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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 back.
It’s embarrassing, it’s painful, and long after the bumps are gone, the scars stick around.
Hormonal acne is different from the breakouts you had as a teenager or when you don’t wash your face before bed. First, treating hormonal acne is really hard to do with conventional topical skincare treatment. Hormonal acne is more complicated than a special cream (often filled with harmful ingredients, none the less).
And then, when a blemish finally “goes away” it doesn’t feel like it’s truly gone—it just recedes a bit. You know it will be back (probably just in time for your next big event).
While most people only deal with acne on their face, hormonal acne often spreads to the shoulders, back, and butt. This makes most people painfully aware of its presence, especially when it’s summer and you’re excited to wear that cute sundress or tank top.
That’s the reality of hormonal acne, and having many clients deal with it personally, I can tell you: it really sucks.
Hormonal Acne Isn’t Normal
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 painful, chronic cystic acne as an adult is a result of hormonal imbalances, and it’s not normal or something you should have to live with.
But there’s one big problem: the #1 prescribed solution for hormonal acne doesn’t actually solve the problem.
That’s right, treating hormonal acne with the birth control pill doesn’t actually solve the problem. 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.
Part 1: Why There is No “Best Birth Control” For Hormonal Acne
When I was researching for this blog post, I found that LOTS of women were searching the phrase “the best birth control for hormonal acne.”
I don’t blame women for thinking hormonal birth control is the solution. Most women know a “beneficial side effect” of hormonal birth control is a reduction in acne. And if you go to your doctor complaining of hormonal acne, they’ll likely prescribe you the Pill and send you on your way.
But, have you ever heard about birth control making acne WORSE?
Here’s the funny thing about the Pill: for some women it clears acne up, and for others, it makes acne worse. In both cases, the root cause of hormonal acne still isn’t being addressed, and long-term it makes matters worse.
Hormonal Acne = Hormone Imbalance
Hormonal acne is different than other kinds of acne in that it’s always caused by a hormone imbalance.
Different hormone imbalances can cause acne. It can be the result of too much or too little of any of your main sex hormones (estrogen, progesterone, and testosterone), but other hormones like DHEA and cortisol can play into it too.
And that’s why the Pill doesn’t always work for hormonal acne.
At best, the Pill can put a band-aid over imbalances, and mask the symptoms temporarily (they will come back when you stop the Pill). Depending on what kind of hormone imbalance you’re dealing with, the Pill can sometimes intensify your hormone imbalance symptoms and even make acne worse.
That’s why if you’re struggling with hormonal acne, I don’t recommend turning to the birth control pill. (If you want help transitioning off the Pill, make sure to read How to Stop Taking Birth Control (Without Side Effects) for more information).
Instead, I suggest you find the root cause of your hormonal acne and treat that.
Part 2: The Root Causes of Hormonal Acne
As the name implies, hormonal acne is caused by hormones, specifically imbalances in the levels of hormones circulating in your body.
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.
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.
Root Cause of Hormonal Acne #1: Gut Issues
The gut is the center of EVERYTHING in our bodies. Gut issues (such as IBS, SIBO, leaky gut, and gut dysbiosis) don’t only cause hormone imbalances, but they are also a sign that something is off with your hormones.
The digestive system and endocrine system (which creates and manages hormones) are so closely intertwined it can be hard to see where one ends and the other begins.
Your gut helps create and detox hormones out of the body, so problems with gut function can lead to hormonal issues. Both too little hormones (because the gut stops producing hormones) and too many hormones (because the gut isn’t getting rid of old hormones) can be the result.
Hormones also control some of the functions of the gut (like peristalsis—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.
The bottom line is if you’re having digestive issues or hormonal issues, you must consider taking action on improving the health of your gut.
Root Cause of Hormonal Acne #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 (among others). 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 PCOS—Polycystic Ovarian Syndrome (more on that to come)—but there are other causes, including medications, genetic conditions, and tumors on the ovaries or adrenal glands.
Those causes of excess androgens are rare, but more common causes of excess androgens include excessive high-intensity exercise (note: this is relative and different for everyone!), prolonged stress, and undereating. 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.
Even in women without PCOS, excess androgens can be the root cause behind hormonal acne. Left untreated, excess androgens can cause long-term problems like infertility, heart disease, and diabetes. Excess androgens can also cause insulin resistance.
