Many cases of chronic acne in adult women are linked to imbalances in the reproductive hormonal system. If you’re a woman over the age of seventeen and you have chronic acne, then there’s a high chance that you have may some form of a hormonal imbalance.
However, hormonal imbalances rarely just happen on their own. If a woman has a hormonal imbalance that is causing her acne, it is my job to work out WHY that hormonal imbalance happening in the first place. Often it’s one of the following:
- Going on or coming off synthetic birth control (including the BCP, IUD, implant, nuvaring).
- Adrenal fatigue
- Hypo or hyperthryoidism
- Heavy metal toxicity
- Sugar/carbohydrate sensitivity, or insulin resistance
- History of eating disorder
- A vegan diet without correct supplementation
And to some extent PCOS and endometriosis, but these conditions are often cause by something else.
It is important to find that underling reasoning for the hormonal imbalance in order to correct it at the root level.
What hormonal imbalances cause acne?
There is a misconception that all adult hormonal acne is caused by high androgens. While this is one possibility, it’s not always the case.
Hormonal acne is often more complicated that a simple deficiency or dominance in a single hormone. And we have multiple hormones under each “umbrella” or group. For instance, we don’t just have one type of estrogen, we have three major types, a fourth type that occurs during pregnancy and a bunch of others that posses estrogenic activity (in fact that are around 40 types!). We also have a bunch of different hormones under the umbrella of “androgens”.
So as you can see, it’s not quite as black and white as you first may think.
Getting a urine or saliva hormone test done one way to check in with what exactly hormones are out of balance, but a hormone test is not always accessible or affordable, or even accurate.
The problem with hormone testing is that as women, we have several hormones that shift and change a lot over the course of a month. So if we are to test our hormones on just one day in that month, it is not a completely accurate snapshot. Our hormones may be all perfectly balancing on that one particular day, but a complete mess two days later.
I appreciate hormone testing in my work, but I always consider the inaccuracies in it. The absolute best hormone testing is done every few days over the course of one month.
In cases where I have a client has not had any hormone testing done, this is absolutely okay. After working with so many women I now have a good idea as to what the signs and signals are for each hormonal imbalances. So know that it is okay to book in a consultation without getting testing done.
In a nutshell, working with adult acne in women is best approached at these levels:
- Create a good balance of good estrogens to progesterone (PG/E2) so there is neither estrogen dominance or estrogen deficiency.
- Raise low progesterone to healthy levels if needed.
- Lower androgens if one or more types are too high.
- Bring cortisol levels into a healthy balance and manage stressors.
- Heal and manage the root cause of the hormone imbalance.
What role do Androgens play in all of this?
One of the keys to curing acne is to return our skin to producing normal amounts of sebum in the sebaceous glands. Sebum is actually really good – it’s our skin’s natural protective barrier, and if your skin is too dry then sebum keeps it hydrated. But too much sebum can mean that it gets stuck in the pores and creates a breeding ground for acne bacteria to get stuck in there too, which is one of the ways a pimple is formed.
Androgens increase the size and activity of the sebaceous glands. So if your level of androgens is too high then it’s likely that you’re producing too much sebum. Interestingly our levels of healthy estrogens does the opposite – they reduce the size and activity of our sebaceous glands (that means nice tight pores and no congestion!!). As you can see, healthy hormones mean a perfect natural balance in our pore size and sebum production, which results in no acne and skin that is not too oily or dry.
Some women that have healthy levels of androgens may still experience androgenic related acne due to androgen sensitivity. Basically this means that their sebaceous glands are sensitive to normal androgen levels and they are therefore still likely to get acne. So please keep this in mind if you do decided to get hormone testing done!
How to Treat Elevated Androgens or Androgen Sensitivity
The remedy to treat elevated androgens or androgen sensitivity is to 1) detox out bad estrogens, and 2) stick to a low sugar and low carbohydrate diet (make sure to read the Eat Well section of this guide to get an understanding of the relationship between androgens, insulin and acne).
I have also written a 6 week anti-androgen detox guide which is the most effective way to reduce raised levels of androgens. You can get a copy of the guide by clicking here.
There are also some supplements that you can take. The best are Zinc, Omega-3, Chromium Picolinate, Vitamin D, Ceylon Cinnamon, B-Complex and Tian Gui capsule (a mix of eleven Chinese Herbs).
Polycystic Ovary Syndrome (PCOS)
Women with PCOS typically have high testosterone and low progesterone, which is a direct cause of chronic acne.
PCOS also often goes hand in hand (although not always) with insulin resistance. Please note that you do not necessarily have insulin resistance if you have PCOS, and not everyone with PCOS is overweight.
You do not need a diagnosis for PCOS unless you want to know or if you’re trying to conceive and are having difficulty. I’d suggest instead to get a hormone test to see if you’re high in testosterone and low in progesterone and just do the treatment for those hormones. If you do in fact have PCOS then you’ll be treating it anyway just by working with balancing those two hormonal levels.
To learn more about PCOS and acne, read this article – Do You Have Polycystic Ovary Syndrome (PCOS) & Acne?.
Insulin & The Link To Acne
Insulin is a hormone secreted from the pancreas that facilities the transportation of blood sugar (glucose) to the cells of the body to use as fuel.
When we eat foods that cause a blood sugar spike (such as sugars or refined carbohydrates), blood glucose rises sharply causing a big release of insulin. After its peak, our blood sugar then drops to too low, causing insulin-like growth factor (IGF-1) to be released to counteract hypoglycemia. When this IGF-1 is released, it raises our levels of androgens and causes excess-androgen symptoms, such as acne.
So as you can see, even though there is not so much of a direct relationship with the consumption of sugars and fast burning foods to acne, there is a chain reaction that can happen that easily leads to chronic acne.
