Introduction to Hormonal Acne
Hormonal acne can be a confusing and debilitating problem, and for the majority of people, it can be difficult to figure out on your own! Characterised by cystic, deep pimples located around the chin, jaw, and face, this is typically caused by an imbalance in your reproductive and stress hormones that leads to an overproduction of sebum (oil) in your skin follicles. Some of our patients with hormonal acne notice breakouts occurring at a particular time in their menstrual cycle that can be quite severe, leading to scarring if left untreated.
It’s integral that you investigate the underlying cause of your acne to understand what is driving this imbalance, something we have talked a lot about before. If you are new to understanding your acne, you can get more information about where to start with you hormonal acne here.
5 Triggers that cause hormonal Acne in women.
Our patients’ age ranges from adolescents to adults. They have all been through the wringer and tried everything from spironolactone to Accutane, and have seen every doctor under the sun but still have plenty of questions. By the time we see them, they are usually fed up with being told their test results are ‘normal’ and have been cutting out so much from their lives to no avail!
They have usually tried many treatments, from benzoyl peroxide to antibiotics, only to get a small amount of relief each time. Each treatment failure causes more anxiety and stress and an endless research quest on what can be helpful.
The recurrent treatment failures occur because they are typically only treating the symptoms, not the cause of their acne, and running into triggers that can exacerbate it along the way!
While these triggers can usually make things worse, they aren’t the be-all and end-all when it comes to acne.
So here is a list of the more common triggers we see that when treated can reduce your acne flares while we investigate the underlying cause.
Trigger 1: Change in Testosterone Levels
Testosterone is an androgen hormone that can increase sebum levels in your follicles, leading to blocked pores that cause acne. When sebum levels increase, bacteria can become trapped in your follicles and result in inflammation, pimples, and cystic acne.
However, a common misconception is that testosterone levels must be high in order to cause acne. We’ve discovered that it can actually be at a normal level but be high relative to the female hormones (estrogen and progesterone). And so even though it’s not high it is the dominant hormone and still triggers acne.
Trigger 2: Working out
Who knew that exercise could actually make things worse instead of better?
Not ALL exercise is problematic, but for people who do a lot of high-intensity interval training, this might actually make their acne worse. Now why is this?
When we do too much intense exercise, it sends a message to our body that we are under physical stress, and this can impact our ability to ovulate and produce our reproductive hormones. If combined with a very low-calorie diet, it can cause something called ‘hypothalamic amenorrhea’, which is where the body suppresses ovulation to avoid pregnancy in times of physical stress.
The way to avoid this is to focus on low-intensity weight-style exercise over high-intensity exercise and make sure you fuel your body efficiently with enough calories to support your activity.
Exercise can also cause acne due to excess sweat and bacteria you might pick up while at the gym, so follow proper hygiene procedures and make sure to shower after a workout!
Trigger 3: Stress
Stress can cause excess production of the hormone cortisol, which in turn can impact our reproductive hormones. Over time, chronically elevated cortisol has a suppressive effect on our reproductive hormones, which can throw things out of balance and cause us to be more sensitive to particular hormones throughout the month.
Stress can also impact our eating and exercise behaviours, which can mean we aren’t getting the right amount of calories or exercise to support our bodies.
Trigger 4: Diet
There are no specific diet guidelines when it comes to acne, but there are a few foods that can make acne worse:
Cows milk dairy
For some, a protein called casein in cows’ milk can increase a cytokine called insulin-like growth factor 1 (IGF-1). This in turn can impact your blood sugar and hormone levels because it acts like the hormone insulin. As with insulin, IGF-1 can cause an increase in androgens like testosterone which causes acne breakouts.
So it can be helpful to reduce or remove dairy products from your diet while you are investigating the root cause of your acne to rule out if dairy is a problem for you or not. This is the easiest way to determine if your acne is dairy-sensitive. Give dairy-free a trial for 3 months before slowly reintroducing it.
Sugar can cause breakouts by increasing your blood sugar levels and creating inflammation. If you consume too much sugar in the long term, it can lead to insulin resistance, a condition that impacts hormones and reproductive health and triggers an overproduction of androgens like testosterone.
So keep processed sugar to a minimum and aim to get your fix using naturally occurring sugary foods like fruits which also contain fiber to reduce the impact on your blood sugar levels.
For some, gluten (a protein in the grains wheat, spelt, rye and barley) is inflammatory and can increase the severity of breakouts. For others, it causes serious food intolerance or even coeliac disease, so it’s important to take note if you are experiencing symptoms when you consume gluten-containing foods.
One of the challenges with gluten is it comes in foods like bread, pizza, and pasta which are delicious carbohydrates that are easy to overindulge in. So it’s best to keep these foods to a minimum or avoid them if you think they are causing symptoms.
Fortunately, there are plenty of naturally gluten-free choices, such as brown rice, quinoa, or potato.
Foods that can be helpful due to their vitamin and mineral content:
Foods rich in zinc
Zinc supports healthy skin by encouraging skin cell turnover and reducing inflammation. Oysters, beef, shellfish, pumpkin seeds, and legumes contain moderate amounts of zinc.
Reducing inflammation is important when it comes to your skin and hormones, so including healthy fats and oily fish, as these contain omega-3 fatty acids, can reduce inflammatory markers that cause red & angry comedones. Also consuming plenty of vegetables, nuts and seeds can have a positive effect on your skin too.
A healthy gut microbiome will ensure that your hormones are being detoxified efficiently to reduce the chance of hormonal symptoms. Include 4-6 servings of fruit or veg a day to make sure that you are getting 20- 30 grams of fibre every day.
