How to Fix Hormonal Acne

Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. For many, those pesky pimples we get as teenagers will fade away as we grow up. But for plenty of others, acne persists well beyond the teen years.

Hormonal acne is a particularly annoying form of adult acne. As the name suggests, it's associated with fluctuations in hormones and tends to flare up at predictable times—like before your period or during perimenopause.

If you're struggling with hormonal acne, you're not alone. Here's what you need to know about identifying it and getting it under control.

What Exactly is Hormonal Acne?

Acne forms when hair follicles get plugged with oil and dead skin cells. This allows bacteria to grow inside the plugged follicles and cause inflammation. The result is red, painful bumps on the skin that can be whiteheads, blackheads, pimples, or cysts.

Hormonal acne occurs when there are changes in your hormone levels. The most common culprits are:

• Androgens - Male sex hormones like testosterone. Androgens trigger increased oil production which can clog pores. Women with high androgen levels often break out around the jawline, chin, and upper neck area where there are a high number of oil glands.
• Estrogen - Just before your period, estrogen levels take a dive while testosterone surges. This imbalance can cause breakouts.

So in summary, hormonal acne is acne caused by changes in hormones like estrogen, progesterone, and testosterone. These hormonal fluctuations stimulate oil production and inflammation leading to breakouts.

What Does Hormonal Acne Look Like?

Hormonal acne tends to have some telltale characteristics:

• It shows up around your monthly cycle. The week before your period you may suddenly break out. As hormone levels shift again, the pimples fade.
• It concentrates on the lower part of your face along the jawline, chin, and upper neck. Sometimes it spreads down onto the chest and upper back.
• Cystic acne is common. These are large, red, painful bumps deep under the skin without a head. They take longer to heal than typical whiteheads or blackheads.
• Breakouts often correspond with major hormone events like starting or stopping birth control pills, pregnancy, perimenopause, or menopause.

So in summary, hormonal acne generally forms on the lower face and jawline. It flares monthly with your cycle. And it’s associated with big hormone changes. If this sounds like your acne, hormones are likely the culprit.

What Causes Hormonal Acne?

Hormonal acne occurs when androgens are elevated. The main causes include:

Puberty

Puberty kicks off a surge of androgens. Boys and girls alike will produce more sebum and can experience breakouts. Fortunately puberty-related acne is often temporary.

Menstruation

Right before your period, progesterone and estrogen dip. This allows androgens to dominate, increasing oil production. Monthly breakouts result.

Pregnancy

Pregnancy brings massive hormone changes. Surging androgens and progesterone can lead to breakouts, especially during the first trimester.

Perimenopause

As women near menopause, estrogen declines while testosterone levels remain high. This imbalance triggers increased oil production and acne.

Polycystic Ovarian Syndrome (PCOS)

Women with PCOS produce excess male hormones like testosterone. The resulting acne often begins in the teen years.

Stress

Stress triggers the adrenal glands to release hormones like cortisol and androgens which rev up oil production.

Medications

Birth control pills, corticosteroids, or lithium can influence hormone levels and lead to acne flares.

Supplements

Whey protein powder and creatine supplements boost insulin levels which in turn ramps up androgen production. Breakouts may follow.

So in review, the main causes of hormonal acne include puberty, monthly menstruation, pregnancy, perimenopause, PCOS, stress, certain medications, and supplements. Identifying the trigger can help you find the right treatment approach.

How to Get Rid of Hormonal Acne

There are many effective acne treatments to consider:

1. Combination Birth Control Pills

For women, combination birth control pills containing estrogen and progesterone can help regulate hormones and reduce acne. The pills lower androgen levels and decrease oil production.

It may take several months to see results. Be patient. Brands like Yaz, Estrostep, and Ortho Tri-Cyclen are FDA approved to treat acne. Discuss options with your gynecologist.

2. Anti-Androgens

Anti-androgen medications like spironolactone can block oil-triggering androgens. Originally a blood pressure drug, “spiro” is prescribed off-label to treat hormonal acne in adult women. It can take 2-3 months to see clearing.

3. Retinoids

Retinoids like tretinoin (Retin-A), tazarotene (Tazorac) and adapalene (Differin) normalize oil production and skin cell turnover. Using a pea-sized amount nightly can prevent clogged pores. Don’t use while pregnant.

4. Benzoyl Peroxide

Benzoyl peroxide kills acne-causing bacteria inside pores and quells inflammation. Look for acne washes with 2.5-10% benzoyl peroxide. It may bleach fabrics so rinse thoroughly after washing your face.

