Last Updated on January 6th, 2020
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.
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When women have mild to moderate acne that comes and goes in sync with their menstrual cycles, bumps usually break out just after ovulation 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 glands 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 testosterone. 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 testosterone and have much lower skin oil production and hair formation than most men.
Estrogen levels start to climb at the beginning of the menstrual cycle. 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 ovulation. 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 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 compound 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:
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.
The worst cases of acne in women of all ages, however, are usually associated with a condition known as polycystic ovarian syndrome, 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 testosterone, 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 radicals. 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 drugs, such as metformin (Glucophage), or it can be done with diet. 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.
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.