Working with insulin & sugar spiking
To prevent sugar spiking stick to a lower sugar (low GI) and low simple carbohydrate diet. You can read more about this in the Eat Well section of this site. You’ll notice that sections of this site cross over a lot. This is because we’re working with the body holistically and honour that working with one area affects all others.
Also make sure that you’re getting regular exercise and reducing your stress levels (see Stress Less).
Supplements to take for normalising blood sugar
Of course it’s best to control insulin and blood sugar with diet and exercise, however there are some supplements you can take to help. The best supplements are Chromium, Magnesium, Alpha-Lipoic Acid, and Coenqyum Q-10. Ceylon Cinnamon and nopal cactus is also a great blood sugar balancer, so consider drinking a cinnamon tea after each meal or taking a nopal cactus superfood powder.
Read more about using ceylon cinnamon here – How To Use Cinnamon To Heal Your Acne.
If you’re experiencing acne just before bleeding (typically after day 14 of your cycle, with day 1 being the first day of bleeding), then you may have an issue with low progesterone or progesterone resistance. If your acne at this time typically comes with a range of other pre-menstrual symptoms, then this is likely the case for you.
There are a few different treatments for low progesterone dependant on symptoms. Some can be too stimulating for the body and cause worsening acne so it is important to use the right one for you. The basic progesterone deficiency treatment options include:
- Dong Quai
- Vitex Agnus-Castus (also called Chasteberry or Chaste Tree)
- Vitamin C (at a minimum of 750mg daily)
- Natural Bio-identical Progesterone Cream
- A combination of zinc, magnesium and Vitamin B6
However, I cannot stress how important it is to work out why your progesterone was low in the first place and to heal it from that level.
A note on Vitex Agnus-Castus:
Vitex is a powerfully stimulating supplement that is usually the preferred treatment for irregular cycles or PMS in Europe. It is often highly successful at correcting acne (in combination with other supplements) in premenopausal women.
However, not all vitex supplements are equal! One of the most effect brands that I personally recommend and trust is FertilityBlend For Women. An alternative for New Zealand and Australians is Premular, or agnolyt in Europe.
Vitex is best taken in the morning, with a break over the days that you are bleeding (which usually means a break of about five days each month).
Within the first month or two of use of Vitex, acne and PMS may worsen – and while this doesn’t happen to all women it is a normal reaction if it does. At the end of the second month, or second cycle, you should be noticing the positive effects. If you have taken vitex for a full two and a half months and have only experienced worsening acne and worsening PMS, then this herb is not for you. However, please note that this is the minority! Many women are afraid of taking this wonderful herb because of bad review on the net. These reviews are simply from women that have had worsening symptoms within the first month and have given up before persisting until at least the second cycle.
A note on progesterone cream:
For alternative treatments, natural progesterone creams are an option but can be expensive and difficult to source outside of the United States. If you choose this option you may need to order online from the US.
Please make sure the progesterone cream that you choose is natural, and use it only between ovulation and bleeding. So if your cycle is an average 28 days, then use it on days 12-26 of your cycle (day 1 is your first day of bleeding).
Just remember that just like vitex, natural progesterone creams will take about four months to begin to show the positive effects.
If you would like to learn more about using natural progesterone creams, this is an excellent article: The Problem of Excess Progesterone.
Dr John Lee has a good natural progesterone cream list that you can source your progesterone cream from. The list is consistently updated and I trust the teachings and information from Dr Lee. I sourced the natural progesterone cream that I personally use from here. You can view the list here.
Are there any side effects with using natural progesterone creams?
Side effects are extremely rare with natural progesterone. The only one concern is that it can potentially alter the timing of your menstrual cycle.
In case you get pregnant…
You need to be careful with the natural progesterone cream and vitex if you become pregnant. You must continue using both natural progesterone and vitex daily for at least the first three months of your pregnancy. Please also consult with your natural therapist, midwife or doctor on the use of these supplements if becoming pregnant.
Alternative supplements to take for low progesterone
In addition to using a natural progesterone cream and/or taking Vitex Agnus-Castus, there are other supplements that will help to naturally raise your progesterone levels and to relieve your premenstrual symtpoms. These include Vitamin C, Bladderwrack (a form of seaweed), Saffron, Magnesium, Vitamin B6, Evening Primrose Oil and St. John’s Wort.
When your pre-menstrual acne is not due to low progesterone…
Alternatively your pre-menstrual acne could be caused by too high levels of estradiol after ovulation (the second half of your cycle).
While progesterone naturally and healthily increases in the second half of our cycle, when these levels become too high then our skin can produce too much sebum (just like what happens when we have too high levels of androgens). If you have absolutely no libido along with your pre-menstrual acne, then potentially this could be your problem.
A good supplement to take for high estradiol is dong quai. Take 600 mg daily, either in the form of 200 mg pills three times a day, or 30 drops (1.5 ml) of fluid extract three times a day.
Alternatively, if you a client is too high in estradiol and too low in testosterone, then I usually recommend a DIM supplement such as EstroBlock regular strength.
If You’d Like To Get Your Hormones Tested First
If you’re not sure about all of this and would like to get your hormones tested first to see what’s up, then you can easily get an at home saliva hormone testing with Dr John Lee, which can be done from all over the world.
The saliva testing is based in the United States but can be shipped globally. You saliva samples will need to be shipped back to the US for testing, which will work from anywhere in the globe because the samples will last for 30 days without refrigeration.
I recommend that you get your progesterone, estradiol and testosterone tested at a minimum. If you like you can also get a complete female saliva profile. Click here to order a testing kit.
Just remember, you do not need to get your hormones tested in order to book in a consultation.