Acne in adulthood doesn’t have to be your normal. Here’s how to figure out the root cause of your hormonal acne, and treat it naturally.
The big red bumps start on your jawline. They spread all around your mouth and on the lower half of your face. Then they start appearing on your forehead, cheeks, and sometimes your back.
It’s embarrassing, it’s painful, and long after the bumps are gone, the scars and redness stick around for what seems like forever.
Research shows adult acne has a different root cause from teenage breakouts. Adult onset acne is often caused by both genetic and hormonal issues, and can persist for decades. While it actually affects both men and women, the American Academy of Dermatology has found women deal with it more often than men because of hormonal shifts that occur during the menstrual cycle, pregnancy, and menopause. For women, acne often flares a week before menstruation.
So, how can you stop hormonal acne? The first step is to balance hormones by taking care of your gut and liver, reducing stress, and avoiding topical triggers. A few simple shifts in how you eat, move, and take care of your skin can make a big difference.
Everyone has occasional acne and blemishes. Breaking out when you’re going through stress—or even a few zits around your menstrual cycle—can all be 100% normal. But, hormonal acne is different. Here are a few symptoms:
- Acne around the chin and jawline
- Painful, chronic cystic acne that can’t be extracted or “popped”
- Acne that spreads to the neck, shoulders, and back
- Zits and pimples that flare in the week leading up to your menstrual cycle
Birth Control For Hormonal Acne
Most conventional doctors recommend treating adult onset acne with hormone based therapies like the birth control pill. This is because the birth control pill works by shutting down ovulation, which suppresses your body’s own production of estrogen and progesterone through a negative feedback loop.
But, what most people don’t tell you? Treating hormonal acne with the birth control pill doesn’t actually solve the problem. The root cause of your hormonal acne will still be there when you come off the pill because it is simply replacing your body’s own hormone production with synthetic hormones.
There is a root cause of hormonal acne, and you can treat hormonal acne naturally. Once you know what is REALLY behind your hormonal acne, you can take steps toward healing it.
Hormonal acne is different from other kinds of acne because it’s tied to hormone imbalances. It can be the result of too much or too little of any of your main sex hormones, specifically estrogen, progesterone, and testosterone. It can also be tied to stress hormones, including DHEA and cortisol.
It’s normal for hormone levels to rise and fall throughout the day and month. For instance, cortisol should be highest in the morning and drop throughout the day. Levels of estrogen and progesterone rise and fall with the menstrual cycle.
When the normal ebbs and flows of hormone levels get disrupted, it can lead to acne, among other issues. This is why finding the root cause of your hormonal acne must involve working on balancing hormones naturally.
5 Root Causes of Hormonal Acne
Since it’s pretty obvious that hormones are what cause hormonal acne, the solution is finding what’s messing with your hormones and which are imbalanced.
1. Gut Imbalances
Your digestive system and endocrine system, which creates and manages hormones, are closely intertwined.
Your gut is home to trillions of bacteria. These microbes not only play an important role in breaking down food, they also impact the detoxification of hormones, specifically estrogens. When you have an overgrowth of too many bad bacteria, research suggests less estrogen is eliminated from the body, and instead is recirculated. These recirculating estrogens can bind to estrogen receptors can can cause high estrogen. For this reason, a healthy gut and diverse microbiome are essential when it comes to balancing hormones.
Hormones also control some of the functions of the gut, specifically the constriction and relaxation of the gut that carries food through the digestive system. That’s why some women experience diarrhea and constipation around their menstrual cycle.
Healthy gut bacteria also enhance GABA activity, which can help to balance mood and stress. GABA is a naturally occurring amino acid that works as a neurotransmitter in your brain and supports progesterone production.
2. Excess Androgens
Any kind of hormone imbalance can potentially cause hormonal acne to flare up, but by far the most common imbalance that causes hormonal acne is excess androgens. In fact, excess androgens are the most common hormonal dysfunction in women of reproductive age.
Androgens are hormones that produce “male traits” and include testosterone and DHEA. Healthy women should have androgens in their body, but excess levels cause a lot of problems such as acne, unwanted hair growth, and thinning hair on the head.
Excess androgens are almost always present in Polycystic Ovarian Syndrome (PCOS), but there are other causes, including excessive high-intensity exercise, prolonged stress, undereating, and estrogen dominance.
Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that occurs in women. Most people assume the tell-tale sign of PCOS is cysts on the ovaries, but there are actually 3 criteria for diagnosis:
- Confirmed androgen excess on labs or androgen excess symptoms, which is what causes acne and other PCOS symptoms like insulin resistance.
- Ovulatory dysfunction
- Multiple cysts on ovaries
There’s also a strong link between the gut and PCOS. Women with PCOS have less diversity in their microbiome than women without the condition.
4. Elevated Cortisol
When you are chronically stressed, cortisol remains elevated. Chronic cortisol production can have a profound effect on your entire physiology, including your endocrine system. Stress elevates your heart rate, blood sugar, and suppresses both immune and sex hormone production. Overtime, this can lead to hormone imbalances.
