In my practice, I have encountered a significant number of women grappling with the persistent challenge of hormonal acne. You might recall battling acne as a teenager, but what happens when those breakouts persist well into your 20s, 30s, or even 40s?
It's a frustrating experience that can deeply affect confidence and self-esteem. As someone who struggled with hormonal acne as a result of PCOS, I understand the struggle first-hand and how it can take a toll. From my own experience, extensive research and clinical experience supporting many other women to heal their acne naturally, I also know effective natural treatments that I’m excited to share with you all in this article.
What is Hormonal Acne?
Before delving into the root causes and treatments, let's first understand what hormonal acne actually is. Hormonal acne, as the name suggests, is acne that is primarily triggered by hormonal fluctuations in the body. While acne can have various causes, hormonal acne tends to manifest as deep, cystic breakouts, particularly along the jawline, chin, and cheeks. Sometimes also the back and chest.
These breakouts often coincide with hormonal changes and appear cyclically. Some women experience hormonal acne during the premenstrual phase when oestrogen and progesterone levels are dropping while others can experience it leading up to ovulation when oestrogen is nearing it’s peak. Where you experience it in your cycle can offer us clues as to what hormones may be causing the issue.
Hormonal acne is not just a cosmetic concern; it reflects imbalances within the body's intricate hormonal system. Addressing these underlying imbalances is key to effectively managing and preventing hormonal acne breakouts.
Often when we have a hormone imbalance, we just want to jump straight to addressing our reproductive hormones like oestrogen, testosterone or progesterone. Addressing these hormones are important for balancing and clearing your acne but more importantly, we need to ask why your hormones are out of balance in the first place. To get to the root cause of your acne, we need to take a step back and view the body as a whole to understand why your hormones are out of balance and causing acne in the first place. This is where I like to address the foundations first and work our way up the pyramid. If we first address the hormones, it’s like putting a roof on a house without first building the foundations. It’s bound to crumble.
Gut & Liver Health
Poor gut health, hormonal imbalances, compromised liver detoxification, and acne are intricately linked in a complex interplay within the body. The gut microbiome plays a pivotal role in hormone metabolism and elimination through our oestrobolome. Disruptions in gut health, such as gut inflammation, leaky gut, and the presence of pathogens, can lead to skin inflammation and hormonal breakouts by impacting the delicate balance of moestrogen, progesterone, and androgens. These hormonal imbalances can further exacerbate acne by increasing sebum production and inflammation, creating an environment conducive to acne development. Additionally, compromised liver function can impair the detoxification of hormones and other toxins, leading to their accumulation in the body and contributing to hormonal disruptions and skin breakouts.
Learn more about the gut-skin connection in this blog post: https://www.sunstonenaturopathy.com/post/gut-health-and-skin-conditions
Adrenal Function & Blood Sugar Regulation (Insulin)
Chronic stress is intricately linked to hormonal acne through its impact on hormone regulation, particularly cortisol and insulin. When the body perceives stress, cortisol levels rise, triggering a cascade of physiological responses, including increased blood sugar levels. This surge in blood sugar is intended to provide energy for the body to respond to the perceived threat, such as running away or fighting. However, in our modern lives, stressors often revolve around finances, family, work, or other life challenges, and the excess blood sugar isn't necessary for physical exertion. Instead, chronically elevated cortisol levels can lead to high insulin & hormone imbalances. Chronic stress and imbalanced blood sugars from diet trigger increased inflammation and can elevate androgens, triggering androgenic acne and increased sebum production.
Thyroid Health
Your thyroid function could be the hidden trigger behind your acne. This small gland in your neck acts as a master regulator, influencing metabolism, hormone balance, gut health, and even skin cell turnover. When your thyroid isn't functioning optimally, symptoms like constipation, dry skin, brain fog, and low energy can arise, slowing down everything, including skin cell turnover and potentially leading to clogged pores and hindered healing. Thyroid issues can upset hormone balance, worsen insulin resistance, disrupt digestion, and cause nutrient deficiencies—all of which can exacerbate skin conditions, especially hormonal acne. Understanding this connection is vital for managing acne.
You can learn more about the thyroid-skin connection here: https://www.sunstonenaturopathy.com/post/is-your-thyroid-triggering-your-acne-or-rosacea
Reproductive Hormones:
·Elevated Androgens:
The underlying hormonal imbalances in hormonal acne typically involve elevated levels of androgens, such as testosterone, which can stimulate excess sebum (oil) production in the skin's oil glands. This excess sebum, along with dead skin cells and bacteria, can clog pores and lead to inflammation, swelling, and the formation of acne lesions. This is often seen in women with PCOS or post-pill acne.
High Oestrogen
Acne breakouts that manifest in the first half of the menstrual cycle (leading up to or around ovulation) are often associated with excess oestrogen. During these phases, oestrogen surges can stimulate sebum production, leading to clogged pores and acne flare-ups. Premenstrual oestrogen dominance relative to progesterone can also trigger acne flare ups and PMS symptoms. This is a very common imbalance I see often in clinic, especially for women with Endometriosis due to the high oestrogen. Sluggish detox pathways often contributes to this oestrogen excess, as well as gut imbalances, environmental toxins, dietary intake, alcohol and the hormonal fluctuations during perimenopause.
