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Helping People Achieve Clear Skin Since 2007

Everything You Need to Know About The Connection Between Estrogen and Acne

By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist

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.

Too much estrogen can be as harmful for skin as too little.


  • 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 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 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 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:

  • 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 moisturized 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 help.

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, and they don’t 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 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.

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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Kathleen Reply

Acne and PCOS are also affected by fat metabolism. If you cannot digest fats well, then you cannot break down the Estrogen, which is also a fat, so that it can be eliminated properly through the digestive tract. When you cannot digest fat, it's because you do not have proper bile flow from the gallbladder which is required for breaking down those fats like estrogen. When it can't break down those fats, it comes out the skin as acne. It will get rid of it one way or another. So taking bile salts, or foods like radishes that stimulate bile flow, you have better chances of minimizing acne than just by minimizing Estrogen. Kind of cool.

August 16, 2014 at 7:22 pm Reply
Elena Reply

HI! Reading your comment I thought that this is exactly what happened to me. I'm not getting rid of estrogens properly and that's why I have water retention, acne ... I've tried B6 in Pyridoxal form and started to pee like crazy and my skin was great but my hair started to fall a lot. So, there is a connection beetwen getting rid of estrogen and hair loss??? I can not find a solution for both skin and hair. When my skin is better the hair is falling out ...

September 18, 2014 at 4:41 pm Reply
Elena Reply

I discovered blackstrap molasses last month and started to take it. Second week my skin was perfect, I was shocked and happy but my hair started to falling out. I searched in google and found some people reporting the same. Molasses is rich in B6 and I was peeing too like crazy. So, question is, maybe hair loss is only initially and will stop?? I was scared and stopped, but would like to know ...

September 18, 2014 at 4:48 pm Reply
hope Reply

HI i'm 18 and I am currently breaking out like crazy during ovulation and a week before my period comes. Will taking 50 mg of vitamin b6 stop my acne?

October 21, 2014 at 1:14 am Reply
Rebecca Byrnes Reply

I currently breakout Alot I've lost weight and I don't get my periods anymore so I was wondering if it has something to do with weight loss and not getting them anymore

May 30, 2015 at 10:44 am Reply
Arlene Reply

I'm very interested in what works. I'm 57, still getting a cycle, and cystic acne. It's bad at my age, and very sore. I like the idea of cutting down on the sugar. Sometimes I make the mistake and dont start back on my birth control right after my menstrual. Then I get more acne, because nothing is on board to level me out.

June 13, 2019 at 5:41 pm Reply