5. Salicylic Acid

Salicylic acid exfoliates dead skin cells and oil trapped within pores. Look for cleansers and leave-on toners with .5-2% salicylic acid. It sloughs off pore-clogging debris to prevent breakouts.

6. Azelaic Acid

Azelaic acid tackles two causes of acne—it kills acne bacteria and reduces inflammation. OTC options include Finacea gel (15%) by prescription or The Ordinary Azelaic Acid Suspension (10%).

7. Tea Tree Oil

Tea tree oil is an antibacterial and anti-inflammatory essential oil effective for acne. Mix a few drops into face wash or moisturizer. Don’t use at full strength which can irritate skin.

8. Aloe Vera Gel

Aloe vera gel is antibacterial and soothing on acne. After cleansing, apply a thin layer of pure aloe gel onto breakouts. Look for a quality product without added ingredients.

9. Zinc Supplements

Oral zinc supplements reduce testosterone and oil production which may help with hormonal acne. Take 30-50 mg of zinc picolinate daily. Zinc can interfere with antibiotics so check with your doctor.

10. Healthy Skin Habits

Good skincare habits help prevent acne by keeping pores clear. Wash morning and night with a gentle cleanser. Avoid harsh scrubs. Limit touching your face to avoid transferring bacteria. Change pillowcases regularly. Manage stress through exercise, meditation, etc.

Many cases of mild hormonal acne can be controlled with healthy skin care plus over-the-counter ingredients like salicylic acid or benzoyl peroxide. See a dermatologist for prescription medications to treat moderate to severe breakouts. Most treatments need 8-12 weeks to work, so be consistent. Pay attention to monthly flares to identify patterns. With the right approach, you can clear hormonal acne for good.

7 Key Tips for Getting Rid of Hormonal Acne

If you struggle with monthly breakouts, here are some quick tips for getting hormonal acne under control:

• Use acne-fighting ingredients like retinoids, benzoyl peroxide, and salicylic acid
• Take zinc supplements to reduce oil and testosterone
• Talk to a gynecologist about birth control pills to regulate hormones
• See a dermatologist for prescription anti-androgens or retinoids if needed
• Lower stress through yoga, meditation, or whatever works for you
• Track monthly flares to identify patterns
• Be patient - it can take 2-3 months to see improvement

Stick with a consistent routine focused on your acne triggers, and you’ll finally clear your hormonal acne.

Common Myths About Hormonal Acne

There's a lot of misinformation floating around about hormonal acne. Let's separate fact from fiction:

Myth: You just have to live with hormonal acne.

Fact: False. Today there are many effective medical treatments to control hormonal acne.

Myth: Only teenagers get hormonal acne.

Fact: Not true. Adult women are more prone to hormonal acne due to monthly menstruation, pregnancy, and fluctuating hormones in perimenopause.

Myth: Avoiding chocolate and greasy foods will help hormonal acne.

Fact: Diet has little impact on hormonal acne which is driven by internal hormone changes.

Myth: You can’t use retinoids like Retin-A if you’re trying to get pregnant.

Fact: Retinoids should be avoided while actively pregnant or breastfeeding. But they can be used safely while trying to conceive.

Myth: Birth control pills just mask acne temporarily.

Fact: When taken continuously, birth control pills can provide long-term acne treatment by regulating hormones.

Don’t let these common myths deter you from seeking treatment. Today’s medical therapies can successfully control stubborn hormonal acne.

When to See a Doctor About Hormonal Acne

Mild hormonal breakouts can often be managed with over-the-counter products. But if you’re struggling with moderate to severe acne, it’s a sign to make an appointment with a dermatologist. Signs it’s time to see a doctor include:

• You’ve tried OTC remedies for several months without improvement
• Deep, painful cysts are developing
• Acne is leaving scars or dark spots
• Breakouts are significantly impacting your self-esteem
• You experience sudden, unexplained acne as an adult woman

A dermatologist has more tools available to diagnose and treat hormonal acne. They can prescribe stronger retinoids, anti-androgen medications, or even medications to regulate hormones. Plus they can recommend medical procedures like cortisone injections to shrink large cysts or laser treatments to address acne scarring. Don’t hesitate to reach out for help. There are always new acne treatments emerging, so a dermatologist can find the right approach for you.

When to See an Endocrinologist for Hormonal Acne

In some moderate to severe cases, a dermatologist may recommend getting evaluated by an endocrinologist as well. An endocrinologist specializes in hormones and can help identify a potential underlying hormonal imbalance contributing to acne.

