Causes, Treatments and Prevention
Dealing with acne breakouts can be frustrating and emotionally taxing. But when those breakouts seem tied to your menstrual cycle, they can feel especially disruptive and difficult to control.
Hormonal acne occurs when fluctuating hormones trigger excess oil production and inflammation in your pores. About 50% of women in their childbearing years suffer from hormonal acne to some degree, making it an exceptionally common skin condition.
The good news is that with the right treatment plan, you can get hormonal acne under control and prevent painful flare-ups month after month. This in-depth guide will walk you through everything you need to understand, treat and prevent hormonal acne outbreaks.
What Causes Hormonal Acne?
Hormonal acne occurs when your androgen hormones spike, stimulating your oil glands and triggering inflammation. Here’s a closer look at why it happens:
Puberty and Menstruation
During puberty, rising levels of androgens like testosterone tell your body to start producing more sebum – the oil that lubricates and protects skin. More sebum can clog pores and cause breakouts. This is also why acne flare-ups tend to coincide with your period.
Right before your period, estrogen dips and androgens like testosterone rise. This shift stimulates sebum production. At the same time, inflammation spikes. The result is painful cysts and pustules.
Pregnancy and Perimenopause
Hormone changes during pregnancy and perimenopause can also trigger acne. In both cases, androgen levels rise while estrogen levels decline. This hormone see-saw tells sebaceous glands to work overtime, resulting in clogged pores and inflammatory breakouts.
Birth Control
For some women, birth control pillsthat contain progestin can make acne worse. Progestin is a synthetic hormone that can increase oil gland activity and kick inflammation into high gear. This effect varies greatly from person to person though. Some women find their skin improves on birth control pills.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by elevated androgens, ovarian cysts and irregular periods. Since higher androgen levels ramp up sebum production, acne is a common side effect. Treating the underlying PCOS can help get skin issues under control.
Stress
Stress doesn’t directly cause hormonal acne, but it can make it worse. Stress hormones like cortisol trigger inflammation and mess with other hormone levels. This can indirectly amp up oil production and irritation. Managing stress is essential for clear skin.
Types of Hormonal Acne
Hormonal acne can take various forms, from small irritated bumps to deep painful nodules:
Whiteheads and Blackheads
Whiteheads occur when dead skin and oils plug the hair follicle just under skin’s surface. This sheltered environment allows P. acnes bacteria to multiply, triggering surrounding inflammation.
Blackheads also start with a blocked pore. But instead of closing up, blackheads remain open to the air. When their contents oxidize, they take on a dark appearance.
Papules and Pustules
Papules are small red, inflamed bumps without visible pus. They form when pores become clogged with excess sebum and bacteria.
Pustules resemble papules, but have white pus at their tips. The pus consists of dead skin cells, bacteria and sebum.
Nodules and Cysts
Nodules are large, painful, solid lesions lodged deep within skin tissue. Cysts feel similar but are filled with pus. Because nodules and cysts extend beyond the follicle and into the dermis, they often leave scars once healed.
Where Does Hormonal Acne Appear?
Hormonal acne frequently crops up along the lower face including the:
- Jawline – The jawline and chin are common locations for hormonal acne. That’s because this area has the highest concentration of oil glands on the face.
- Neck – Oil glands also dot the neck, making it prone to breakouts. Friction from collars and hair can further irritate skin.
- Cheeks – While cheeks have fewer oil glands than other areas, they remain vulnerable to hormonal pimples.
- Upper back and chest – Body breakouts in areas like the upper back, chest and shoulders may also stem from fluctuating hormones.
In rare cases, hormonal acne can spread to arms, thighs and buttocks as well.
Hormonal Acne vs. Regular Acne
While all types of acne stem from clogged follicles, hormonal acne differs from regular breakouts in a few key ways:
- Timing – Hormonal acne aligns with your menstrual cycle, frequently appearing 7-10 days before your period starts. It then clears up during or right after your period.
