Medically reviewed

Beating the breakouts: Skin, the menstrual cycle and hormonal acne

SEPTEMBER 16, 2021

Adult acne is far more common in people with cycles than those without. The saying, ‘it’s just your hormones’, is casually reeled off whenever anyone mentions a bad breakout—but which hormones cause acne? Read on to discover how the menstrual cycle affects our skin and which treatments can help you get a handle on hormonal acne

Key Takeaways

  • Acne is a super, super common PMS symptom, affecting up to 65% of people with cycles (1)

  • Acne can range from the odd breakout to more serious cystic or nodular acne, and is caused by overactivity of our sebaceous glands and sebum production

  • Androgens (like testosterone), SBGH and estrogen, all play a role in our likelihood of developing acne

  • All of these hormones (plus sweat levels), flux during the menstrual cycle which can contribute to pre-period breakouts 

  • Finding a good hormonal birth control with anti-androgenic activity can help improve your skin if you are struggling with hormonal acne

The last thing we need when we’re full-swing into the bloated, crampy and cranky pre-period loveliness is a damn breakout. 

But just like many of our other well-acquainted favorites (migraines, mood swings, and sore boobs), acne breakouts are just another, oh so common, PMS symptom.

Although acne is more common during our teenage years (just when things literally couldn’t get any more embarrassing), it’s definitely not just a puberty problem. 

People with cycles are more likely to experience adult acne than those without (2), and 65% of us experience acne flares pre and during our periods (1).

The line ‘it’s just your hormones’ is frequently thrown around whenever there's so much as a single pimple in sight—but is acne caused by hormones? And if so, which hormones cause acne?

Before we get all hormonal on ya, let’s get to know what we’re dealing with first...

What is acne?

Acne can present itself in many different shapes and sizes, from the odd breakout to more serious or consistent cystic acne. 

Our skin contains lots and lots of sebaceous glands that produce oil, known as sebum. Whilst many of us might not be too hot on the greasy look, sebum is really important for maintaining our skin's moisture and protective barrier (3) (basically keeping our insides safe from the outsides).

Our sebaceous glands secrete sebum out via our skin’s hair follicles, onto the skin surface (4). But, sometimes these follicles become blocked with excess sebum and dead skin cells, and—voila—out pop pimples (5). 

Although pimples or spots are used as pretty generic terms for acne breakouts, our pimply pals can actually be categorized into 6 major types:

  1. Whiteheads: Formally known as comedones (6), these are those small inflamed pimples with a closed (usually) poppable white top.
     

  2.  Blackheads: Formally known as open comedones (6), these are clogged hair follicles where the skin has opened and sebum has oxidized, forming a blacktop.

  3. Papules: These are pimples that have formed deep underneath the skin and present as raised red bumps on the skin’s surface without an open-top (6) (unpoppable).

  4. Pustules: basically a much larger, angrier, inflamed whitehead, or pus-filled spot on the surface of the skin (6).

  5. Nodules: these are deep inflamed nodes that form underneath the skin and present as large, hard, red lumps on the surface of the skin. Nodules don’t have a ‘head’ and are un-poppable (5).

  6. Cysts: Often confused with nodules, cystic acne also forms deep within the skin, but cysts are filled with pus. Cysts will usually present as a large pus-filled, raised red bump on the skin surface and do not heal like normal papules or pustules, but remain for a much longer time (5).

Cystic and nodular acne are the most serious types of acne, but all types of acne can be both physically and emotionally painful. 

Acne normally affects the skin on our faces the most because this is where our sebaceous glands are at their most active (2,3), but it's also common for acne to flare on our arms, backs, necks and chests (2).

Is acne caused by hormones?

Alright, now we're well and truly acquainted with what we’re tackling, let’s get to the punchline—do hormones cause acne?

The long and short is, there are many things that can contribute to our likelihood of developing acne, from genetics to smoking (although despite popular myths, diet, lack of exercise, greasy hair and even lack of washing, don’t)(7). 

Although the causes of our acne will differ from person to person, raised levels of certain hormones, or hormonal imbalances, can increase our susceptibility for spots (8). 

Androgens (like testosterone) can cause increased activity of our sebaceous glands, meaning more sebum secretion and more blocked follicles (3).

So, if we have higher androgen levels (either genetically, because of a developed hormone imbalance, or the effects of certain birth control we are taking) it may make us more prone to pimples. 

Additionally, our favorite group hugger—Sex Hormone Binding Globulin (SHBG), plays a role in acne onset too (10).  If we’ve got free testosterone that’s at a loose end, SHBG will find it and bind to it, taking as much as it can (but not all) under its wing and stopping it from being able to exert its effects on our sebaceous glands (9). 

So, if our SHBG is low (again either from genetic predisposition, a hormone imbalance, or brought on by hormonal birth control) our testosterone has more free reign, which may trigger bigger breakouts. This is common in polycystic ovarian syndrome (PCOS) sufferers. 

Although this knowledge may make you want to go and hang, draw and quarter your hormones (we don’t blame you), remember our hormones are still our friends. They are working tirelessly to try and keep us healthy, functioning and thriving. 

If you have high levels of androgens or low SHBG levels, these can both be improved with certain types of hormonal birth control (9).

The menstrual cycle and acne

Okay, but why do we always seem to break out during those pre-period weeks?