Signs you may need to see an endocrinologist include:

• You have additional symptoms like excess facial or body hair, thinning hair, irregular periods, infertility, obesity, etc.
• Blood tests indicate high androgen levels
• Your acne began in early teens and is not resolving
• Acne flares are worsening despite multiple treatments
• You have a condition like PCOS that is known to cause hormonal issues

By pinpointing hormonal imbalances, an endocrinologist can recommend targeted therapies like birth control pills or anti-androgens to get at the root of your acne. Getting your hormones in proper balance may finally clear your skin.

When to Consider Hormonal Testing for Acne

If you’ve tried the usual acne treatments without success, hormonal testing may be warranted. Hormonal testing isn’t always necessary, but can be useful in some scenarios:

• You suspect you have elevated androgens, PCOS, or another hormonal disorder
• You experience monthly acne flares suggesting a hormonal tie
• Topical and oral acne medications haven’t adequately controlled your breakouts
• You have other hormonal symptoms like excess facial hair or irregular periods
• You started breaking out later in life as a adult woman

Common hormonal tests include:

• Total and free testosterone
• DHEA-sulfate (DHEA-S)
• Androstenedione
• Dihydrotestosterone (DHT)
• Dehydroepiandrosterone (DHEA)
• Sex hormone binding globulin (SHBG)

Work with an endocrinologist to determine which tests are appropriate. If hormonal irregularities are found, you can receive targeted treatment to finally clear up hormonal acne.

Birth Control for Hormonal Acne - Does it Work?

For women struggling monthly with acne around their cycle, birth control pills can be an effective treatment. Here’s a look at how they work:

Birth control pills like Yaz, Estrostep, and Ortho Tri-Cyclen contain two key hormones—estrogen and progestin (synthetic progesterone). This combination helps in several ways:

• Lowers testosterone levels
• Decreases oil gland production
• Normalizes ovulation and menstrual cycles
• Stabilizes hormone fluctuations

By regulating hormones and limiting testosterone, birth control reduces excessive oil production and inflammation that contribute to breakouts.

While all combination pills may offer some acne relief by making hormone levels more consistent month to month, brands like Yaz and Ortho Tri Cyclen are FDA approved specifically to treat moderate acne. Those with more severe acne can be prescribed higher dose Diane-35 or derivatives like Dianette.

It typically takes at least three months for acne improvement to become noticeable when starting birth control pills. Consistent long-term use provides the most lasting acne relief by controlling hormonal fluctuations. Some women do turn to birth control pills solely to manage stubborn hormonal acne. Discuss your options with an understanding gynecologist.

How Long Does it Take for Hormonal Acne to Go Away?

If you’re battling hormonal acne, you want clear skin ASAP. But how long does it actually take to see results from treatments? Here’s what to expect:

• OTC acne products: 4-6 weeks
• Topical prescription treatments: 4-6 weeks
• Oral antibiotics: 6-8 weeks
• Birth control pills: 2-3 months
• Spironolactone: 2-3 months
• Isotretinoin (Accutane): Up to 6 months

Patience and consistency are key—most acne medications take 8-12 weeks to kick in. It can feel frustrating waiting weeks or months for your skin to clear while continuing to break out. But trust the process. Stay on track with your dermatologist’s recommendations and your hormonal acne will begin to resolve.

Some tips to help you cope while treatments ramp up:

• Use makeup to conceal breakouts
• Avoid picking and popping pimples
• Continue using products even when skin clears to prevent acne from returning
• Take progress photos to track subtle improvements
• Find peer support from others on acne forums

With the right combination of medical treatment plus lifestyle adjustments, your hormonal acne can finally become a thing of the past!

Hormonal Imbalances that Cause Acne

While fluctuating testosterone, estrogen and progesterone play a major role in hormonal acne, other hormonal imbalances can also trigger breakouts. Common culprits include:

Insulin - Higher insulin levels increase androgen production. This stimulates oil glands and clogs pores.

Cortisol - Stress triggers excess cortisol, which ramps up oil and triggers inflammatory acne.

Growth Hormone - Excess growth hormone (GH) overstimulates oil glands and sebum production leading to clogged pores.

Insulin Growth Factor (IGF-1) - Higher levels of this growth hormone can spark breakouts.

Polycystic Ovarian Syndrome (PCOS) - This condition disrupts normal hormone cycles and can significantly increase testosterone. Acne, facial hair, irregular periods, and infertility often result.