- Location – While regular acne can pop up all over, hormonal acne concentrates around the lower face, neck, shoulders and upper back.
- Cystic lesions – Hormonal acne also produces painful cysts and nodules more frequently than other acne types.
- Age – While teenage acne may involve hormones, true hormonal acne often doesn’t set in until adulthood when menstrual cycles and hormones stabilize.
- Persistence – With the right solutions, regular acne often goes away entirely after the teenage years. But hormonal acne keeps coming back month after month without the right interventions.
If you regularly deal with moderate to severe breakouts around your period, hormones likely play a driving role.
Diagnosing Hormonal Acne
To diagnose hormonal acne, dermatologists consider your symptoms, medical history, diet and lifestyle. Lab tests can provide confirmation:
Medical History Questions
Be prepared to share details about your periods, contraception methods, pregnancies and supplements with your doctor. This info illuminates how hormones impact your skin.
Blood Tests
Blood tests assess levels of key hormones like androgens, estrogen and testosterone. Higher than normal androgen levels point to hormonal acne triggers.
Skin Swabs
Collecting oil and skin cell samples helps identify acne-causing bacteria on your skin. Understanding your unique microbial mix allows for targeted treatment.
Once your doctor pinpoints hormonal influences, customized solutions become possible.
Treatments for Hormonal Acne
From over-the-counter washes to prescription medications, various approaches can tackle tough hormonal acne. Work with your dermatologist to build an appropriate regimen based on your acne’s specific characteristics and causes.
The Right Skincare Routine
Consistently clearing away excess oil, dirt, makeup and dead skin curtails the development of new pimples. Try to incorporate these practices:
- Cleanse twice a day with a gentle, antimicrobial face wash to remove debris without irritation.
- Exfoliate regularly to accelerate skin cell turnover and keep pores clear.Glycolic, salicylic and lactic acids all drive effective exfoliation.
- Always remove makeup thoroughly before bedtime to prevent clogged follicles. Oil cleansers excel at dissolving stubborn cosmetics.
- Spot treat existing pimples with benzyl peroxide, salicylic acid or benzoyl peroxide to zap acne-causing bacteria.
- Hydrate with oil-free moisturizers to repair skin’s moisture barrier without aggravating sebum production.
- Use sunscreen daily since UV exposure exacerbates inflammation and delays healing.
Over-the-Counter Medications
When implemented properly, many non-prescription solutions can eliminate hormonal acne breakouts:
- Benzoyl peroxide kills p. acnes bacteria to stop pimples in their tracks. It also moderately exfoliates.
- Salicylic acid penetrates pores to dissolve dead skin, debris and sebum. This BHA breaks up congestion gently without stripping.
- Sulfur acts as a mild antibacterial and exfoliant to clear acne and regulate oiliness.
- Retinoids like adapalene and tretinoin not only clear existing comedones but also prevent new ones from forming. They regulate skin cell turnover inside pores without irritation.
- Nicotinamide (vitamin B3) reduces inflammation and facial sebum production to treat moderate inflammatory acne. Studies show 4% nicotinamide gels twice daily effectively control breakouts.
OTC options work well for mild cases. Moderate to severe acne often calls for a prescription though.
Prescription Medications
Doctors turn to prescription drugs when over-the-counter regimens don’t provide sufficient relief. Commonly recommended medications include:
- Oral antibiotics like Doxycycline, Minocycline and Erythromycin treat bacterial infection while reducing inflammation. They work best paired with topical retinoids.
- Topical antibiotics featuring clindamycin phosphate or erythromycin base clear up mild to moderate inflammatory acne without antibiotic resistance worries.
- Oral contraceptives balance hormonal fluctuations in women. Estrogen- or progestin-dominant pills help control acne depending on your hormone profile.
- Anti-androgens like drospirenone and spironolactone block androgen hormone receptors. This reduces DHT-triggered sebum production and inflammation.
