Hormonal imbalance and acne: Causes and treatment

Can a hormonal imbalance cause acne?

Yes. Androgens, a group of hormones that includes testosterone, stimulate oil glands. Excess sebum, the skin's natural oil, combines with dead skin cells to block pores. Bacteria and inflammation then contribute to pimples. All people make testosterone; hormonal acne is not limited to people with unusually high hormone levels.345

Breakouts can appear around periods, during pregnancy, during the transition to menopause or after starting or stopping birth control pills. Stress also stimulates hormone activity that can worsen acne. Adult acne can begin for the first time in adulthood or continue from adolescence, and women experience it more often than men.1

What does hormonal acne look like?

Hormonal acne often produces inflamed bumps or deeper, painful cysts along the chin, jawline and lower cheeks. Period related acne can also affect the neck, around the mouth, shoulders and back. Some deeper bumps never develop a visible head. A repeated flare before your period is a useful clue, but location alone cannot identify the cause.45

Note when breakouts begin, whether they follow your menstrual cycle and what seems to improve or worsen them. Also note any recent medication or contraceptive changes. These details help a clinician choose treatment. A menstrual breakout can last a few days or a few weeks; the timing is not identical every month.145

When should you ask about hormone testing?

Acne is usually diagnosed through a skin examination, without diagnostic tests. Sudden, severe adult acne is a reason to discuss an underlying condition. Irregular periods, increased facial or body hair, or scalp hair thinning alongside persistent acne also deserve assessment rather than another change of cleanser.235

Polycystic ovary syndrome, or PCOS, is associated with acne, excess hair growth and female pattern hair loss. In ovarian hormone disorders, increased androgens can stimulate more oil and slow skin turnover, making clogged pores more likely. Skin appearance cannot confirm or rule out an ovarian hormone disorder; assessment can include hormone testing or an ultrasound.26

Can skincare treat acne caused by hormones?

Yes. Topical treatments, meaning medicines applied to the skin, can help even when hormones contribute to acne. Benzoyl peroxide and salicylic acid are options for mild to moderate breakouts. Persistent acne can need prescription topicals, hormonal treatment or both; treatment depends on the type and severity of acne.24

• Benzoyl peroxide reduces bacteria involved in acne. It comes in washes and treatments left on the skin. Lower concentrations and wash formulations are less irritating.
• Salicylic acid helps clear dead skin cells that can block pores. It is available in acne cleansers and lotions.
• Retinoids are vitamin A derived medicines that clear and help prevent clogged pores. Apply them across the affected area rather than only to individual spots.
• Azelaic acid reduces microorganisms on the skin and swelling. Prescription topical antibiotics are more effective when combined with benzoyl peroxide.

How should you build the routine?

1. 1Wash with a gentle cleanser and avoid scrubbing.
2. 2Use your acne treatment as directed. For sensitive skin, a lower concentration of benzoyl peroxide is a less irritating option.
3. 3Pair acne treatment with a gentle moisturizer, because acne medicines commonly cause dryness.
4. 4Avoid picking or squeezing. Picking can increase inflammation.

A gentle cleanser and moisturizer belong alongside acne treatment, even if neither has a dramatic origin story.4

Choose products marked "noncomedogenic," "oil free" or "won't clog pores," because the useful part of the packaging is rarely the inspirational paragraph. Noncomedogenic means designed not to clog pores. Check hair products as well as cleansers, moisturizers, makeup and sunscreen; these choices are less likely to contribute to acne.15

For a tender breakout, a cold compress can reduce pain and inflammation. A warm compress can ease pressure by helping draw out pus. Hydrocolloid pimple patches absorb fluid and discourage picking, but they do not work on deep acne. They are an aid for individual pimples, not a treatment for hormone activity.45

When do hormonal medicines help?

Spironolactone can help hormonal acne when other treatments have not worked. It counters androgen activity, reducing the effect of hormones on oil production. Certain birth control pills also improve acne, whether or not an ovarian hormone disorder is present. These treatments can be combined with topical acne medicines.247

Not every contraceptive pill treats acne. Combined pills contain estrogen and a progestogen; the particular progestogen matters because some have androgen effects. Progestogen only pills are not effective treatments for androgen driven skin problems. A clinician should select the medication rather than treating all birth control pills as interchangeable.7

Combined contraceptive pills increase the risk of blood clots. A previous clot, smoking, high blood pressure, heart disease, significant liver disease or migraine can affect suitability. Discuss your medical history and other medicines before starting. Possible side effects include breast tenderness, irregular bleeding, nausea, headaches and mood changes; report bleeding between periods to your doctor.7

What if you are pregnant or trying to conceive?

Do not use spironolactone during pregnancy because it can harm a developing fetus. Birth control pills are not suitable during pregnancy or when trying to conceive. Benzoyl peroxide and salicylic acid are generally considered safe during pregnancy; discuss the specific product and treatment plan with your clinician.27

How long does treatment take, and when should you get help?

Retinoids often need several months before improvement becomes noticeable, and birth control pills take a few months to improve acne. Hormonal treatment can continue improving skin over longer use, but acne can return within months of stopping contraceptive treatment. If treatment is not helping after a few months, ask about a dermatology referral.357

Seek help earlier for deep, painful cysts or nodules because they can cause permanent scars. Severe or resistant acne can need antibiotics, hormonal treatment or isotretinoin. If a prescribed medicine seems to trigger breakouts, continue taking it and contact the prescriber about alternatives rather than stopping it yourself.14