Could Estrogen Levels Be Affecting Your Acne?
Tens of millions of women in their reproductive years have acne that comes and goes about once a month, along with the fall and rise of estrogen levels. Estrogen can be very important in managing women’s acne, but it’s never as simple a matter as getting estrogen levels higher to clear up the skin.
- Estrogen relieves acne, but more estrogen is not always the answer.
- Women who have premenstrual acne develop breakouts when progesterone levels go up and estrogen levels go down after ovulation.
- Certain formulations of the Pill can reduce premenstrual acne, but no contraceptive ever stops 100% of premenstrual acne.
- A condition called PCOS triggers acne by increased production of both estrogen and testosterone.
- Too much estrogen can be as harmful for skin as too little.
- PCOS is often correctable with diet, although it can take up to 12 months for results to be visible in the skin.
- Hormonal fluctuations don’t make acne inevitable. Even when hormones cannot be brought back into balance, acne can be stopped in its tracks with the help of a complete acne treatment system such as Exposed Skin Care.
The Link Between Estrogen and Acne
When women have mild to moderate acne that comes and goes in sync with their menstrual cycles, bumps usually break out just after ovulation1 and clear up just after menstruation. “Menstrual acne” begins when estrogen levels begin to decline, about the midpoint of the menstrual cycle, and is at its worst just before menstruation, when estrogen levels start to go up again.
The way hormones have an influence on acne in women is through activation of oil making glands2 in the skin known as sebocytes. These cells make the oils that flush dead skin cells and excess bacteria out of a pore. Small amounts of oil in pores actually help keep them clean, as well as making the skin more flexible.
The sebocytes are activated by testosterone3. Every woman’s body makes tiny amounts of testosterone, primarily in the ovaries. Androgen-activated receptor sites in a woman’s body respond to testosterone in the same way they would respond in a man’s body, except that most women’s bodies make much less testosterone4 and have much lower skin oil production and hair formation than most men.
Estrogen levels start to climb at the beginning of the menstrual cycle5. The estrogen binds to the cell receptors that would otherwise respond to testosterone. This “turns off” oil production and helps clear up pores.
Estrogen levels fall after ovulation6. There is less estrogen to bind to the cell receptors in oil glands, so they are more likely to be activated by testosterone. They continue to produce excess oil until estrogen levels begin to climb again the next month.
There can be some lag time between increased oil production in the skin and acne breakouts timed to the menstrual cycle. If the skin is properly cleansed, acne may not break out at all. Not all of the pores in women’s skin that respond to testosterone are in the face. There may be about 1/3 as many activated pores on the back as in the face, and it is even possible for acne to break out on the chest in women.
Changing Estrogen Levels to Treat Acne
Changing estrogen levels is the way women can use the contraceptive Pill to fight acne. Most oral contraceptives are a mixture of synthetic estrogen and a synthetic progesterone-like compound7 known as progestin. Switching to a brand of contraceptive that contains more estrogen may stop the production of excess skin oils, and reduce the severity of acne.
Just switching contraceptives, however, never gets rid of all acne blemishes. Using a different brand of the Pill usually gets rid of just 30 to 50% of blemishes. Women who have premenstrual acne also need to:
- Avoid irritating the skin with alcohol, perfumes, and certain botanicals (especially menthol and cinnamon oil), especially in the second half of their menstrual cycle, the 10 days to 2 weeks before their periods. The skin repairs irritation and inflammation by making more oil.
- Gently cleanse the skin at least once a day. Detergent cleansers that make big bubbles can damage the skin and make oil formation worse. Mild cleansers that make small bubbles are better. Just place the cleanser on the skin and let the cleanser do all the “scrubbing” for you.
- Keep the skin moisturized8 so it is soft and supple and pores can drain. Alcohol-based moisturizers can aggravate oil production, so it is best to use water-based or thin oil-based moisturizers on the skin. Moisturizers with skin-identical ingredients such as ceramides also help9.