Studies show chronic stress is positively correlated with acne because it can increase oil production. Stress disrupts the hypothalamic-pituitary-adrenal (HPA) axis, causing it to produce higher quantities of the androgens DHEA and DHEA-S, which are then converted to testosterone. This can cause unwanted acne, specifically hormonal acne around the chin and jawline.
Common sources of chronic cortisol output include lack of sleep, over-exercising and undereating, anxiety and worry, gut infections, unresolved trauma, mental and emotional stress, and even chronic inflammation from a poor diet.
5. Food Sensitivities
A food sensitivity occurs when someone has difficulty digesting or processing a specific type of food. Most of the time, reactions are delayed and can include anything from digestive issues to breakouts.
One of the most common foods that can trigger acne is dairy. Dairy is rich in hormones, and one of them—called insulin-like growth factor-1 (IGF-1)—can be particularly problematic for people with acne. IGF-1 mimics insulin and increases oil production and inflammation in the skin.
Research also suggests increased consumption of processed sugar like soda is positively associated with acne.
How to Treat It Naturally
Hormonal acne can have many root causes. But, there are many things you can do from a functional perspective to help your body balance hormones naturally.
- Eat probiotic foods: Probiotic foods are rich in beneficial gut microbes that can help balance gut bacteria. Regularly incorporate fermented foods such as yogurt, kombucha, sauerkraut, and kimchi.
- Eat gut healing foods: Foods that are rich in omega-3s and fat-soluble vitamins, such as cold water fish, grass fed meats, and pasture-raised eggs, all play an important role in supporting proper gut function since Omega-3s help to reduce inflammation, and low Vitamin D has been associated with decreased immune function.
- Remove potentially problematic foods: It’s important to remove foods that are irritating your gut or triggering inflammation. Common culprits include gluten, dairy, and refined sugar.
- Get serious about reducing stress: For hormones to be in balance, you must prioritize eliminating sources of chronic stress in your life, improving mental and emotional health, and getting 7-9 hours of sleep each night.
- Support your liver: Your liver is responsible for metabolizing hormones. If your liver is “sluggish”, it can lead to hormone imbalances. Support liver detoxification by eating cruciferous vegetables like leafy greens daily, sulfur-rich foods like eggs and onions, and limit or avoid alcohol.
- Avoid topical triggers: One of the biggest aggravators for acne is UV radiation from the sun. Make sure to use a mineral based sunscreen, and avoid oxybenzone as it’s a known endocrine disruptor.
- Reduce endocrine disruptors: An endocrine disruptor is a chemical or substance that can alter hormone function. They are found in cosmetics, cleaners, pesticides, plastics, and even food. Make swaps to safer skin care and cleaning products, and do not cook with or store food in plastic.
Topical treatments can be a part of the solution to help manage hormonal acne, reduce redness and inflammation, and prevent scarring. Avoid treatments that are harsh and contain unsafe ingredients that strip the skin of both bad and good bacteria. Avoid all acne products that contain known hormone disruptors, harsh surfactants, benzoyl peroxide, and silicones.
As tempting as it is to try and get rid of excess oil with harsh cleansers, it’s actually better to use products that help to maintain the skin’s moisturize so it doesn’t overproduce oil to compensate for the dryness.
I recommend all people with hormonal acne utilize plant-based salicylic acid topically, as it is a safer hormonal acne treatment that has been shown to help exfoliate dead skin cells and restore the imbalance of bacteria to a healthy level.
Here is the basic topical treatment plan I recommend for people struggling with hormonal acne:
- Cleanse: Use a gentle pore cleanser that removes oil and impurities
- Treat: Use an All-Over Acne Treatment and/or Spot Treatment that contains plant-based salicylic acid when breakouts occur
- Moisturize: Use an Oil-Free Moisturizer that can help to balance skin and maintain moisture.
- For scarring: Experiment with a safe Overnight Resurfacing Peel. This MUST be spot tested first to ensure it works with your skin.
- For body acne: Use a Charcoal Cleansing Bar in the shower on your back, arms, and shoulders to help absorb oil and impurities, and balance the skin.
All of these suggestions must be done in tandem with the recommended changes above to be effective long-term.
Finding a Functional Doctor
While these recommendations might help you treat hormonal acne naturally, I recommend finding a Functional Medicine Practitioner who can order the right tests and come up with a personalized plan for balancing your hormones.
Functional Medicine Practitioners approach health from a holistic perspective, and can help you uncover what’s triggering inflammation in your gut or look at sex and adrenal hormones with comprehensive tests.
Remember, hormonal acne isn’t just a cosmetic issue, it’s a sign of an underlying imbalance that could lead to serious issues down the road. You are worthy of having your concerns listened to and recognized.
Related Podcast Episodes
#213: The Pill, Irregular Periods, & Post-Birth Control Syndrome with Dr. Jolene Brighten
#217: Finding and Treating the Root Cause of Thyroid Diseases with Dr. Becky Campbell
#221: Healing Hormonal Issues with Dr. Brooke Kalanick, ND, MS
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