Interestingly, whilst androgens increase sebum production, estrogens have been found to reduce it (10).

So when our estrogen is higher mid-menstrual cycle, our skin is much more likely to be a pimple-free paradise. Estrogen is also involved in collagen production, regulating our skin's thickness, hydration and barrier function (11,12)—basically all the ingredients for that mid-cycle glow-up. 

When our estrogen levels drop during the latter half of our cycles, in the run-up to our bleed, less sebum blocking estrogen means our skin becomes more oily, potentially causing those pesky breakouts (10). We are also more prone to inflammation in general during this phase of our cycles, which can cause flare-ups to already sore skin. 

What’s more, our basal body temperature also changes throughout our cycles, increasing in the latter (luteal) phase—meaning, essentially, we’re sweatier (13). Increased sweating can contribute to more full-body acne breakouts (13).

Hormonal acne treatments

If you’re struggling with your skin, or skin self-esteem, which is o’so easy in the age of insta filters and flawlessly edited skin images, remember that you are authentic and so so SO much more than a skin condition.

Acne is unbelievably common, with up to 80% of us experiencing some form of acne at some point in our lives (3). Skin conditions are the 4th most common cause of illness (14).

Battling with our skin can easily leave us feeling isolated, and people with cycles are even more susceptible to feeling this way than those without (15).

But, we are not alone—there are great treatments available for many skin conditions, including acne—plus the incredible societal step changes in embracing skin positivity. 

As well as topical treatments and oral antibiotic treatments, certain types of hormonal birth control can help to reduce acne. But, we aren’t just talking about popping any old pill—it’s SO important to find the right one for you, as certain types of hormonal birth control can make acne worse. 

Generally, hormonal birth controls that have more androgenic effects (that temptress testosterone) can contribute to acne—whereas ones that contain less androgenic activity may improve it. 

You don’t need to partake in the side-effects gamble of ‘trial and error’ to find the right birth control that doesn’t aggravate your acne anymore.

At Tuune, we can help you find the right birth control choice for you, one that won’t play havoc with your skin. 

A few skintastic facts to leave you with

The skin is the human body's largest organ (nope, it's not the liver)(10).

  1. The skin is actually part of the immune system—it’s the main job is to protect our insides from all the nasties on the outside (think jacket potato) (10)

  2. Males usually have thicker skin than females (10)

  3. Our skin isn’t just a place we call home, it’s also home to a diverse ecosystem of millions of microorganisms, including many many many bacteria, mites, and fungi (gross)

All in all, our skin is pretty darn cool. If you are struggling with your skin—get in touch, we’re here to help.


References
  1. Geller L, Rosen J, Frankel A, Goldenberg G. Perimenstrual Flare of Adult Acne. J Clin Aesthetic Dermatol. 2014 Aug;7(8):30–4.

  2. Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the Burden of Adult Female Acne. J Clin Aesthetic Dermatol. 2014 Feb;7(2):22–30.

  3. Hoover E, Aslam S, Krishnamurthy K. Physiology, Sebaceous Glands. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Aug 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499819/

  4. Martel JL, Miao JH, Badri T. Anatomy, Hair Follicle. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Aug 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470321/

  5. Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD004425.

  6. Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020 Apr 1;10(1):5754.

  7. Ayer J. Acne: more than skin deep. Postgrad Med J. 2006 Aug 1;82(970):500–6.

  8. Stoll S, Shalita AR, Webster GF, Kaplan R, Danesh S, Penstein A. The effect of the menstrual cycle on acne. J Am Acad Dermatol. 2001 Dec;45(6):957–60.

  9. O’Connell K, Westhoff C. Pharmacology of hormonal contraceptives and acne. Cutis. 2008 Jan;81(1 Suppl):8–12.

  10. Dao H, Kazin RA. Gender differences in skin: a review of the literature. Gend Med. 2007 Dec;4(4):308–28.

  11. Raghunath RS, Venables ZC, Millington GWM. The menstrual cycle and the skin. Clin Exp Dermatol. 2015 Mar;40(2):111–5.

  12. Shah MG, Maibach HI. Estrogen and skin. An overview. Am J Clin Dermatol. 2001;2(3):143–50.

  13. Lee H, Petrofsky J, Shah N, Awali A, Shah K, Alotaibi M, et al. Higher sweating rate and skin blood flow during the luteal phase of the menstrual cycle. Tohoku J Exp Med. 2014 Oct;234(2):117–22.

  14. Tizek L, Schielein MC, Seifert F, Biedermann T, Böhner A, Zink A. Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest. J Eur Acad Dermatol Venereol JEADV. 2019 Jul;33(7):1421–8.

  15. Davern J, O’Donnell AT. Stigma predicts health-related quality of life impairment, psychological distress, and somatic symptoms in acne sufferers. Picardo M, editor. PLOS ONE. 2018 Sep 28;13(9):e0205009.


Written by
Annalisa Hayes (she/her)

Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.


Medically reviewed by
Dr. Arushee Prasad, GP, MBBS (she/her)

Dr Arushee Prasad is a GP for NHS England with an MBBS in Medicine and Surgery, and an MRCGP from the Royal College of General Practitioners. Passionate about digital health and algorithmic medicine, Arushee was previously an Algorithmic Medical Doctor for Docly.


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