What causes hormonal acne?

Why do breakouts start or return?

• Puberty increases androgen activity, making oil glands larger and increasing the oil they produce.
• Periods can bring recurring breakouts as hormone activity changes during the menstrual cycle.
• Pregnancy causes hormone fluctuations. Acne can improve as pregnancy progresses or continue after birth.
• Menopause lowers estrogen and increases androgens, stimulating oil production.
• Stopping birth control containing estrogen can bring breakouts as hormones readjust.
• Testosterone treatment and anabolic steroids can increase oil production and cause or worsen acne.

Stress can worsen existing acne, but it is not a cause on its own. Too little sleep and oily makeup, skincare or hair products can also aggravate breakouts. A family history of severe acne increases your risk. These factors can overlap with hormone changes rather than pointing to one single cause.1

What hormonal imbalance causes acne?

Polyendocrine metabolic ovarian syndrome, or PMOS, can raise testosterone and another androgen called DHEA. These hormones increase oil production and slow skin cell turnover, making pores more likely to clog. Acne alongside irregular periods, excess facial or body hair, or thinning scalp hair is a reason to discuss a possible hormonal condition with a clinician.45

Adult hormonal acne often appears on the chin and jawline, but it can also affect the rest of the face, chest, shoulders and back. Location alone cannot diagnose PMOS. Some people with PMOS have mild acne or none, and diagnosis can require hormone tests or an ultrasound. Sudden, severe adult breakouts also warrant assessment for an underlying condition.245

Certain medicines can cause acne or eruptions that resemble it, including corticosteroids, some epilepsy medicines and lithium. Some contraceptives can worsen acne, while others help treat it. Tell your clinician about medicines and contraception you have recently started or stopped so treatment addresses the right trigger.46

What can you do about hormonal acne?

Wash twice daily, remove makeup at night and choose products labelled noncomedogenic, meaning they are designed not to clog pores. Avoid scrubbing or squeezing spots, which can worsen irritation or cause scars.3

Acne treatments come as washes, gels and creams, so the bathroom does not need one of every format. Salicylic acid helps open clogged pores, while benzoyl peroxide reduces acne causing bacteria. These can help mild to moderate acne even when hormones contribute. A pharmacist can help you choose a suitable treatment.57

Persistent hormonal acne can need prescription treatment, including certain birth control pills or spironolactone. Pregnancy plans change the options: spironolactone can harm a developing fetus and should not be used during pregnancy. Discuss pregnancy or plans to conceive before choosing hormonal treatment.45

Expect at least 6 to 8 weeks before treatment starts producing fewer breakouts. Follow the treatment directions rather than applying extra medication to speed things up. If a prescribed treatment causes irritation, contact your dermatologist about adjusting it.7

What does acne cause?

Acne can cause pain, lasting scars and changes in skin colour or texture. It can also affect mental health, including anxiety, depression and low self esteem. Seek medical help for deep painful spots, scarring, acne that is not improving with treatment, or breakouts affecting your mental health. Hot, swollen skin with redness also needs assessment for possible infection.3