- Isotretinoin provides powerful long-term remission for severe, treatment-resistant acne. It also prevents cystic scarring.
Prescriptions deliver concentrated doses of acne fighters. Follow your doctor’s instructions carefully to avoid complications. Schedule regular progress checks as well.
Lifestyle Remedies for Hormonal Acne
While cleansers and medications tackle existing pimples, certain lifestyle measures may reduce the severity of monthly flare-ups over time. Try incorporating more:
Stress Management
As mentioned, higher stress hormone levels can trigger sebum and inflammation changes. Activities like exercise, meditation, yoga and art help keep stress in check for clear skin. Maintain work-life balance as well.
Sleep
Aim for 7-9 hours of quality sleep per night. Missing out on sleep increases cortisol secretions and alters hormone equilibrium. Teens need 8-10 hours while adults require 7-8.
Healthy Fats
Nutrient-dense fats nourish skin’s moisture barrier so it better retains hydration while repelling bacteria. Avocados, fatty fish, nuts and olive oil provide skin-loving omega-3s and omega-6s.
Micronutrients
Vitamins A, D, E and zinc support many vital skin functions that help resist acne. Load up on colorful fruits and vegetables to obtain enough of these essential micronutrients. Consider supplements if diet proves insufficient.
Water Intake
Drink at least 8 glasses of water daily to flush out excess sebum, dead skin cells and toxins from pores. Proper hydration prevents dehydrated, irritation-prone skin as well.
While lifestyle tweaks alone rarely cure acne, they might make monthly breakouts less angry and severe. Discuss diet and stress management with your dermatologist or primary care provider. Customized wellness strategies combined with the right medications deliver the best results.
How to Cover Hormonal Acne
When painful cysts crop up before important photos or events, you may feel tempted to mask them with makeup. Take care to avoid products and practices that can worsen breakouts though. Here are some cover up tips:
Use Oil-Free, Non-Comedogenic Formulas
Stick to products explicitly labeled non-comedogenic and oil-free. These won’t contain waxes, mineral oils and other pore-cloggers that exacerbate acne.
Try Tinted Moisturizers and BB Creams
Sheer-to-medium coverage foundations like BB creams and tinted moisturizers let skin breathe while minimizing pimples. They deposit far less pigment into pores than heavier foundations.
Spot Conceal Strategically
Rather than slathering on thick foundation everywhere, use a targeted concealer wand just on angry cysts. Then apply light foundation where needed to even out redness.
Avoid Touching Up Too Often
Excessive blending and touching up transfers bacteria onto skin. Stick to two applications max spaced a few minutes apart before leaving makeup alone.
Remove Carefully and Thoroughly
Gently take off every trace of makeup with cleansing oil or balm followed by face wash. Leftover pigments will transfer to pillowcases and clog pores further. Harsh scrubbing makes irritation worse.
Can Birth Control Pills Cause Acne?
Ironically, the same hormonal birth control pills taken to prevent pregnancy can sometimes trigger breakouts. Certain pills contain androgen-based progestin hormones that rev up oil glands. If you develop acne after starting a new contraceptive, the formulation may be to blame.
Talk to your gynecologist about switching to a pill with less androgenic progestins like desogestrel or drospirenone. Or opt for a hormone-free IUD instead. Figuring out which contraception options suit your hormone profile prevents contraception-induced breakouts.
Natural Hormonal Acne Remedies: Do They Work?
You may come across DIY acne solutions featuring ingredients like apple cider vinegar, honey, turmeric, green tea and aloe vera. Unfortunately, none boast enough research support for hormonal acne specifically.
Some natural remedies have minor antibacterial, anti-inflammatory or antioxidant benefits. But they simply aren’t strong enough to override systemic hormonal imbalances driving breakouts.
That doesn’t mean quality natural skincare products can’t still hydrate and protect your skin though! Just pair botanical cleansers and lotions with proven medical therapies rather than substituting one for the other.