Many of the natural remedies for PMS help stop premenstrual acne because they block both testosterone and estrogen. Soy, green tea, and red clover can help with acne symptoms, but they don’t get rid of all blemishes, either, and they do not replace the proper use of cleansers and moisturizers.
When Estrogen Is Not the Only Problem
The worst cases of acne in women of all ages, however, are usually associated with a condition known as polycystic ovarian syndrome10, or PCOS. This condition occurs when the ovaries are overstimulated, usually by an influx of sugar from the bloodstream. The ovaries make more than the usual amount of both estrogen and testosterone11, and the testosterone keeps oil glands overactive all the time. Many women who have PCOS have irregular periods or do not menstruate at all, so they never get a break from acne. Excess testosterone production may also cause unwanted hair growth.
The reason the ovaries work overtime to make testosterone in PCOS usually has to do with a phenomenon called insulin resistance. In insulin resistance, some toxin or trauma produces an enormous amount of free radicals12. It’s often impossible to tell the real origins of the problem.
Since burning sugar for fuel generates free radicals inside cells, most tissues in the body “switch off” their insulin receptors so they can avoid taking in too much glucose. These tissues are said to become “insulin resistant.” This leaves more glucose in the bloodstream.
The ovaries don’t have an “off switch” for insulin, since the ovaries and the brain are given priority for receiving energy. They are flooded with sugar they have to use, and they use the added energy to make both estrogen and testosterone.
The simplest way to correct PCOS is to correct insulin sensitivity. This can be done with drugs13, such as metformin (Glucophage), or it can be done with diet14. Lowering the amount of sugar in the bloodstream, even slightly, slowly reverses insulin resistance, and over a period of months, the ovaries stop making excessive amounts of testosterone. Normal periods may be restored, and acne and hair growth stop.
It doesn’t take very much dieting to reverse PCOS. Losing 2-3% of total body mass through calorie reduction more often than not is enough to restore hormonal balance. Fertility returns about the same time acne disappears. This approach only works if women eat less. Exercising more does not have the same effect on the ovaries or on the skin.
Another Way to Stop Hormone-Induced Acne
Even when women cannot get their hormones to normal levels, acne is not inevitable. Diligent daily skin care can keep the skin clear, but you need a complete treatment system, such as Exposed Skin Care.
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- Szöllősi AG, Oláh A, Bíró T, Tóth BI. Recent advances in the endocrinology of the sebaceous gland. Dermatoendocrinol. 2018;9(1):e1361576. Published 2018 Jan 23.
- Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. 2011;3(1):41–49.
- van Anders SM, Steiger J, Goldey KL. Effects of gendered behavior on testosterone in women and men. Proc Natl Acad Sci U S A. 2015;112(45):13805–13810.
- Beverly G Reed, MD and Bruce R Carr, MD. The Normal Menstrual Cycle and the Controle of Ovulation.
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- Danielle B. Cooper; Rotimi Adigun; Steve S. Bhimji. Oral Contraceptive Pills. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
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- Lynde CW, Andriessen A, Barankin B, et al. Moisturizers and Ceramide-containing Moisturizers May Offer Concomitant Therapy with Benefits. J Clin Aesthet Dermatol. 2014;7(3):18–26.
- Chuan SS, Chang RJ. Polycystic ovary syndrome and acne. Skin Therapy Lett. 2010 Nov-Dec;15(10):1-4.
- Dumitrescu R, Mehedintu C, Briceag I, Purcarea VL, Hudita D. The polycystic ovary syndrome: an update on metabolic and hormonal mechanisms. J Med Life. 2015;8(2):142–145.
- Hurrle S, Hsu WH. The etiology of oxidative stress in insulin resistance. Biomed J. 2017;40(5):257–262.
- Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med. 2014;2(6):56.
- Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril. 2006;85(3):679–688.
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