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Hormonal acne is not only difficult to treat but, is embarrassing. Especially if you’re dealing with it as an adult. Acne is often widely associated with puberty. But, pre-teens and teens aren’t the only ones that struggle with it. Indeed hormonal fluctuations can happen at any stage and age of life. And, are quite common for women. Specifically during transitory periods such as pregnancy, perimenopause, and menopause. Yet, there are other underlying conditions that contribute to hormonal imbalance and lead to acne. Getting to the root cause of the hormonal imbalance and addressing it can help with resolving your acne.  So, let’s talk about common underlying issues that cause hormonal acne and how to fix them. 


How Is Hormonal Acne Triggered?

It’s common for women to experience issues with hormonal acne in their 20’s to late ’40s. And, it’s characterized by its appearance on the cheeks and along the jawline. Typical lesions associated with hormonal acne include blackheads, whiteheads, small pimples, and/or cysts. These breakouts are triggered by hormonal imbalances that lead to issues with

  • Inflammation within the skin
  • Excessive sebum (oil) production
  • Clogged pores
  • Increased propionibacterium acnes (p.acnes) bacteria production
  • Overproduction of male androgens specifically testosterone

One or a combination of these issues contributes to the development of hormonal acne. 


But, when it comes to hormonal imbalances and hormonal acne there is usually an underlying cause or reason for the imbalance. Five common issues that contribute to the onset of hormonal acne include polycystic ovary syndrome (PCOS), hypothyroidism, progestin-only birth control, menstruation, and menopause. 


Polycystic Ovary Syndrome


PCOS is a hormonal disorder that affects 10% of teenagers and young women. Consequently, it prevents the body from properly producing the correct amount of estrogen, progesterone, and testosterone. Thus leading to a decrease in estrogen and progesterone. Hence, causing a spike in testosterone production. Not only does this imbalance impact the menstrual cycle leading to ovulation dysfunction and irregular periods. But, it contributes to skin complications such as excess oil production and clogged pores. Which are a direct result of the hormonal imbalance caused by the overproduction of male androgens. 



Experiencing issues with an underactive thyroid can also influence the presence of hormonal acne. Your thyroid is responsible for creating and regulating hormones that control metabolism, energy production, as well as cell growth and repair. If the body fails to produce enough thyroid hormone it can lead to digestive issues, cognitive dysfunction, weight gain, and acne. 


An underactive thyroid gland contributes to the decline of progesterone production. This, in turn, leads to an excess level of estrogen and androgens. High levels of androgens specifically dihydrotestosterone (DHT) contribute to oily skin and clogged pores. On the other hand, poor circulation can cause dry skin that fails to shed itself properly. Thus, causing an issue with clogged pores and breakouts. 


Progestin Only Birth Control

Many women that struggle with acne may decide to take a combination birth control pill such as Yaz or Ortho-Tri-Cyclen to address skin issues. And, indeed these brands are 2 out of many that are FDA cleared for treating acne. But, there are types of birth control that may aggravate breakouts and contribute to hormonal imbalance. Particularly, progestin-only pills. This type of birth control is recommended for women that are breastfeeding, contraindicated from taking combination birth control, or do not want to use birth control with estrogen. 


But, these progestin-only pills have an adverse effect on androgen hormones. The influx of progestin triggers an increase in androgens. Thus, creating a hormonal imbalance and leading to issues with breakouts and hormonal acne. 



Experiencing breakouts and acne is common for many women before or during their period. This occurs due to hormonal fluctuations that occur around this time. These hormonal imbalances are caused by plummeting progesterone levels and elevated estrogen levels. This, in turn, leads to breakouts and acne becoming an issue. To make matters worse estrogen and progesterone will take a dive at the beginning of your period. Consequently, leading to a surge of testosterone. This influx of testosterone will increase oil production and clogged pores. Thus, causing breakouts and acne to develop. 



In the case of menopause, this is a natural process that women in their 40’s and 50’s go through. It signals the transition from a woman’s reproductive years and the end of menstruation. This process results in the slow decline of reproductive hormones and an issue with high levels of androgens. All of which may trigger breakouts and acne. 


On the other hand, undergoing hormone replacement therapy (HRT) may also lead to hormonal imbalances. An influx of hormones to replace those hormones that are declining may lead to elevated hormone levels. Thus, causing issues with hormonal acne. 


