Hormonal acne is a type of acne that is primarily influenced by hormonal fluctuations in the body. It often occurs during puberty, menstruation, pregnancy, and menopause, when there are significant changes in hormone levels. Hormonal fluctuations can lead to increased oil production in the skin, which, in turn, can contribute to the development of acne. In this article, we dive into the main types of hormonal acne and their main triggers.
1. Hormonal Acne and Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects people with ovaries, typically during their reproductive years. PCOS is characterised by the presence of cysts on the ovaries, irregular menstrual cycles, and hormonal imbalances. One of the common symptoms associated with PCOS is hormonal acne.
The relationship between PCOS and hormonal acne can be explained by the following factors:
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Increased Androgen Levels: People with PCOS often have elevated levels of androgens, which can stimulate the sebaceous glands to produce more oil. This excess oil can lead to the formation of acne.
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Insulin Resistance: Insulin resistance is another common feature of PCOS. Insulin resistance can lead to higher insulin levels, which, in turn, may contribute to increased androgen production. Elevated insulin levels can also stimulate the production of insulin-like growth factor 1 (IGF-1), which may further influence acne development.
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Inflammation: PCOS is associated with chronic low-grade inflammation, and inflammation plays a role in the development and exacerbation of acne.
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Menstrual Irregularities: Irregular menstrual cycles are a hallmark of PCOS. Changes in hormone levels throughout the menstrual cycle, particularly during the luteal phase, can contribute to the occurrence of hormonal acne.
2. Puberty and Hormonal Acne
Puberty is a complex biological process marked by the onset of sexual maturity and the development of secondary sexual characteristics. It typically begins around the ages of 8 to 14 in girls, although the timing can vary. One of the prominent features of puberty is the activation of the endocrine system, leading to hormonal changes that drive physical and emotional transformations.
In puberty, hormonal changes in girls are initiated by the release of gonadotropin-releasing hormone (GnRH), leading to the production of estrogen and progesterone. These hormones contribute to the development of secondary sexual characteristics. Androgens, including testosterone, are also produced, stimulating the sebaceous glands to increase oil (sebum) production. This hormonal shift is linked to the prevalence of acne in teenage girls.
Acne is a common skin condition during puberty, affecting both boys and girls. In girls, hormonal fluctuations related to the menstrual cycle can influence the severity and distribution of acne. Acne in teenage girls often appears on the lower face, jawline, and neck, indicating hormonal influences. While many teens outgrow acne, some may continue to experience it into adulthood.
It’s important for teenagers experiencing acne to maintain good skincare habits, seek advice from a health professional or a hormone naturopath, and understand that acne is a common and treatable aspect of puberty.
3. Menstrual Cycle Phases: Identifying Acne Patterns
The menstrual cycle is divided into several phases, each characterised by distinct hormonal changes and physiological events. The phases of the menstrual cycle include the menstrual phase, the follicular phase, ovulation, and the luteal phase. Hormonal fluctuations during these phases can influence the pattern and severity of women’s acne.
- Menstrual Phase: Days 1-5 (approximately). During this phase, estrogen and progesterone levels are low. Some individuals may experience a temporary improvement in acne during the menstrual phase due to the low levels of hormones. However, others may still have existing acne lesions.
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Follicular Phase: Days 6-14 (approximately). During the follicular phase, the estrogen level begins to rise, reaching its peak. FSH (follicle-stimulating hormone) stimulates the development of ovarian follicles. As estrogen rises, it can have a positive impact on the skin, promoting a smoother complexion. Acne may be less severe during this phase for some individuals.
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Ovulation: Around Day 14 (mid-cycle). During this phase, the LH (luteinising hormone) surges, triggering the release of an egg from the ovary. Some individuals may experience a temporary increase in women’s acne around ovulation due to hormonal fluctuations. This increase is often attributed to the rise in androgens.
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Luteal Phase: Days 15-28 (approximately). During the luteal phase, the progesterone rises and the estrogen decreases. If pregnancy does not occur, hormone levels decline towards the end of this phase. Acne may worsen for some individuals during this phase. The rise in progesterone can lead to increased sebum production, and the subsequent decline in estrogen may contribute to the development of acne lesions.
For those who observe a connection between their menstrual cycle and acne, understanding these hormonal fluctuations may help in tailoring skincare and lifestyle practices to manage acne more effectively throughout the month. A healthcare professional, such as a Women’s Naturopath, can help.
4. Hormonal Birth Control and Acne: Unpacking the Effects
Hormonal birth control methods can influence acne in various ways due to their impact on hormone levels in the body. It’s important to note that individual responses to hormonal birth control can vary, and what works positively for one person may not have the same effect for another, seeking Hormone Naturopath can be beneficial.