Blood sugar-balancing foods
Foods like cinnamon or LOW GI carbohydrates such as brown rice will help to balance your blood sugar to avoid those insulin spikes that can impact your hormones.
Trigger 5: Post-pill Acne
If you have been prescribed birth control pills for your acne, you will know that these can have great results while you take them but they don’t relieve symptoms long-term and can come with some nasty post-pill effects. While the birth control pill prevents male hormones from impacting your skin while you use it, it doesn’t treat the underlying imbalances that are causing your acne.
For most people, the pill is a short-term fix that will only work while you are taking the medication, and 3-6 months after coming off the pill your acne will return.
What does the pill do?
One of the main functions of contraceptives is to suppress ovulation so that you won’t get pregnant. In doing so, your natural hormones are put on hold so that the synthetic hormones in the pill can have their effect. For anyone with hormonal acne, this means the hormones that were causing the acne have been silenced, but deep down the imbalance still exists.
Once you stop taking the pill, the hormones that have been lying dormant realise they need to come back, and sometimes they do this…with a vengeance!
This can mean a surge of androgen hormones that leads to an increase in breakouts, which typically happens in the 3-6 months post taking the pill.
To reduce the risk of post-pill acne if you are currently taking it you can work with me or one of our other naturopaths to form a plan before you stop taking the pill.
Strategies: Considerations for reducing Hormonal Acne in Women.
Strategy 1: Consider your Diet
Concentrate on adding plenty of fibre, moderate amounts of protein, and healthy fats to your diet to reduce inflammation.
Decrease sugar, alcohol, gluten, and dairy for a couple of months before reintroducing one at a time to see if any of them cause flare-ups for you. Make sure that you eat every few hours to balance your blood sugar levels too. Consume foods that are rich in antioxidants such as brightly coloured vegetables, and make sure that you are eating low GI carbs.
Studies have shown that people with a healthy diet are less likely to have acne vulgaris.
Strategy 2: Reduce Stress
Cortisol, our main stress hormone, can really impact your hormones in a negative way. Excess cortisol can suppress ovulation and cause an imbalance in your hormones that leads to acne. In addition, the inflammatory effect of cortisol has been well documented.
Stress levels impact how much cortisol is made, so the higher your stress, the more cortisol you might produce.
Some research has shown that an increase in stress hormones can impact the production of sebum, and it definitely impacts people with polycystic ovary syndrome (PCOS), a condition that also comes with acne as a symptom.
It is important to limit this effect by implementing stress reduction techniques such as mindfulness, deep breathing, gentle exercise, and limiting screen time because supplements on their own won’t cut it.
Strategy 3: Don’t overdo the exercise
While exercise is important, too much high-intensity exercise can stress the body in a way that impacts hormones. Instead, try something more gentle, like yoga, pilates or walks in nature.
Strategy 4: Remove any makeup before bed
Cleansing your skin properly at the end of that day helps to reduce clogged pores that can turn into breakouts! Using a gentle, natural skin cleanser to remove makeup before bed can help to reduce breakouts caused by blocked pores.
This is particularly important if you are experiencing blackheads and whiteheads alongside deep cystic acne.
Strategy 5: Use the right products
It can be tempting to try lots of different types of skincare when you are breaking out, but some skincare is laden with chemicals, so it’s important to be careful when looking for skincare products.
There are so many options available, such as retinoids, tretinoin, moisturisers, creams, hyaluronic acid, and serums to name a few, but the thing we recommend as naturopaths is to create a skincare routine that includes ingredients that are as natural as possible.
Because we know the answer lies underneath, skin care products will only improve things to a minor degree. Even products recommended by a dermatologist can only get you so far if you aren’t addressing the underlying issue, which is usually a hormonal imbalance.
So while you are investigating, try to reduce the number of chemicals going into your skin cells and opt for natural skin care such as tea tree oil to calm your inflamed skin.
Strategy 6: Test your hormones
This is where the real magic is! Hormone testing gets to the bottom of what is causing your acne and helps you and us figure out what hormonal imbalance is occurring. So, let’s look at what testing we use to see what is causing your acne.
Blood testing can reveal a lot about what is happening to your hormones, but it’s important that you know where you are in your menstrual cycle when you do the testing because hormones fluctuate throughout your cycle.
Blood testing can reveal high androgens such as androstenedione, testosterone and free testosterone.
Luteinizing hormone (LH) & Follicle stimulating hormone (FSH)
These are important hormones to test at the start of your cycle because their ratio to one another can reveal an underlying issue.
Fasting insulin and glucose
As you will now be aware, blood sugar levels and insulin resistance can cause big problems for your hormones if they are out of range. Checking these first thing in the morning, and fasting on an empty stomach are key to understanding if they are playing a part.
Saliva hormone testing
Saliva hormone testing is a lot easier to utilise, and it looks at the context of your hormones in the luteal phase of your cycle (after ovulation). The beauty of this testing is that it also checks your adrenal hormones to understand the extent to which stress plays a part.
Saliva testing checks testosterone, estrogen, and progesterone at a time in your cycle when estrogen and progesterone should be dominant. Looking at the hormone levels at this time of the menstrual cycle helps us to decipher if it’s actually low female hormones or high testosterone causing your breakouts.
The next part of the story is that we can help you understand why your hormonal acne is occurring. Figuring out what hormone imbalances you have is the secret to knowing what natural treatment of herbs and supplements you’ll need. Our body is complex, so having someone who can provide a holistic approach to managing your hormonal acne is best. This way your treatment is personalised.
We have the experience and expertise from helping more than 1000 women fix their ance naturally and we can help you too.
To start getting to the bottom of things, head to this link to organise a chat with us here.