We've all experienced hormonal acne at some point, but do you understand what actually causes it? Read on to learn more, plus breakout tips.
Read on if you’re interested in learning:
Our hormones all have very specific roles during these phases, and understanding what our bodies are doing throughout the month can make it easier to understand why hormonal acne even happens in the first place.
The first phase of our cycle is called the follicular phase and lasts for about 7-10 days. During this time, estrogen levels are increasing, in order to prepare the uterine lining for implantation.
When it comes to our skin, this is likely the part of the month with the least amount of breakouts because of this steady increase in estrogen. Estrogen positively impacts the skin by improving skin elasticity, skin hydration and supporting a healthy skin barrier - all factors that contribute to healthy, blemish-free skin.
Next, ovulation occurs. This period lasts roughly 3-5 days. This phase is marked by a rise in FSH, followed by a rise in LH, stimulating the follicle to release an egg.
While estrogen is still increasing at this time, testosterone is also starting to increase. This means increased sebum production in our pores, increasing a potential for breakouts to occur.
The third phase is the luteal phase, and this is the phase where many women start to experience hormonal-related acne breakouts. During this phase, which lasts 10-14 days, estrogen, progesterone and testosterone all continue to rise but will drop off drastically nearing the end of the phase if no fertilization of the egg has occurred.
When estrogen levels drop, we can experience a loss in skin hydration leading to a compromised skin barrier, as well as shifting the relative balance with progesterone and testosterone. This means that there is an increased likelihood of sebum production and water retention leading to compression of the pore, trapping oil and dead skin cells, to occur.
Our cycle’s final phase is the menstrual phase, lasting 3-7 days. This is the time when reproductive hormones are at their lowest concentrations.
During the menstrual phase, you are more likely to experience skin dryness and dullness.
Hormonal acne more has to do with the relativity of estrogen to progesterone and testosterone than it does with high or low levels of hormones. This is exactly why it’s unlikely to find high or low levels of reproductive hormones on blood work results in acne clients, unless pre-existing conditions like polycystic ovarian syndrome (PCOS) are present.
For example, when estrogen levels are lower during certain phases of our cycle, this increases the likelihood of testosterone’s less than desirable effects on our skin to become more apparent. And depending on the activity of an enzyme in our bodies called 5-alpha-reductase, those androgenic effects can be even more pronounced.
If this particular enzyme is operating on overdrive, testosterone becomes metabolized into its more potent metabolite, dihydrotestosterone (DHT). This means an increased chance for hormonal breakouts flaring up even with a small relative dip in estrogen.
On the flip side, if progesterone levels are lower in our bodies, this will also increase the conversion of testosterone into its more potent form, DHT. This is where concerns such as higher estrogen levels relative to progesterone, or estrogen dominance, can be a factor.
This in mind, estrogen dominance is more of a concern when we look at our body’s detoxification and elimination pathways. Unfavorable metabolism of estrogen and higher levels of circulating free estrogens in our bodies can negatively contribute to pro-inflammatory metabolic changes and potential concerns with our body's natural elimination pathways, contributing to acne flare-ups as well.
This is where the health of our liver, gut and gut microbiome come into play for the health of our skin. Estrogen metabolism is influenced by conversion pathways and enzymes in our liver and gut lining, as well as by certain types of gut flora. This is called the “estrobolome” and is responsible for optimal estrogen elimination from the body. While estrogen can be great for skin health in moderation, too much of a good thing can lead to long-term health consequences.
Two overlooked factors include insulin and cortisol regulation. Both of these hormones can impact the health and regulation of estrogen, testosterone and progesterone.
Insulin is a hormone that helps our bodies regulate and utilize glucose for energy production. It also happens to be capable of stimulating testosterone production, while at the same time inhibiting sex hormone binding globulin (SHBG), an important glycoprotein that binds estrogens and androgens in our bodies that controls the amount of free circulating levels of these hormones. When insulin is high or not being properly regulated, it will tell our ovaries to produce more testosterone, leading to an increased likelihood of hormonal-related acne flares.
Cortisol is produced by the adrenal glands and is our body’s primary stress hormone. Cortisol is necessary in our bodies but too much or too little of this hormone can also negatively impact insulin levels, testosterone levels and testosterone metabolism, thus leading to breakouts.
While all of these products and suggestions can help, it’s important to consult with a functional medicine professional who can help you figure out the right dose and exact products you may need to help your particular case.
If you have been struggling with hormonal acne for a long time, it’s in your best interest to work with a professional who can help identify and address the root cause of the acne in order to formulate a custom plan catered specifically to you and your unique needs. This may include testing as well as targeted nutritional, lifestyle and supplement recommendations.
*Note: This information is educational and not medical advice; be sure to consult with a qualified practitioner before making changes to your lifestyle, diet, or supplements.