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Birth Control Pills (Combined Oral Contraceptives): COCs, containing both estrogen and progestin, can have a positive impact on women’s acne by reducing androgen levels and stabilising hormonal fluctuations. This can result in decreased sebum production and improved acne for some individuals. However, there might be an initial period of flare-ups before seeing positive effects.
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Progestin-Only Pills (Mini Pills): Progestin-only pills may have variable effects on acne, with some individuals experiencing improvement and others noticing worsened acne. Responses can differ, and it’s essential to monitor individual reactions.
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Hormonal Patches and Injections: Similar to combined oral contraceptives, hormonal patches and injections can influence androgen levels, affecting women’s acne differently for each individual. Responses to these methods can vary, and adjustments may be necessary based on individual reactions.
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Hormonal IUDs (Intrauterine Devices): Hormonal IUDs, with localised progestin release, may have a positive impact on acne for some individuals due to minimal systemic effects. However, responses can be variable, and changes in acne may occur.
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Anti-Androgen Medications (e.g., Spironolactone): Medications like spironolactone, with anti-androgenic effects, can be specifically prescribed to address hormonal acne by reducing androgen levels, offering a targeted approach to acne management.
If you’re planning to come off birth control tablets and are concerned about post-pill acne, we recommend you reach out to a specialised Acne Naturopath who can develop a custom treatment plan for your post-pill acne.
5. Pregnancy Hormones: Skin Changes and Acne Concerns
Pregnancy involves significant hormonal shifts that play a crucial role in supporting fetal development. These hormonal changes can impact various aspects of a woman’s health, including the condition of her skin. While many women experience positive changes in their skin during pregnancy, such as a healthy glow, others may encounter skin issues, including the development or exacerbation of acne.
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Elevated hCG Levels: Elevated levels of Human Chorionic Gonadotropin can contribute to a pregnancy “glow” for some women, giving the skin a radiant appearance. However, in some cases, hCG may also play a role in the development of pregnancy-related acne.
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Increased Estrogen Levels: Estrogen levels increase significantly during pregnancy which can contribute to improved skin hydration and increased blood flow, potentially leading to a healthier complexion. However, individual responses to estrogen can vary, and some women may experience skin changes, including the development of acne.
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Increased Progesterone Levels: While progesterone can contribute to a radiant appearance for some, it may also stimulate the sebaceous glands, leading to increased oil production. This excess oil can contribute to the development of women’s acne in some pregnant women.
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Lower Androgen Levels: While androgen levels are generally lower during pregnancy, hormonal fluctuations can still occur. Some women may experience changes in acne, with some noticing improvement, while others may develop pregnancy-related acne.
6. Thyroid Function and Hormonal Acne: An Overlooked Factor
The influence of thyroid hormones on hormonal acne is not as direct or prominent as with other hormones such as androgens (e.g., testosterone). However, disruptions in thyroid function can indirectly impact skin health, and in some cases, contribute to acne-related issues. Here are some considerations:
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Dry Skin: Hypothyroidism, an underactive thyroid condition, can lead to dry and rough skin. Reduced thyroid hormone levels may result in decreased activity of sweat glands and a lack of skin moisture, contributing to dryness.
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Edema and Swelling: Hypothyroidism can cause fluid retention and swelling (edema). While this is not directly linked to acne, facial swelling may affect the appearance of the skin.
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Inflammation: Thyroid disorders, particularly autoimmune conditions like Hashimoto’s thyroiditis, involve inflammation. Inflammation can be a contributing factor to various skin issues, including acne.
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Altered Immune Function: Thyroid disorders can impact the immune system. Disruptions in immune function may affect the body’s ability to regulate skin health, potentially influencing the development or exacerbation of acne.
7. Hormonal Acne and Menopause: Navigating Skin Changes
Menopause is a natural biological process marking the end of a woman’s reproductive years. It typically occurs around the age of 50, although the timing can vary. While menopause is not a direct cause of acne, hormonal shifts during this transitional phase can influence women’s acne occurrence. Here are some hormonal changes during menopause:
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Estrogen Decline: The decline in estrogen leads to a reduction in collagen and elastin, resulting in thinner and more fragile skin. Thinning skin is more prone to irritation and may be more susceptible to the development of acne lesions.
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Progesterone Decline: Progesterone levels also decrease during menopause. Progesterone has some anti-androgenic properties, and its decline relative to estrogen may influence the hormonal balance.
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Androgen Dominance: While estrogen and progesterone decrease, androgen levels may remain relatively stable or even increase. The relative increase in androgens, such as testosterone, can stimulate the sebaceous glands to produce more oil. This excess oil production can contribute to the development of acne.
Addressing hormonal acne often involves a combination of lifestyle modifications, skincare routines, and, in some cases, medical interventions. Consulting with a dermatologist or healthcare professional is essential. An Acne Naturopath, also known as a naturopathic doctor specialising in acne and skin health, can help address hormonal acne in women through a holistic and natural approach.