Hormonal Acne Scar Treatment
While hormonal acne eventually goes away each month, the scars left behind linger unless treated. Don’t pick or pop pimples to avoid pushing debris deeper into skin and worsening marks. Immediately start appropriate scar treatment instead:
OTC Scar Gels and Patches
Silicone scar sheets, scar gels and patches help flatten and fade discoloration via compression, hydration and protection from UV rays. Look for drugstore products containing silicone, vitamin C or hydroquinone.
Retinoids
OTC retinols and prescription retinoids promote collagen production to help indented scars look and feel less conspicuous. They also accelerate skin cell turnover to fade discoloration faster.
Professional Procedures
See a board-certified dermatologist for collagen stimulating laser treatments, microneedling, chemical peels and filler injections. In-office procedures treat scar texture, size and pigmentation changes for smoother, clearer skin.
The earlier you implement scar treatment post-breakout, the better your results. Newer marks respond quicker to remedies than older ones.
How Long Does It Take for Hormonal Acne To Go Away?
With consistent proper care, hormonal acne breakouts usually resolve each month in this general timeline:
- Days 1-3: Period ends. Rising androgen levels increase oil production. Early comedones start forming deep within pores. Surface texture remains smooth.
- Days 4-7: More noticeable clogged pores, whiteheads and small red pimples emerge. Larger inflammatory papules and pustules may occur.
- Days 8-12: Acne reaches full peak with a mix of non-inflammatory bumps alongside inflamed pustules and tender cysts. Counts will range from a few scattered pimples up to over a dozen on lower face/jawline.
- Days 13-20: Androgen surge ends. Estrogen output increases stopping sebum spike. Acne starts fading, flattening out and disappearing until next cycle. Scars remain without treatment.
So while individual pimples clear quickly with proper care, the overall tendency for cyclical breakouts continues month after month. Getting to the root hormonal triggers remains key to enjoying consistently clear, glowing skin long-term.
How to Prevent Hormonal Acne
While you can’t eliminate natural hormonal shifts, you can prevent them from inciting acne each month. Here’s how:
Take Medications Pre-Emptively
Track your cycle so you know exactly when flare-ups tend to start. Begin taking medications like oral contraceptives or spironolactone supplements several days prior to disrupt the hormonal cascade before it damages skin. Stay consistent month after month.
Lower Androgen Levels
Discuss prescription anti-androgens with your doctor to reduce DHT and other acne-fueling androgens in your bloodstream. Many resolve breakouts for 96% of women long-term.
Support Hormonal Balance Holistically
Eat more fiber and beneficial fats while reducing processed carbs and sugars. Manage stress through relaxing activities too. Optimizing diet, sleep and lifestyle habits helps minimize inflammation. Supplement as needed.
Book Regular Facials
Seeing an esthetician monthly right before your period ensures pores stay clear of congestion that could ignite breakouts later on. Extractions, cleansing and exfoliation all help prevent inflammatory lesions.
With some trial and error, you can absolutely control cyclic acne triggers for consistently clear skin month after month.
Can Men Get Hormonal Acne Too?
Absolutely. While male sex hormones like testosterone don’t fluctuate as rapidly as female ones, they can still trigger acne.
In teen boys, rising testosterone production during puberty activates oil glands. When excess sebum and dead skin cells clog pores, breakouts result. Such “teenage” acne often resolves once hormones level out in adulthood.
However, adult men remain susceptible too. Certain health conditions lead to elevated androgens that overstimulate sebaceous glands just like in women.
Causes of Hormonal Acne in Men
Possible hormonal triggers include:
- Andropause – The male equivalent of menopause involves testosterone decline later in life. The testes produce fewer natural hormones while SHBG (sex hormone binding globulin) increases. This imbalance can activate sebum production.
