December 17 2020 | Written by Pri Dogra (She/Her)
I hate the word “pimple.” It’s gross. So, I always euphemize it with “breakout.” But let’s be real: sometimes we do get pimples. And sometimes they’re painful - like, really painful - and they’re red, enlarged, enraged, and despite several layers of foundation, they’re excruciatingly visible.
It’s no coincidence that your breakouts might appear in the same spots at roughly the same time every month. Although they play a crucial role in regulating your health, your hormones can be to blame for the less-than-welcome guests. Do you know your period is just around the corner when you start ‘randomly’ seeing new spots? Does your forehead indicate you’ve just had your period by breaking out profusely (me)? Enter: the cycle’s effect on the skin.
Understanding Your Cycle
As you may recall from last week’s blog, there are some key hormones to be familiarized with when talking about the menstrual cycle:
Estrogen: One of the main female sex hormones. It is responsible for the onset of puberty and is “produced primarily in [the] ovaries” with or by the eggs.
Progesterone: The second main sex hormone in females. It prepares the body for pregnancy by causing the uterine lining to thicken.
Follicular stimulating hormone (FSH): Stored in the pituitary gland and triggers the “growth of eggs in the ovaries.”
Luteinizing hormone (LH): Also stemming from the pituitary gland, it stimulates the release of the egg from the ovary, known as ovulation.
Testosterone: A type of androgen that works to help maintain bone strength and overall reproductive functions.
According to board-certified dermatologist S. Manjula Jegasothy, also an M.D. and founder of the Miami Skin Institute, the main culprits of hormonal acne are estrogen and progesterone. She notes that “[t]he ratio of each of these hormones to each other can also affect women’s testosterone levels, and can also be causative in hormonal acne.” It is also suspected that an increase in “oil production in the pores” can be caused by the fluctuation in hormone levels.
Before continuing to connect the cycle and the skin, let’s briefly recap a 28ish-day cycle to understand how the hormones actually change:
Menstrual (Day 1-5): Estrogen and progesterone levels drop when there is no egg fertilization. This causes the shedding of your uterine lining, which is your ‘actual period.’
Follicular (Day 6-10): Estrogen starts to rise as there is an output of FSH.
Ovulatory (Day 11-18): LH is in action, causing an egg to be released (ovulation). FSH and estrogen also peak as the egg is released.
Luteal (Day 19-28): The egg is turned into corpus luteum, which releases high levels of progesterone to prepare for fertilization.
You may see the first half of the cycle referred to elsewhere as “follicular” and the second half as “luteal.” Some may number the days slightly differently or position the menstrual/bleeding as the last part of the cycle. Either way, it’s necessary to understand what happens to your body in a month, aside from the cramps and cravings to which you may already be well-attuned.
Understanding Your Skin
I certainly notice changes in my skin that are perfectly timed to the different weeks in my cycle. For example, on the very first day of my follicular phase I breakout on my forehead. Also like clockwork, three days before my period I notice a new pimple on my cheek.
Although all menstruators may not be able to relate, these are some changes you might notice throughout the month:
Menstrual (Day 1-5): The skin may appear duller and feel more sensitive. Try upping the hydration with a moisturizer or hyaluronic acid as sebaceous glands are less active, and avoid any waxing or laser hair removal.
Follicular (Day 6-10): The skin’s vibrancy increases, along with collagen production. Keeping up with your normal skincare routine here can help maintain the skin’s glow.
Ovulatory (Day 11-18): The skin’s prime may correspond with the peak in estrogen. Try taking advantage of this time with proactive measures before the luteal phase, such as with chemical exfoliation and the use of non-comedogenic products.
Luteal (Day 19-28): The skin may look oilier due to more active sebaceous glands as androgen production rises. Along with larger pores, you may start to notice those cystic breakouts. Working to keep the skin balanced through continued exfoliation and regular cleansing may be useful.
How To Know If Your Acne Is Hormonal
Hormonal acne differs from your run-of-the-mill pimples for a couple of reasons. First, the breakouts are cyclical and might follow hormone-driven patterns. For example, Dr. Clarissa Yang, Chief of Dermatology at Tufts Medical Centre, explains that “jawline acne in women can suggest a hormonal imbalance.” If you notice, for instance, pimples along your jawline before your period in your luteal phase, this could be connected to rising levels of progesterone or androgens. Other areas commonly associated with the reproductive system include the cheeks, chin and neck.
Another indicator of hormonal acne is the type of pimple. Hormonal acne usually presents itself as deeper, heavily inflamed, cystic pimples that are often painful to touch, whereas pimples strictly on the surface - regular red breakouts, whiteheads, or blackheads - might be smaller, not as wide, and more responsive to topical treatments.
What You Can Do About It
As you may be able to tell from the name, hormonal acne is determined by your hormones, thus rendering it an internal issue. So if you really want to tackle hormonal acne, you need to focus on supporting healthy hormones. As someone who has suffered from (and is still dealing with) painful, cystic acne, I know how frustrating it is to hear that regular sleep, proper nutrition, exercise, and stress management are the answers, so I won’t say only that. For me, there has been great benefit in getting specific by identifying my estrogen dominance post-birth control pill. Through consulting with professionals and conducting my own proper research, I have been able to determine that my liver needs extra support to metabolize the pill’s leftover estrogen. If this blog resonates with you, I encourage you to dig deeper to establish: when you breakout, where the breakouts are, and what they look and feel like. If I’ve learned anything, it’s that you don’t have acne for no reason; it’s often an indication of something deeper.
Now I’m not saying there’s no point in testing different products. I love my skincare routine but recognize that it has limited efficacy when my breakouts hurt. Some skincare companies to check out that focus on working with the cycle include Phase and Amareta.
Acne is frustrating and emotionally and physically painful, no doubt. But, we can conclude that the issues are skin deep and may actually paint a picture of what’s going on with our health, largely influenced by our hormones.
Do you have acne? Do you have hormonal acne? Have you found anything that works for you? Let me know in the comments below!