Treating Hormonal Acne

When it comes to properly treat hormonal acne this will depend on what’s causing it in the first place. It’s important to address the root cause of hormonal imbalance before purchasing expensive products or treatments. While proper skin care is important the hormonal imbalance must be addressed to truly treat the condition. So, take the time to work with your doctor to identify if there’s an underlying cause. Discuss your symptoms and request the proper diagnostic tests such as blood panels, thyroid panels, and testing hormone levels. 


If you’re taking a progestin-only birth control pill or you’re undergoing HRT discuss with your doctor your issue with acne. Explore the possibility of either choosing a lower dosage or finding an alternative method that would better suit you if at all possible. Also, if your period causes acne, discuss with your doctor options that can help with this.  Once, you’ve addressed the root cause of the hormonal imbalance that’s causing acne can you begin to make the appropriate wellness-based lifestyle changes. 


Skin Care

Prioritize high-performance skincare products in your skincare routine. While it may be tempting to overhaul your routine with products that are full of active ingredients, don’t. Using too many active ingredients in your skincare routine can increase irritation and contribute to more inflammation within the skin. Make sure to address the skin’s basic needs pertaining to your skin type (dry, oily, combo). Then infuse targeted treatments into your regimen. 


For example, using a skin appropriate cleanser, moisturizer, and SPF is a great foundation to start with. Then you can choose to use treatment serums, exfoliators, and masks to address acne. Look for products that contain alpha-hydroxy acids such as glycolic acid which helps to decrease skin turnover while decreasing acne scarring. Additionally using products that contain salicylic acid, which is a beta hydroxy acid, is effective at helping to combat oiliness and open up clogged pores. You may also speak with your doctor about obtaining a prescription of Retin-A which is effective at increasing cellular turnover and removing the build-up of dead skin cells. 


Furthermore, it’s important to use sunscreen daily with these treatments. They are known to cause photosensitivity. Meaning they increase your skin’s sensitivity to light. And may cause hyperpigmentation or uneven skin tone if you don’t properly protect it from the sun. 


Proper Skin Habits

In addition to proper skincare, you want to make sure that you have proper skin habits. Make sure to cleanse the skin regularly every morning and every evening. While also avoiding the use of heavy make-up products that clog the pores. Additionally, refrain from picking at blemishes and breakouts. Doing so will only lead to scarring and may contribute to breakouts spreading on the face. If possible work with a dermatologist or skin specialist. They can advise you on proper skin treatments, products and provide facials to help improve your skin’s appearance. 


Improve Your Nutrition

In some cases, inflammation caused by hormonal acne may be aggravated by certain foods you eat. Take the time to analyze what you’re putting in your body. Identify if there are potential trigger foods that are linked to breakouts. Common inflammatory foods include:

  • Red meat
  • Dairy
  • Refined Carbs (pasta and white bread)
  • Sugar


You may find that working with a nutritionist or nutrition coach can help you determine trigger foods and help heal your acne from the inside out. 


Get To The Root Cause

At the end of the day when it comes to properly treat and addressing hormonal acne, you have to get to the root cause. Since hormonal acne is not influenced by outside factors rather inside factors that must be addressed first. Figuring out what’s causing the hormonal imbalance in the first place and getting that properly treated will positively affect the appearance and health of your skin. Additionally, you shouldn’t expect your skin to clear up right away. Fixing hormonal imbalances takes time. And your body may need a few months to regulate itself. Furthermore, enlisting the help of a nutrition coach and skin specialist may prove beneficial in helping you clear up your skin. This way you’re addressing the underlying cause while creating healthy lifestyle habits to heal your acne. 

  1. Very Well Health | Treating Acne with Retin-A written by Angela Palmer medically reviewed b Casey Gallagher MD on November 3, 2019
  2. Web MD | Skin Problems and Treatments | Birth Control for Acne
  3. Mayo Clinic | Minipill (progestin-only birth control pill) written by Mayo Clinic staff, published on March 2, 2018
  4. Thyroid Central | Hypothyroidism and Acne Relationship published on February 8, 2018
  5. Healthline | Hormonal Acne: Traditional Treatments, Natural Remedies and More written by Kristeen Cherney medically reviewed by Cynthia Cobb APRN on April 14, 2017
  6. Healthline | Polycystic Ovary Syndrome and Acne: Connection, Treatment and More written Kristeen Cherney medically reviewed by Deborah Weatherspoon Ph.D., RN, CRNA on November 2, 2018