Root Cause of Hormonal Acne #3: PCOS
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 (though you only need 2 to be diagnosed officially):
- Confirmed androgen excess on labs or androgen excess symptoms (which is what causes acne and other PCOS symptoms like insulin resistance)
- Ovulatory dysfunction (you’re not ovulating every menstrual cycle)
- Multiple cysts on ovaries (diagnosed with an ultrasound)
PCOS, like other “syndromes” such as IBS, isn’t a disease, it’s a collection of related symptoms without a clear cause or “cure”. Many practitioners now understand that there are likely multiple causes or types of PCOS, including insulin resistance leading to ovarian overproduction of testosterone; and stress, overexercising, and undereating leading to adrenal-driven androgen excess.
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.
Researchers have found that women who had some symptoms of PCOS but weren’t at a diagnosable level had less gut diversity than healthy women, but more microbiome diversity than those who met all the criteria for PCOS. This suggests that PCOS is the end result of hormone and gut issues left untreated too long.
Part 3: How To Treat Hormonal Acne Naturally
Hormonal acne is caused by a combination of gut and hormone imbalances, which can escalate into PCOS for some women.
Knowing that, it doesn’t make much sense to treat hormonal acne with hormonal birth control pills. The Pill covers up hormone issues and can make gut issues worse. (Some practitioners now think the Pill is equally harmful to your gut microbiome as antibiotics.)
So what can you do instead?
#1 Take Care of Your Gut
No, it’s not sexy or exciting, but taking good care of your gut health is almost always the first step toward healing.
First, it’s important to remove foods that are irritating your gut or triggering inflammation. Common culprits include gluten, dairy, vegetable oils, and refined sugar (see my book, Coconuts and Kettlebells, for more information about how to do an easy elimination protocol to see which foods are the culprit).
Second, regularly consume foods rich in nutrients that can heal the gut. Foods that are rich in omega-3s and fat-soluble vitamins like vitamin D, such as salmon, sardines, 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.
Drinking bone broth, which is rich in collagen and glutamine, can also help to restore gut integrity.
Third, it’s important to eat probiotic rich foods regularly, and add in a high-quality probiotic supplement that will support your microbiome (this is the one I recommend). For a more in-depth look at healing the gut, check out 3 Simple Gut Healing Strategies That Will Revolutionize Your Health.
#2 Ditch the Dairy
If you have hormonal acne (and especially if you have PCOS) you will definitely want to consider eliminating 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.
Eliminating a food doesn’t have to be scary. You can treat it like a science experiment. I recommend using the 4 x 4 plan in my book, Coconuts and Kettlebells, to test dairy and determine if it’s a trigger for your hormonal acne. You’ll want to eliminate dairy for at least four weeks, and bring it back in different forms to see how your skin responds.
#3 Eliminate Sources of Chronic Stress and Reduce Cortisol Output
Hormone imbalances are strongly connected to stress. Chronic cortisol, a stress hormone produced by the adrenals, can disrupt the entire endocrine system.
Common sources of chronic cortisol output include lack of sleep, over-exercising and undereating, constant anxiety and worry, unresolved trauma or mental and emotional stress, and even chronic inflammation from a poor diet.
For hormones to be in balance—and hormonal acne to go away—you must prioritize eliminating sources of chronic stress in your life (like overexercising), improving mental and emotional health (with solutions like therapy or meditation), and getting at least 7 hours of sleep each night. Get to bed before 11pm to make sure your cortisol rhythms are properly balanced.
#4 Avoid Acne Aggravators and Use Safe Topical Treatments
Hormonal acne is an internal problem, but external factors can absolutely make it better or worse.
One of the biggest aggravators for acne is UV radiation from the sun. If you’re dealing with acne, you need protect your skin from the sun. However, it’s important to never use chemical sunscreens on your skin. Not only can they aggravate the skin (making your acne look worse) but oxybenzone is a known hormone disruptor.
The Best Topical Treatment for Hormonal Acne
Topical treatments can be a part of the solution to help manage hormonal acne, reduce redness and inflammation, and prevent scarring. What you don’t want? 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:
1. Cleanse: Use a gentle pore cleanser that removes oil and impurities
4. For scarring, experiment with a safe Overnight Resurfacing Peel. This MUST be spot tested first to ensure it works with your skin.
5. 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.
#5 Work With A Pro
While these recommendations are a killer place to start (and for some women it might be all that’s needed to 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.
Want more resources? Check out the following Well-Fed Women Podcast episodes related to hormones:
Get Rid Of Hormonal Acne For Good
Hormonal acne is tough to deal with, and I know we all wish there was a quick and simple solution.
As obnoxious as it is, it’s also your body’s way of telling you “something is not working!” Your body is communicating with you the best way it can. Don’t tune it out.