What is Hormonal Acne? Causes, Symptoms and Treatments

    Hormonal acne is a type of acne that forms as a result of fluctuations in the levels of hormones your body produces.

    It’s common, affecting anywhere from 29 to 49 percent of women, depending on age. It’s also predictable, with hormonal acne outbreaks often occurring at the same time as your period. It’s also highly annoying, affecting everything from your appearance to your self-confidence.

    Hormonal acne is so common that it’s usually just referred to as “acne” by doctors. It’s usually the result of male hormones such as testosterone (yes, even as a woman, your body produces a small amount of testosterone) and other androgens.

    Luckily, like other forms of acne, hormonal acne can be treated. Using a combination of safe, effective medications, over-the-counter products and small changes to your lifestyle, it’s very possible to take control of your hormonal acne and minimize the effects of outbreaks.

    Below, we’ve explained everything you need to know about hormonal acne, from how hormonal acne occurs to the key symptoms of an outbreak. We’ve also shared the best treatment options for hormonal acne, ranging from safe, everyday products to proven medications.

    What is Hormonal Acne?

    Simply put, all acne is hormonal. Acne occurs when your body produces an increased amount of certain hormones that stimulate the production of sebum (a form of oil that your body uses to lubricate your skin).

    Normal sebum production keeps your skin fresh, smooth and healthy. However, when hormones signal to your body to increase its sebum production, the extra sebum can clog hair follicles and cause you develop acne.

    Everyone has a different sensitivity to certain hormones, meaning an increase in hormone levels that could cause one person to break out with acne could have no effect on a person with lower sensitive to acne-causing hormones.  

    So, which hormones are responsible for acne outbreaks? The biggest culprit is testosterone -- an androgen hormone that can stimulate sebum production and increase clogging of your hair follicles.

    How Androgens Cause Hormonal Acne

    Believe it or not, male hormones could be causing your hormonal acne. As a woman, you have small amounts of male hormones such as testosterone circulating throughout your body. These hormones are essential for everything from your energy levels to your strength and fitness.

    Hormones exist in a delicate balance in your body. Even a small increase in one hormone can have a noticeable effect on your health and appearance.

    Hormonal acne occurs when your body produces more androgens (male hormones such as testosterone) than it needs. Most of the time, this boost in androgen production occurs at the same time as your period.

    Sound familiar? According to dermatologist Dr. Anjali Mahto, about two thirds of women with a genetic predisposition for acne will notice more pimples right before their periods as androgen levels increase.

    Hormonal acne is also very common in puberty. During puberty, your body produces far higher levels of androgens such as testosterone, leading to an increase in sebum that can clog pores and trigger acne outbreaks.

    Hormonal acne can vary between people. If you have high androgen levels during your period, plus a genetic sensitivity to androgens, you could experience worse acne outbreaks than your peers.

    Luckily, hormonal acne isn’t completely out of your control. From antibiotics to skin creams and topical retinoids, a variety of options are available for taking control of hormonal acne outbreaks.

    How Hormonal Acne Develops

    Acne breakouts are a four-step process, with each step contributing to the development of a noticeable pimple:

    • Hormone production. Before your period, your body starts to increase its androgen production. Higher testosterone levels trigger your body to create more sebum, which can lead to oilier facial skin.
    • Clogged hair follicle. Sebum clogs one or several hair follicles. These clogged hair follicles are called “comedones.” Comedones can be completely blocked, forming a whitehead pimple, or partially blocked, resulting in a blackhead.
    • Bacterial infection. Bacteria trapped inside the comedone causes an infection, resulting in a painful, irritated pimple.
    • Inflammation. In response to the bacterial infection, your immune system causes the clogged hair follicle to become red, swollen and uncomfortable.

    Usually, it takes four to five days for this cycle to complete, meaning you’ll notice each pimple a few days before it’s fully developed. Pimples caused by hormonal acne usually go away in four to five days after they initially become clogged and inflamed.

    This means you’ll usually need to wait just over a week for a hormonal acne outbreak to fully go away after you first notice it starting.  

