Last Updated on August 7th, 2019
Every woman dreads that time of the month when they have to deal with cramps, bloating and all-things-PMS. For some, that list also includes acne and breakouts, known as menstrual acne.
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Menstrual acne is the skin flare-up that occurs about 7 – 10 days before a woman’s period begins and usually goes away once they actually begin bleeding. This sudden onset of pimples and blemishes is actually quite common amongst women, affecting about 63% of them1, most of which are acne-prone.
The simple answer is that menstrual acne is caused by the fluctuations in hormones due to a woman’s menstrual cycle. As explained by ob-gyn Elizabeth Lyster, MD., during the menstrual cycle, different hormones are predominant at different times of the month, resulting in several changes to a woman’s body and, especially, her skin. The main hormones present are estrogen, progesterone and, the male hormone, testosterone in fairly small amounts. During the average 28 days menstrual cycle, estrogen is the most dominant in the first half of the cycle. Progesterone is the main hormone during the second half. Just before the part of the cycle where bleeding begins, both progesterone and estrogen drop to their lowest levels, while testosterone levels stay relatively the same throughout the entire month. This results in testosterone levels being higher than the female hormone levels right before and during the time of menstruation.
What causes menstrual acne occurs during the switch from progesterone and testosterone. When progesterone levels rise, skin swells, pores become compressed shut and the production of sebum is stimulated2. Sebum is a natural oily substance that keeps skin lubricated. When a woman’s skin swells to minimize and close pores, sebum begins to build up beneath the surface of the skin. Even when progesterone levels drop toward the time of menstruation, testosterone continues to stimulate the sebaceous glands to continue producing sebum.
For some women, this transition helps them achieve a healthy, glowing looking with minimized pores. However, for many, it results in an oily complexion and plenty of nourishment for the acne-causing bacteria, P.acnes. This causes an increase of the bacteria, which naturally leads to an increase in breakouts, inflammation, and redness around the time of menstruation.
As you can see, acne related to menstruation isn’t caused by poor hygiene or other external conditions, but rather the changing of hormones and how that affects the behavior of skin. As a result, there isn’t much that can be done about the acne-hormone relationship, but there are things that can be done to take special care of the skin around the time of menstruation. For many, this involves doing things to affect the hormones directly.
Birth control pills, or BCPs, are commonly known to help women who are acne-prone during the time of their periods. BCPs raise the levels of estrogen in a woman’s body, which in turn lessens the levels of testosterone. BCPs work by increasing sex hormone-binding globulin (SHBG)3, a protein that actually absorbs the free testosterone in the body, much like the way a sponge soaks up liquids. According to Dr. Lyster, “this means there is less testosterone available to cause acne.” BCPs also cause the sebaceous glands to slow down on oil production, meaning there is less sebum available to support acne-causing bacteria.
For those suffering from menstrual acne, there are BCPs that are specifically approved for managing this skin problem, including Estrogen, Ortho Tri-Cyclen, and Yaz. When taking BCP for acne management, some women experience increased acne during the 3 to 4-month adjustment period before their bodies adjust to the hormone change. So, be wary and patient if this is your choice of treatment.
Sometimes menstrual acne doesn’t respond to BCPs alone, as your testosterone levels may still be quite high. In this case, many doctors prescribe Spironolactone, a medication designed to further lower testosterone levels and lessen oil production in the skin caused by testosterone. However, there are a few side effects to be wary of4, including fatigue, irregular periods, breast tenderness, and headaches. This drug should only be taken under the advice of a doctor, as it may not be suitable for all women.
For those suffering from obesity, hormone treatment may not work for you. This is because obesity can significantly lower SHBG5, and it increases testosterone production in the blood. Even though BCPs are designed to do the opposite, your current health conditions will render their effects void. In this case, eating healthy and maintaining a healthy weight is a key way to reduce and control menstrual acne breakouts.
Despite the fact that menstrual acne is not the result of poor hygiene, proper hygiene is still necessary for the management of menstrual acne. Since sebum acts as food for acne-related bacteria6, it is helpful to keep your skin as clean as possible as to avoid the build-up of extra bacteria. In order to keep the skin on your face clean, you should:
Acne is caused by bacteria, and sometimes that bacteria is so deep-seated in the skin that surface and hormonal treatments aren’t enough to manage it, especially in the beginning. For this, your doctor can prescribe low-dose tetracycline7, an antibiotic you can take for five days right before your period begins.
If you suffer from cystic acne and have tried other remedies that just didn’t work, you should talk to your doctor about using Accutane, also known as isotretinoin. Although it’s a natural derivative of vitamin A, it does come with a few side effects8. These include increased risk of potential drug associations, suicide and birth-defects in pregnant women, which is why you need talk to a doctor about it before you attempt to use it.
Further treatments for menstrual acne can be done, as directed by a dermatologist and performed in-office. These treatments include chemical peels, laser therapy, cortisone injections and acne surgery.
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