- Anabolic steroid abuse – Illegal use of testosterone analogues rapidly increases androgen levels. About 54% of users break out from the hormonal disruption.
- Testicular or adrenal gland tumors – While very rare, tumors that spike male sex hormones can cause hormonal acne even in older men. Get checked out for underlying conditions.
- Stress – Stress hormones stimulate increased oil production. Staying chronically stressed raises androgens while lowering testosterone.
If standard acne treatments prove ineffective, ask your doctor to check various androgen levels through bloodwork. Addressing any hormone abnormalities often clears up stubborn bumps.
Hormonal Acne FAQs
Still have more questions about managing monthly breakouts? Here are answers to some frequently asked questions:
How Long Does Puberty Acne Last?
Acne beginning in early puberty usually lasts until your early 20s. That’s when hormone levels typically stabilize in both young men and women. Maintaining a solid skincare routine helps control and prevent pimples during this time.
Does Diet Impact Hormonal Acne?
No specific food causes or cures hormonal acne, but an unbalanced diet can worsen inflammation. Eating more processed carbs, sugar and dairy while falling short on vitamins and omega fats may amplify breakout intensity.
Can Working Out Cause Hormonal Acne?
Working up a sweat doesn’t directly trigger acne. However, not promptly cleansing away grime and body oils post-workout can lead to clogged pores and bacteria overgrowth. Shower immediately after exercise while leaving sweaty gym clothes festering in your bag invites breakouts.
How Do You Treat Hormonal Chin Acne?
Recurring chin and jawline pimples must be treated at the internal hormonal source, not just the surface level. Oral medications like drospirenone-containing birth control pills or supplemental spironolactone are best for adult hormonal chin and jaw acne in women.
What Vitamins Should I Take for Acne Prone Skin?
Vitamins A, D, E and zinc all help strengthen skin against inflammation and infection. Take them as separate supplements or obtain them through eating more fresh fruits, veggies, eggs, nuts and enriched grains. Fish oil capsules provide vital skin-healthy omega-3s too.
Can You Get Rid of Cystic Acne Permanently?
Prescription isotretinoin offers the best chance for permanent cystic acne remission. A 4-6 month course shrinks oil glands long-term, preventing recurrent severe breakouts. Milder comedonal acne may still occur though. Maintaining healthy lifestyle habits post-treatment keeps more serious flare-ups away.
When to Seek Emergency Acne Treatment
Severely painful, worsening acne may require prompt medical intervention, especially if you develop:
- Extreme redness, warmth and swelling spreading outward from pimples
- Draining pus
- Crusting skin lesions
- Fever over 101 F
- Generally feeling sick and fatigued
These signs indicate a spreading skin infection requiring immediate treatment to avoid permanent scarring.
See your dermatologist right away or visit an urgent care center if home care isn’t rapidly improving worrisome breakouts. Abscesses must be surgically drained while antibiotics combat inflammation and bacteria burdens.
Don’t wait with worsening acne, as delaying treatment risks complication and longer recovery times. Report severe side effects from acne medications promptly as well.
The Takeaway: Understanding Your Hormonal Acne Triggers is Key
Battling monthly breakouts feels frustrating, but with the right solutions, clear skin is achievable long-term. Identify your unique hormonal acne triggers – whether menstrual fluctuations, androgen effects from medications or underlying illnesses – then craft a treatment plan targeting the root causes.
Alongside prescription treatments, incorporate daily skincare essentials like cleansing, exfoliating and hydrating without over-drying. Protect existing breakouts from infection while preventing new ones from forming. Avoid picking and popping which drives bacteria deeper and slows healing.
Finally, reduce lifestyle triggers like chronic stress that exacerbate hormonal imbalance and inflammation. Your multi-pronged management plan will get breakouts under control for consistently clear, confident skin.
Have you cracked the code on your hormonal acne yet? What combinations of medications, skincare and lifestyle changes work to prevent monthly flare-ups? Share your experiences and tips in the comments below!