Why Do Women Get Acne Around Their Period?

Monthly flare-ups of acne where standard therapeutic options fail to work, can be frustrating for women living it. The thing is, acne is a common skin condition that is best treated from the inside out. Keeping your hormones in check is actually more important than having your skin care regime perfected.


How do hormones cause acne?

The Estrogen-Progesterone Connection

Women’s hormones work best when they are in balance with one another, specifically estrogen and progesterone. If estrogen is not metabolized adequately by the liver, it re-circulates in the body creating an excess and can lead to acne. Too much estrogen alone, however, is not solely responsible for hormonal acne. Rather, low progesterone in relation to estrogen is a reason that women experience hormonal acne in their lifetime. This is because progesterone regulates the amount of testosterone converted to the more potent hormone, dihydrotestosterone (DHT). More specifically progesterone lowers the activity of 5-alpha reductase, the enzyme responsible for converting testosterone to DHT.



It is well established that sebaceous glands, which are responsible for producing oil, are triggered by testosterone. Therefore, higher levels of androgens in the body lead to increased sebum production causing oily skin and breakouts. This is the reason why many women go on the oral contraceptive pill (OCP), because it reduces the number of circulating androgens in the body.


What tests can women do to assess their hormone levels?

Women are encouraged to assess their hormone levels if they have symptoms of acne that have not been managed by medical interventions. Saliva or dried urine hormone testing can assess the top hormones that play a role in hormonal acne: estrogen, progesterone, testosterone, DHEA, and cortisol.

A dried urine hormone test (DUTCH) is simple, accurate and easily obtained. It is best to collect urine samples 7-9 days before the start of your menstrual cycle (this day will shift depending on the length of your cycle). You will collect 4-5 urine samples across 2 days (at specified times), which allows for a better representation of your hormone levels.


What can women do to cure their hormonal acne?

(1) Reduce bad estrogens: Cruciferous vegetables (e.g. broccoli, brussel sprouts, cabbage, kale) contain an ingredient called DIM (diindolylmethane) that promotes the breakdown of estrogen in the body. Increasing these vegetables in the diet can be useful, however, to gain therapeutic benefits women can also supplement with DIM. This is one of the most commonly utilized supplements to enhance estrogen metabolism and promote overall hormonal balance.


(2) Optimize progesterone levels: Just like too much of a good thing can be bad, so can too little. If a woman is experiencing insomnia, anxiety, breakthrough bleeding during menses, mood swings or weight gain, it is important that she have her progesterone levels assessed. Vitamin B6 is essential for the development of the corpus luteum, which is responsible for producing progesterone. Therefore, supplementing with vitamin B6 should be considered when balancing hormones and preventing progesterone deficiency.


(3) Reduce testosterone levels: Sex hormone binding globulin (SHBG) carries testosterone through the body and can regulate the amount of free testosterone available. Fiber may help increase SHBG and lower testosterone levels. Consuming 2 tablespoons of ground flaxseeds can contribute to your daily fiber consumption and work to increase SHBG.


Interactions between your hormones are fundamental to your overall health, which is why imbalances can have such a significant impact on your overall well-being. As there are other conditions that share similar symptoms to the ones outlined above, I encourage you to work with a naturopathic doctor to get a thorough assessment with the necessary laboratory testing done.

Erin Enns