Elizabeth Shimer Bowers
Stephanie Gardner, MD
Between the moodiness, cramps, and bloating, the last thing a woman with PMS needs is to look in the mirror and see a big red pimple. But unfortunately, many women do.
Menstrual acne, a flare-up of blemishes every month that coincides with menstruation, is fairly common. According to a study published in the Archives of Dermatology, 63% of acne-prone women experience these premenstrual flares. They usually strike about seven to 10 days before the onset of a woman’s period and then subside as soon as bleeding begins.
The average menstrual cycle is 28 days, and each of these days is different hormonally. “In the first half of a woman’s menstrual cycle, the predominant hormone is estrogen; in the second half, the main hormone is progesterone,” explains ob-gyn Elizabeth Gutrecht Lyster, MD. Lyster is part of Holtorf Medical Group in Orange County, Calif. “Then levels of both hormones fall to their lowest levels of the month as bleeding approaches,” she says.
Meanwhile, the male hormone testosterone (made in smaller amounts by women) stays at a constant level all month. “This means that before and during menstruation, testosterone is relatively higher than the female hormones,” Lyster says.
These behind-the-scenes hormonal shifts do all sorts of things to a woman’s skin. For one, the mid-cycle progesterone rise stimulates the production of sebum. Sebum is a thick, oily substance that acts as a natural skin lubricant.
“And as levels of progesterone increase, skin swells and pores are compressed shut,” explains dermatologist Audrey Kunin, MD, of DERMAdoctor.com. As a result, pores never looked so minimized. “But this tourniquet effect also causes sebum to build up beneath the skin’s surface.”
In addition, higher testosterone levels around menstruation further activate the sebaceous glands to make even more sebum.
Sebum yields different effects in different women. “For some, it produces a healthy glow; for others, it creates a chronic oil slick,” Kunin says. The oil provides food for the bacterium P. acnes. This bacterium causes increased breakouts and inflammation around the time of women's periods.
Unfortunately, you can’t change the relationship between acne and hormones. But there are some things you can do to make those breakouts less severe.
“Menstrual-related acne is not a matter of hygiene; it is an internal effect. However, women still need to take special care of their skin around their periods in order not to make things worse,” Lyster says.
For acne closely related to your period, you may need to do something hormonally to intervene. An ob-gyn or endocrinologist can help. Treatment options include the following:
Birth control pillsBirth control pills may help women who see a clear link between their acne and periods. “Anything that raises estrogen levels will lessen the effects of testosterone in women,” Lyster says. Birth control pills work by increasing a protein called sex-hormone binding globulin (SHBG) in the blood. “SHBG acts like a sponge, soaking up the free testosterone in the bloodstream,” she says. “This means there is less testosterone available to cause acne.”
Birth control pills also work by slowing down oil production. Some pills are specifically approved for the management of acne. These pills include Ortho Tri-Cyclen, Estrosten, and Yaz.
If you start using birth control pills to control acne, be patient. When some women begin taking the pill, they experience increased acne for the first three to four months in response to the change in hormones. This should subside as your body adjusts.
SpironolactoneIf acne doesn’t respond to birth control pills alone, your doctor may add medication to lower testosterone levels. This medication, called spironolactone, curbs testosterone-related oil production in the skin. Side effects include breast tenderness, irregular periods, headaches, and fatigue. Spironolactone is not appropriate for all women; be sure to discuss its risks and benefits with your doctor.
For those who are obese, weight loss.
“Anything that lowers SHBG may lead to increased acne,” Lyster says. One major factor that reduces SHBG and increases testosterone is obesity. “Therefore, eating a healthful diet and maintaining a healthy weight will help control acne breakouts around the time of menstruation.”
In addition, you can try the following non-hormonal remedies:
Practice good skin hygieneAny extra bacteria you introduce to your face will worsen menstrual acne. To keep your skin as clean as possible, New York City dermatologist Francesca Fusco, MD, suggests the following:
For menstrual acne that is more severe, see a dermatologistA dermatologist may be able to prescribe one of the following medications to help:
In addition to prescribing oral and topical medications, a dermatologist can ease menstrual acne by performing some in-office treatments. Treatments may include cortisone injections, acne surgery, laser therapy, or a chemical peel.
SOURCES:Elizabeth Gutrecht Lyster, MD, MPH, Halter Medical Group, Orange County, Calif. Audrey Kunin, MD, board-certified dermatologist, Kansas City, Mo.; president, DERMAdoctor.com.Francesca Fusco, MD, board-certified dermatologist, New York.Brad Douglas, MD, women’s health expert, JustAnswer.com.Suzanne Friedler, MD, board-certified dermatologist, New York.Shahla Nader, MD, professor of medicine, University of Texas Medical School.Lucky, A. Archives of Dermatology, April 2004; vol 140(4): pp 423-424.National Women’s Health Information Center: “Acne: Frequently Asked Questions.” The Mayo Clinic. “Birth Control Pills for Acne?”
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