Acne is often perceived as a teenage flaw. High testosterone, pimples and mood swings at 18 are normal: your body undergoes a set of physiological changes driven by hormones known as puberty. However, half of all women in their 20s and a third of women in their 30s have acne. Even 15% of women over 50 reportedly still have acne.¹ These findings are not that surprising. We all know those persistent blemishes appear right before a date, party or business meeting, don’t they? Putting the discomfort of acne aside, skin inflammation in your adult days is a reason to examine your health in detail. 

The condition of your skin always depends on many factors, such as nutrition, gut microbiome, appropriate skincare regimen, stress level, hydration and so much more so it’s almost never impossible to pin down the particular root of the problem.  Nonetheless,  hormones play a crucial role in all of our systems so it’s definitely one of the first things you should look at on your healing journey.

A hormonal imbalance will often lead to hormonal acne. Perhaps you noticed a rogue blemish appearance just before your menstruation or after a cookie snack – both orchestrated by hormone spikes in the blood.  Acne is also one of the most common symptoms for people with chronic hormonal disorders, such as polycystic ovary syndrome (PCOS) or endometriosis.²  Each hormone imbalance and root cause will be unique to your case, but let’s dissect the main responsible players.

Androgens

Very often hormonal acne is a consequence of the increased presence of male hormones – androgens, primarily testosterone and its more aggressive form - dihydrotestosterone (DHT). Androgens stimulate the sebaceous glands in our skin to produce excess sebum.³ The level of androgens can rise due to genetic factors, excessive levels of cholesterol, gynaecological diseases or stress. However, more often than not, excessive androgens production is caused by increased blood glucose and insulin signalling, which can be resolved by the correct order of food intake and a healthy diet without refined sugar and fast carbs (learn more here on how to avoid sugar spikes). Also, women often have acne in the late luteal phase of the menstrual cycle, when the levels of sex hormones increase dramatically.⁴

Oestrogen

Oestrogens, female sex hormones, control the levels and activity of androgens in women’s bodies. When oestrogen drops too low, testosterone begins to provoke skin inflammation.⁵ Oestrogens are also responsible for the production of collagen, which maintains the thickness of the epidermis and keeps the skin smooth and hydrated.

Progesterone

Progesterone helps to balance the levels of androgens and oestrogens. It stabilizes levels of cortisol and other stress hormones and thereby calms our nervous system.⁶ Progesterone also promotes healthy sleep, which has a positive effect on the condition of the skin.⁷

Thyroid hormones

Thyroid hormones affect metabolism, skin moisture levels, menstrual cycles, weight and cholesterol levels. There is also solid scientific evidence showing the connection between acne and hypothyroidism.⁸

Cortisol

Cortisol is a stress hormone. Research shows that stress causes more sebum production for bacteria to flourish and inflammation in the body.⁹ The combination of these factors can cause hormone-related breakouts during times of stress.¹⁰

By identifying the culprit of your hormonal balance you will have more chances of healing your acne at the root, always naturally with simple lifestyle interventions. Keep in mind that the long-term result would be hardly achievable without restoring your hormonal balance and looking at your health holistically.

References:

1. Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008; 58(1):56-9.
2. Chang WY, Knochenhauer ES, Bartolucci AA, et al. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 83(6):1717-23 (2005 Jun).
3. Seirafi H, Farnaghi F, Vasheghani-Farahani A, et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007; 46(11):1188-91.
4. Geller L, Rosen J, Frankel A, Goldenberg G. Perimenstrual flare of adult acne. J Clin Aesthet Dermatol. 2014; 7(8):30-4.
5. Arora MK, Yadav A, Saini V. Role of hormones in acne vulgaris. Clin Biochem. 2011; 44 (13):1035-1040.
6. Toyoda M, Morohashi M. Pathogenesis of acne. Med Electron Microsc. 2001; 34(1):29-40.
7. Andersen ML, Bittencourt LR, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575-82.
8. Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009; 20(2):158-61.
9. Liu YZ, Wang YX, Jiang CL. Inflammation: The Common Pathway of Stress-Related Diseases. Front Hum Neurosci. 2017; 20;11:316.
10. Kligman AM. Postadolescent acne in women. Cutis. 1991; 48(1):75-7.