    Hormonal Acne Symptoms

    Hormonal acne outbreaks tend to happen in the T-zone -- an area of your face that covers your nose, chin and forehead.

    Pimples caused by hormonal acne can also affect other parts of your face. As an adult, it’s very common for hormonal acne outbreaks to affect your jawline, your cheeks and the areas around your lips.

    Hormonal acne can range from mild to severe. Mild acne is usually characterized by non-painful whiteheads and blackheads that occur in outbreaks of less than 30 lesions at a time. Most of the time, this type of hormonal acne resolves itself with no need for medication.

    Moderate acne is characterized by 30 to 125 total acne lesions, with a large number of infected, inflamed lesions. Hormonal acne outbreaks can advance from moderate to sever when most of the lesions are inflamed, red and painful to the touch.

    As well as whiteheads and blackheads, hormonal acne outbreaks can also lead to acne nodules (large, deep-set pimples that sit beneath the skin) and pus-filled, cystic lesions. These are more common if you suffer from moderate to severe acne and can often require medical treatment.

    How to Treat Hormonal Acne

    The treatment options for hormonal acne vary depending on the severity of your outbreaks. If your hormonal acne is mild and manageable (for example, a few small pimples in the weeks leading up to your period), there’s a good chance you’ll be able to treat it without medication.

    If your hormonal acne is more severe, the best option could be the use of an acne medication such as tretinoin, isotretinoin or an antibiotic.

    Below, we’ve covered all of the treatment options for hormonal acne, ranging from changes to your lifestyle and habits (which are usually enough to manage mild outbreaks) to topical and oral hormonal acne medications.

    Lifestyle Changes and Natural Treatments

    While small changes to your lifestyle and hygiene habits usually won’t be enough to deal with severe acne outbreaks, making a few modifications to the way you take care of your skin can usually help to improve mild to moderate hormonal acne.

    From a hygiene and skincare perspective, you can:

    • Avoid scratching, scraping or picking pimples. This can open pimples to the air and allow bacteria to enter into the pore, increasing your risk of dealing with an inflamed and infected acne lesion.
    • Wash your face no more than twice daily. Excessive washing can irritate your facial skin and make acne outbreaks more severe. Try to limit your facial washing to twice a day, usually after you’ve been active and sweating.
    • Avoid harsh, chemical-laden face washes. Unfortunately, many over-the-counter facial washes are packed with chemicals that can irritate your skin. During an acne outbreak, it’s best to avoid exfoliating face washes and other harsh skincare products.
    • Limit your makeup usage. During an outbreak, it’s best to completely avoid using any makeup that isn’t water-based. We know this is practically impossible, so just try to limit your makeup usage to occasions when you really need it.

    From an environmental perspective, you can:

    • Avoid sweaty weather. Hot day? Try to avoid spending extra time outside if the weather is hot and humid, as excessive sweating can worsen your outbreaks and make inflamed, infected pimples worse.
    • Shower right after working out. Just finished a serious gym sesh? Try to shower right after you finish your workout to reduce the amount of time your bare skin is exposed to sweat.

    From a natural treatment perspective, you can:

    • Try a natural anti-acne mask. Anti-acne facial masks usually contain alpha hydroxy acids -- a classic of naturally-occurring compounds that can produce improvements in your skin.

      Like green tea, natural face masks are unlikely to have any major positive effects on your acne, but the small boost in skin health they can provide could help to bring your hormonal acne under control.
    • Eat more antioxidant-rich foods. A lack of antioxidants can make inflammation worse, potentially worsening your hormonal acne outbreaks. Plant-based foods rich in natural antioxidants, while not as effective as medicine, can potentially decrease skin irritation.

    Retinoids and Other Topical Products

    Natural products like green tea can have some positive effects on mild acne. However, they’re usually not powerful enough to produce any improvement in moderate to severe outbreaks of hormonal acne.

    Retinoids, on the other hand, can be powerful tools for controlling your hormonal acne. Made using a derivative of vitamin A, retinoids work by speeding up your skin’s growth process and causing your skin to turn over more quickly than normal.

