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I was just entering my twenties when the dreaded hormonal acne appeared. I’d always struggled with acne, but this was different: large, painful blemishes that I could feel deep in my skin, accompanied by bad scarring. I’d always heard that leaving your teens behind meant leaving your acne behind, but with me (and my mother and grandmother before me), it was different. Instead of the tiny blemishes my teenage sister complained about, I was plagued with big, ugly cysts on my chin, jawline, and cheeks—no matter how much time I devoted to skincare or what I cut from my diet.

Our suspicions were confirmed by a doctor's visit: I was diagnosed with polycystic ovarian syndrome (PCOS). A condition with a variety of symptoms including unwanted hair growth, irregular periods, unexplained weight gain, and the stubborn hormonal acne I was struggling with, PCOS can be diagnosed through symptoms or through a blood test that can indicate an excess of androgens, a group of hormones that includes testosterone (read more here).

Steering away from birth control

The easy solution for hormonal acne is birth control. An excess of androgens—even without PCOS—can cause acne issues, and birth control can decrease the circulation of androgens. But I was concerned about birth control’s serious mental and emotional side effects.

Thankfully, in the hands of experienced doctors, I knew I had other options. I started with spironolactone, a hormone blocker often prescribed for PCOS. While the spironolactone definitely helped my skin, I didn’t feel that I’d found a long-term solution. It’s dangerous to take while pregnant, and I couldn’t shake the feeling that my hormones were still unbalanced. While spironolactone works for many women, I was looking for something that would work cooperatively with my existing hormones, rather than blocking unwanted ones.

Bioidentical progesterone: an alternative option

I visited a holistic doctor and went on a new diet protocol with one more change. “I’m going to put you on bioidentical progesterone,” said the doctor after showing me my extensive blood tests. “This is the same kind of progesterone that your body naturally makes. It will help with the PCOS symptoms until we can heal your gut and your hormones are more balanced.”

After I started taking the progesterone, I immediately felt a difference. I felt somehow more vibrant—more energetic, less anxious and antsy. It also encouraged me to know that I could avoid a miscarriage in the future caused by low progesterone levels. Knowing that I was taking bioidentical progesterone (not progestin, a synthetic alternative that is in hormonal contraceptives) left me at ease about what I was putting in my body—something that belonged there.

Even though I didn’t find the diet for my particular needs that year, my acne dramatically improved. I’d never been able to get away without a plethora of skin products from face wash to nightly topicals—I found myself washing my face in pure Colorado water without any side effects. My acne still cropped up every once in a while, of course—a response to stress or PMS—but it wasn’t the plague of my life that it had been before.

Progesterone side effects and learning more about my cycle

But there was one more problem: my cycles had become uneven. I assumed that my weird diets and stressful year had contributed to my irregular periods, but after things began to settle down a bit, I became concerned. Though they’re often a symptom of PCOS, I’d never struggled with irregular periods before, and I was concerned that progesterone had caused an unwanted side effect. At the same time, I didn’t want to give up my newly glowing skin.

At the advice of a friend, I visited a doctor who specialized in progesterone therapy. As a NaPro consultant, he was aware of my desire to work cooperatively with my cycle rather than disturb the natural processes of my body. While there, I got the clearest answers I had ever received about the menstrual cycle. Taking progesterone every day of the month wasn’t good for my body because the body doesn’t naturally produce progesterone every day of the month. I had been pressuring my body with progesterone all the time, thereby delaying my periods. (For more on the various phases of the menstrual cycle, read Verily’s guide!) Instead, this doctor recommended that I take progesterone only ten days out of my cycle—at the time when my body would produce progesterone naturally. This involved a more hands-on approach to tracking my cycles, but the peace of mind that came with working with and not against my natural cycle was totally worth it.

An unexpected journey

I may not be able to say that I never struggled with bad skin again, or that my body magically bounced back into perfectly regular periods. But my skin is night-and-day better—the cystic acne that plagued me hasn’t reared its ugly head for months. Best of all, I feel more like myself than ever, and I’m equipped with new knowledge about my cycle and confidence in my future fertility health. I’m thankful to have avoided the side effects of birth control, but more than that, I am grateful that what began as a quest for better skin became a journey to new knowledge about myself and my body.