Why does our menstrual cycle cause acne?

Acne is a common skin condition that affects many individuals, particularly during adolescence. However, for some people, acne can persist into adulthood, and for women, it may be closely linked to their menstrual cycle. But why does our menstrual cycle cause acne?

Understanding the Menstrual Cycle

The menstrual cycle is a complex process that involves hormonal fluctuations throughout the month. 

1. Menstruation (Days 1-5):
• Bleeding phase.
• Estrogen and progesterone levels are low.
2. Follicular Phase (Days 1-13):
• Follicle-stimulating hormone (FSH) rises, stimulating the development of follicles in the ovaries.
• Estrogen levels rise, leading to the thickening of the uterine lining.
3. Ovulation (Day 14):
• Luteinizing hormone (LH) surge triggers the release of an egg from the ovary.
• Estrogen peaks just before ovulation.
4. Luteal Phase (Days 15-28):
• The ruptured follicle transforms into the corpus luteum, which produces progesterone.
• Progesterone levels rise, preparing the uterine lining for possible pregnancy.
• If pregnancy doesn't occur, estrogen and progesterone levels drop, leading to menstruation and the start of a new cycle.

When is acne mostly likely to occur in our cycle?

During the Luteal phase in the days leading up to menstruation, there is a drop in oestrogen and progesterone levels which persist into the Follicular phase when we are menstruating. During this time our levels of Androgens or Testosterone are HIGH in relation to our Oestrogen.

Higher levels of Androgens or Testosterone can lead to increased inflammation, sebum (oil) production, formation of skin cells and reduce skin exfoliation which can clog pores and contribute to acne development. 

Can acne occur at other phases of our cycle?

Acne CAN occur during all phases of our menstrual cycle if our hormones are not balanced. Too much or too little oestrogen and progesterone can lead to acne, as well as high levels of androgens in relation to oestrogen and progesterone (increasing oil flow).

• We commonly see women experience an increase in acne around ovulation, a key phase responsible for balance between oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
• During optimal ovulation, successful development and release of eggs (corpus lutuem) from the ovaries will result in a progesterone spike. When suboptimal ovulation occurs, we may not see this progesterone spike which can cause acne and other menstrual issues.

• We optimise ovulation by reducing inflammation in the body; reducing stress levels, eating an anti-inflammatory diet, increasing omega-3 fatty acids, regular low-intensity exercise, adequate sleep, limiting alcohol consumption and smoking or vaping. 

• The effect of stress on our hormones and skin can be a never-ending cycle because our endocrine (hormone) system is heavily intertwined. Hormonal fluctuations during our menstrual cycle can affect the body's stress response, increasing states of stress. While external stress triggers can increase cortisol levels and cause other hormonal balances.
• Oestrogen can have a mood enhancing effect and the ability to buffer stress sensitivity. This means during phases of low Oestrogen we may experience an increase in mood swings and states of stress.
• External and chronic stress factors (including family, work, financial, relationship, traffic, worrying about our acne! etc) will induce feelings of overwhelm and anxiety that will increase cortisol levels that can dysregulate other hormones causing acne during all phases of our cycle.

• High cortisol can lead to reduced oestrogen detoxification, which can will cause a pro-inflammatory environment.
• Cortisol spikes trigger hormonal processes that increase androgen levels (and as we already know, high androgens = acne).
• Cortisol spikes increase insulin levels, which can cause a spike in insulin-like growth factor (IGF-1) and androgens.
• High levels of cortisol blocks progesterone production. Low progesterone can increase Dihydrotestosterone (DHT), a derivative of testosterone (androgen).
• When we have high cortisol, the body produces DHEAs to protect the brain. This is an androgen that converts to DHT.

High Insulin levels can cause acne

• We know that cortisol causes an increase in insulin, IGF-1 and androgens that can exacerbate acne, but what else increases insulin levels?
• High Glycemix Index (GI) foods cause a blood sugar spike. When our blood sugar is high, Insulin increases. This means we can experience acne during all phases of our cycle if we are eating foods that cause a blood sugar spike. To avoid this, make sure you are eating a low GI or blood sugar balancing diet.

PCOS

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. One of the frustrating symptoms that many women with PCOS experience is acne. PCOS can contribute to acne in all phases of our menstrual cycle due to various hormonal imbalances and physiological changes. 

1. Increased Androgens (Testosterone):

   • PCOS is often associated with elevated levels of androgens, including testosterone.
   • Higher levels of testosterone can lead to increased sebum (oil) production in the skin, which can clog pores and contribute to acne development.
     
     

2. Hormonal Imbalance:

   • PCOS disrupts the balance of hormones involved in regulating the menstrual cycle, including estrogen, progesterone, and luteinizing hormone (LH).
   • Imbalances in these hormones can lead to increased androgen production, which can trigger acne.
     
     

3. Insulin Resistance:

   • Many women with PCOS also have insulin resistance, a condition in which the body's cells become less responsive to insulin, leading to high levels of insulin in the blood.
   • Insulin resistance can stimulate the production of androgens, exacerbating acne.
     
     

4. Inflammation:

   • PCOS is associated with chronic low-grade inflammation, which can contribute to acne development.
   • Inflammatory processes in the body can worsen acne lesions and increase the likelihood of scarring.
     
     

5. Follicular Hyperkeratinisation:

   • PCOS may lead to alterations in skin cell turnover, resulting in the accumulation of dead skin cells within hair follicles.
   • This process, known as follicular hyperkeratinization, can contribute to the formation of comedones (blackheads and whiteheads) and acne lesions.

Managing Acne During the Menstrual Cycle

While hormonal acne related to the menstrual cycle can be challenging to manage, there are steps that you can take to balance your hormones and minimise the negative effects of hormonal fluctuations on our skin. Reduce inflammation, having regular and quality sleep, managing and reducing stress, eating am anti-inflammatory diet AND a low GI or blood sugar balancing diet, increasing omega-3 fatty acids, regular low-intensity exercise, limiting alcohol consumption and smoking or vaping. 

Skincare and treatments
Although the cause of hormonal fluctuations must be addressed to improve and prevent hormonal acne, we can make improvements with skin care and treatments.

• Maintain a consistent skin care regime during all phases of your cycle to maintain hydration, barrier strength and encourage an anti-inflammatory environment.
• Increase the use of retinol, AHAs and BHAs (as directed by your skin professional) approximately 5-7 days before your period, during the luteal phase to minimise the effect of a hormone dip on the skin. This also applies to other phases of the cycle where you regularly experience acne - during ovulation.
• Plan your in-clinic treatments to coincide with the days BEFORE you typically breakout to normalise oil flow, cell exfoliation and reduce inflammation to prevent blockages and breakouts.

Struggling with hormonal acne? At Silk Space Clinic we are acne specialists who take pride in supporting our clients with personalised and detailed treatment plans to improve acne. Simply book in an Acne Consultation and Treatment Plan service with one of our skin therapists.

We highly reccomend following Dr. Stacey Shillington on Instagram @naturopathicbeauty for more help on treating hormonal acne.