Low Progesterone
Acne associated with progesterone fluctuations often presents as flare-ups that tend to intensify just before menstruation. While commonly observed on the chin, these pimples may also emerge on the cheeks or forehead. As the body experiences a sharp decline in progesterone or low luteal phase progesterone levels, this acne type often coincides with other PMS symptoms like mood swings, irritability, disrupted sleep, breast tenderness, or bloating. It's noteworthy that this pattern often overlaps with estrogen excess, further contributing to hormonal imbalances and exacerbating acne symptoms.
High Prolactin
Prolactin is a hormone that’s made by the pituitary gland to stimulate breastmilk production. Being a hormone that’s more associated with breastfeeding, it commonly gets forgotten about but even if you aren’t breastfeeding or have never breastfed, prolactin can still cause hormonal issues & acne.If prolactin is very high in a non-breastfeeding women, it impacts oestrogen causing a host of symptoms including:
Irregular and/or missing periods
Low sex drive
Weight gain
Acne
Breast tenderness (& in very high levels it can cause leakage)
Infertility
Vaginal dryness
Hot flushes
·PCOS
If you have PCOS, a common symptom is acne, especially acne that presents around the chin, jawline, cheek but also on the back and chest in some women. Acne in PCOS is a result of elevated androgens. Androgens are typically known as male sex hormones however, they are important and present in both males and females. When androgens are elevated, it stimulates excess sebum production and hyperkeratinisation, leading to acne. High sugar intake can contribute to high circulating insulin levels, stimulating androgen production. Stress is another factor that can drive DHEA, a type of adrenal androgen. Other causes of elevated androgens can result from chronic inflammation, thyroid dysfunction, post hormonal birth control and some medications.
Download my free PCOS guide here: https://www.sunstonenaturopathy.com/free-resources
Post-Pill Acne
Post-pill acne is a result of a temporary surge in androgens and typically flares around 3-6 months after stopping hormonal contraceptives.This can last months, to years with some women getting a diagnosis of Polysystic ovarian syndrome (PCOS) as a result.When you go on the pill, the synthetic hormones suppress ovulation, along with androgens & sebum production to below normal levels. Once you stop taking the pill, your body then up-regulate both sebum and androgens in an attempt to return to normal levels. This causes a huge flare, typically around the chin, jawline and back.
Read my other post here for more information: https://www.sunstonenaturopathy.com/post/balance-your-hormones-post-pill
Testing to further understand the drivers of Hormonal Acne
· Hormones day 2 or 3 of menstruation: LH, FSH, Oestradiol, SHBG, DHEAs, Testosterone, FAI
· Hormones Day 21 (or 7 days post ovulation): Oestradiol & Progesterone
· Thyroid Function: TSH, T4, T3, rT3 (& thyroid antibodies if indicated)
· General Bloods: FBC, eLFT, Iron studies, B12 & folate, CRP, Vitamin D, Zinc
· Fasting blood glucose, Insulin
· Gut Microbiome Testing (If indicated)
· Salivary Cortisol (if indicated)
Natural Support for Hormonal Acne
Dietary changes that promote digestive health, nutering the microbiome, improving natural cleansing processes and address nutrient deficiencies can make a huge difference in hormonal acne. This is often combined with selective herbal and nutrient supplements that are tailored to address the underlying root cause and specific hormonal imbalances to resolve acne troubles once and for all.
Dietary Strategies:
Anti-inflammatory diet full of antioxidant rich foods (berries, leafy greens), fibre, polyphenols & omega-3s.
Probiotics, Prebiotics, digestive enzymes, bone broth & diverse diet for nourishing the gut
Limiting refined sugars, processed foods, vegetable oils & artificial food additives.
Balancing blood sugars with nutrient dense meals containing bioavailable protein, healthy fats and complex (slow) carbohydrates.
Staying hydrated with filtered and/or spring water
Cruciferous veggies, green tea, turmeric, ginger & bitter greens to support detox pathways
Lifestyle strategies:
Stress management techniques such as breath work, meditation, yoga, time in nature, journaling, EFT tapping
Prioritising sleep quality
Daily movement
Topical support: natural skincare products that support & nourish the skin barrier
Supplements & Herbs
Skin nourishing supplements specific to the individual needs may include zinc, vitamin A, omega-3s, myo-inositol, magnesium, specific probiotic strains, broccoli sprout
Herbs: adaptogenic herbs (such as ashwagandha), adrenal (Rehmannia, licorice), Anti-infammatory (turmeric), hormone balancing herbs (vitex, peony), liver & lymphatic herbs (St mary’s thistle, burdock, Echinacea) & blood sugar regulating herbs (goats’ rue, gymnema, cinnamon).
It's important to note that hormonal acne is a complex condition, and what works for one person may not work for another. It often requires a holistic approach that addresses diet, lifestyle, stress management, and targeted supplementation. Consulting with a qualified healthcare practitioner who specializes in hormonal health can provide personalised guidance and support on your journey to clearer, healthier skin. I don’t recommend self-prescribing herbs & supplements as it may worsen your hormonal imbalance if it’s not the right herb for what hormone is out of balance.
Your journey is unique, and we are here to walk alongside you, offering understanding and guidance every step of the way.
Book a free call with Allison to see how we can support you holistically throughout your acne healing journey.
Who is Allison?
Allison is the owner of Sunstone Naturopathy, offering Naturopathic support specialising in the intricacies of reproductive hormones, fertility, skin conditions, thyroid disorders, and gut health.
Her passion for holistic wellness is driven by a profound belief in the body's innate capacity to heal itself when provided with the right tools and guidance. Allison's approach is a harmonious fusion of evidence-based medicine, functional labs, and a deep understanding of the healing power of nature.
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