    This faster turnover process means sebum doesn’t have as much time to build up inside your pores, resulting in fewer pimples and milder hormonal acne outbreaks.

    Retinoids can be applied topically or taken orally. The most common topical retinoid is tretinoin (often sold as Retin-A), a retinoic acid that you can find in our Hers Anti Aging, Hers Melasma and Hers Acne products.

    Using tretinoin is simple -- all you need to do is apply it daily. Studies of tretinoin for acne usually show that it takes three to six months to control most acne, making topical retinoids like tretinoin a mainstay of medical acne treatment.

    Oral retinoids, such as isotretinoin (commonly sold as Accutane) can be even more effective for treating hormonal acne. They also have more significant potential side effects, meaning you’ll usually only be prescribed an oral retinoid if topical treatments like tretinoin don’t work for you.

    Antibiotics

    Because hormonal acne is equal parts sebum and bacteria, antibiotics (drugs that fight against bacterial infections) can be highly effective for controlling outbreaks and making your hormonal acne less severe.

    Doctors often prescribe antibiotics in combination with retinoids like tretinoin. The retinoid works by speeding up your skin cell turnover process, making blockages less frequent. If a blockage does occur, the antibiotic stops it from becoming infected, reducing your risk of inflammation.

    Our Hers Acne combines tretinoin (contained in the PM version of the product) with clindamycin to deliver a one-two punch to hormonal acne.

    As well as clindamycin, some of the most commonly used antibiotics for acne are tetracycline, doxycycline, erythromycin and minocycline.

    Like tretinoin, antibiotics start working immediately but usually need several months to reach their full potential. You’ll usually get the full acne prevention effects of antibiotics after taking them for three to six months.

    Hormonal Medication

    Finally, if your hormonal acne doesn’t respond to retinoids, antibiotics and other widely used treatments, your doctor might recommend a hormonal medication.

    For women, the most common hormonal acne prevention medication is a simple birth control pill. Hormonal contraceptives contain ethinyl estradiol -- an estrogen that can help to balance the effects of androgens and prevent your skin from breaking out with acne.

    In short, there’s a good chance you can manage your hormonal acne and your contraception with one treatment -- score one for convenience.

    As always, the best way to begin using hormonal medication to control your acne is to talk to your doctor. They’ll be able to recommend the best oral contraceptive for you based on your health history, needs and lifestyle.  

    Already taking an oral contraceptive? If your current contraceptive isn’t controlling your acne, you might be able to improve your skin and stop breakouts by changing to a different type of oral contraceptive. Again, this is something that you’ll need to talk to your doctor about.

    Menopause and Hormonal Acne

    Entering menopause causes a normal, natural reduction in your body’s production of female reproductive hormones such as estrogen. For some women, this can lead to an increase in hormonal acne outbreaks.

    Like hormonal acne for non-menopausal women, menopause-related hormonal acne is the result of fluctuations in your body’s hormone levels. As your estrogen levels decrease, your balance of androgens to estrogenic hormones can cause your body to create more sebum.

    If you’re acne prone, this can lead to everything from a few occasional pimples to severe and regular acne outbreaks. Menopausal hormonal acne can even occur if you use HRT (hormone replacement therapy) to deal with the symptoms of aging.

    As always, if you’re experiencing menopause-related hormonal acne, the best approach is to talk to your doctor about retinoids, antibiotics and hormonal medications to limit outbreaks and control your body’s sebum production.

    Learn More About Acne

    Acne is one of the most common skin conditions, affecting around 50 million Americans every year. While all acne is hormonal, it can be triggered by a variety of factors, from androgens to stress, medication and more.

    Interested in learning more about acne? Our guide to androgen hormones that cause acne goes into more detail about how testosterone and other androgens can trigger an acne outbreak. You can also learn more about common acne triggers in our guide to what causes acne breakouts.

    Want to solve your acne breakouts as quickly as possible? Our guide to getting rid of acne fast covers the most effective acne treatments available, as well as the amount of time required for you to see results.

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.