatment] that the woman wants,” she adds. One option is a topical treatment in the form of an ointment. Another option is taking oral hormones, which can balance out estrogen, progesterone, and androgen levels. Dr. Green also mentions the possible prescription of spironolactone, an anti-androgen medicine. “We may also have you visit your gynecologist,” she says. This will enable your providers to zero in on the issue from all sides.

Hormonal acne is a tricky battle to combat. After all, our bodies can do some pretty powerful things, whether we like it or not. Hopefully these facts can paint a better picture of how our bodies work from the inside out, empowering you to make next moves for your skin and endocrine health.