Thyroid - Both overactive and underactive thyroid function influence hormones like testosterone that lead to acne.

Gut hormones - Recent research suggests leptin, ghrelin and other gastrointestinal hormones modulate oil gland function.

In some moderate to severe acne cases, it pays to look beyond the usual suspects like testosterone and estrogen. Explore other hormone pathways that may be out of balance and contributing to stubborn breakouts.

How Long Does Post-Birth Control Acne Last?

Many women take birth control pills to regulate hormones and keep acne at bay. But what happens when you decide to go off the pill? Post-birth control acne is common. Here’s what to expect:

When you stop taking birth control pills, your body kicks back into its normal hormonal rhythm. Estrogen and progesterone levels decline. Testosterone temporarily surges. This hormonal rollercoaster usually lasts about three to six months as the body adjusts.

It’s during this time that breakouts are most likely to occur. Acne is essentially “unmasked” as your natural hormones rebound. The acne was kept suppressed by being on birth control pills.

Here are some tips to minimize post-birth control acne:

• Phase out birth control pills gradually if possible (i.e. skip placebo days)
• Continue using topical acne treatments to keep skin clear
• Try anti-androgen spironolactone to block testosterone
• Take zinc supplements to reduce testosterone production
• Use salicylic acid or retinoid products to prevent clogged pores

Be patient during the initial months as your hormones recalibrate. Within six months, hormone levels typically stabilize and post-birth control acne improves. Consistent skin care keeps breakouts under control as hormones naturally balance out.

Frequently Asked Questions About Hormonal Acne

What is the difference between hormonal acne and regular acne?

The main difference is the cause. Regular acne is triggered by factors like bacteria, clogged pores, excess oil production, etc. Hormonal acne occurs specifically due to changes in hormones like testosterone, estrogen and progesterone that increase oil production and inflammation.

What are the best birth control pills for treating hormonal acne?

Birth control pills containing the progestins drospirenone (like Yaz) or norgestimate (like Ortho Tri-Cyclen) are preferred for acne. These progestins have minimal androgenic (testosterone-like) side effects. Branded pills specifically approved for acne like Yaz or Diane-35 contain cyproterone, a strong anti-androgen.

How do you get rid of hormonal acne naturally?

Natural remedies like zinc supplements, spearmint tea, evening primrose oil, and DIY masks with apple cider vinegar or honey can help balance hormones and reduce inflammation. Boosting antioxidants through berries, greens, and nuts may also help. Reduce stress and get sufficient sleep.

What should you avoid eating if you have hormonal acne?

Limit foods that spike blood sugar like refined carbs, sugary foods and sodas. High glycemic foods boost insulin which in turn drives androgen production. Avoid whey protein and creatine supplements which are implicated in acne. Minimize dairy which contains hormones that may exacerbate acne.

How do you stop hormonal acne from coming back?

Long-term management requires controlling fluctuations in estrogen, progesterone and testosterone. Options include combination birth control pills, anti-androgens like spironolactone, or isotretinoin (Accutane) for more resistant severe acne. Lifestyle adjustments like regular exercise, stress reduction, and a low glycemic diet also help stabilize hormones.

What vitamin deficiency causes hormonal acne?

Vitamin B5 plays an important role in hormone and oil gland function. Low levels are linked to acne. Zinc is also critical - it can lower testosterone. Vitamins A, D, E and Omega-3s reduce inflammation. Boosting these vitamins may help prevent hormonal breakouts.

Does hormonal acne go away after pregnancy?

Acne flares are common during pregnancy due to surging hormones like androgens and progesterone. Post-partum, hormone levels stabilize and pregnancy acne usually resolves within several months. Oral contraceptives are a safe treatment option after giving birth. Nursing mothers can opt for topicals like benzoyl peroxide, azelaic acid or retinoids.

How can you tell if acne is hormonal versus fungal?

Clues your acne may be fungal include itchy red bumps, scaling, acne concentrated in moist areas like sides of nose and mouth, and breakouts triggered by sweat or humidity. Fungal acne often responds to dandruff shampoos containing zinc pyrithione or ketoconazole. See a dermatologist to confirm fungal acne.

Can hormones like estrogen and testosterone be used to treat acne?

Hormonal therapies focus mainly on anti-androgens to lower elevated testosterone and regulate menstrual cycles. Estrogen is given in combination birth control pills but is not used alone due to increased health risks. Bioidentical hormone therapy is controversial but may help relieve perimenopausal acne in some cases. See an endocrinologist to discuss hormonal treatment options.