Hormones circulate within our bodies and act as messengers, sending important information to our organs. Hormones fluctuate during the female menstrual cycle and throughout life’s various physiologic stages including puberty, pregnancy, perimenopause, and menopause. Hormones can also become unbalanced as a result of excessive stress, chronic disease, or poor dietary habits. Visible changes in our skin’s health are one of the first indicators of hormone imbalance. Hormonal acne, also known as Acne Vulgaris, is therefore tied to fluctuations in our hormone levels.

Hormonal acne falls under the category of inflammatory acne, which is characterized by raised red bumps or large red/white bumps filled with pus (considered cysts). Hormonal acne often covers the lower half of the face including the cheeks, jawline, chin, and neck region. Hormonal body acne on the chest, shoulders, and back are also very common.

Causes of Hormonal Acne 

Hormonal fluctuations combined with bacteria and inflammation trigger the production of sebum which leads to the formation of pimples. Excess oils on the skin and hair follicles provide the perfect breeding ground for bacteria and clogged follicles. The lower half of the cheeks, the chin, and the jawline region are the most common areas for hormonal breakouts during adulthood. This is because there is a higher density of sebaceous glands in these areas. These oil glands are highly sensitive to hormonal fluctuations within our bloodstream.

Females are more susceptible to hormonal acne because we experience fluctuations in female sex hormones, estrogen, progesterone, and testosterone, monthly with our menses. Before your period starts, estrogen and progesterone levels fluctuate, triggering the oil glands to produce more sebum which can result in clogged pores and breakouts. Toward the end of one’s period, testosterone stimulates sebaceous gland sensitivity which can also result in acne.

Aside from menstruation, other conditions that can affect hormone levels, increase the production of sebum in the pores, and trigger acne along with overall skin inflammation include puberty, pregnancy, perimenopause, menopause, and polycystic ovarian syndrome (PCOS).

Hormonal Acne During Puberty

Around eleven years old, many girls start to experience oily skin and hormonal acne. Internally, the growth hormone, androgen receptor hormone, and Gonadotropin-releasing hormone (GnRH) get turned on during this hormonal life stage, travel to the testicles and ovaries, and turn on genes that were not turned on before. GnRH sends signals to the ovaries to turn on estrogen and testosterone. For females going through puberty, these hormones begin to be released into the bloodstream for the first time in their lives and trigger sebaceous stimulation, causing oily skin and acne breakouts.

Hormonal Acne During Pregnancy

While some women experience the pregnancy glow due to higher levels of estrogen, elevated progesterone levels can cause acne during pregnancy. Progesterone can serve as a hormonal acne-causing cocktail in some women’s bodies.

Treating acne during pregnancy is limited due to the potential toxicities posed to the fetus. Hormonal therapy, oral antibiotics (like tetracyclines), and both oral and topical retinoids should be avoided during pregnancy. There are some safe topical therapies for pregnancy-induced acne, like topical erythromycin and sulfur-based products. Always consult with a board-certified dermatologist for approved topical therapies during pregnancy. 

Hormonal Acne During Perimenopause & Menopause

Our hair follicles contain a cocktail of hormones. When that cocktail shifts, we get a higher androgen effect which can trigger hormonal acne. During perimenopause and menopause, collagen and estrogen drop in women, but there is an unopposed testosterone influence on the skin that can manifest itself as hormonal acne. Decreasing estrogen levels, therefore, make the skin more susceptible to dehydration, dryness, hypersensitivity, inflammation, and acne.

Dr. Zenovia's products are the only dermatologist-developed topical, over the counter skincare products on the market scientifically formulated to address hormonal acne at the skin level. Additionally, Dr. Zenovia's products contain the first-ever, medical-grade technology clinically formulated to help address the appearance of hormonally impacted skin. The REG-ulate360 Complex™ includes a unique Phytoestrogen component to help balance hormonal fluctuations at the skin level. By regulating hormonal fluctuations at the skin level, you experience fewer acne flare-ups. The REG-ulate360 Complex™ is revolutionary in its approach to support the tissue from a hormonal standpoint and help decrease the cutaneous effect of lower estrogen levels and skin aging.

Polycystic Ovarian Syndrome & Hormonal Acne

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that causes enlarged ovaries. Hormonal imbalance is the root of this condition. Our bodies depend on signals from the pituitary gland in order to produce the right amount of estrogen, progesterone, and testosterone. Without the right signals from the pituitary gland, estrogen and progesterone levels drop and testosterone levels increase. In addition to preventing ovulation, these hormonal fluctuations can cause acne.

For those with polycystic ovarian syndrome and hormonal acne, topical treatments aren’t usually enough to clear the skin. Dr. Zenovia recommends discussing treatment options with a board-certified dermatologist if topical treatments don’t seem to be helping.

Increased Androgen Levels

Overall, hormonal acne in women is typically triggered by an increase in androgens, male sex hormones. Testosterone, for example, plays a major role in regulating the skin’s oil levels. Both males and females produce testosterone, but males produce 10-25% more. Because the female body has less testosterone compared to males, it is much more sensitive to small fluctuations in androgen levels. When the female body begins producing more testosterone than normal, the sebaceous glands begin producing excess sebum. Sebum then clogs the hair follicles and leads to the formation of pimples.

Note from Dr. Zenovia: In order to keep sebum production under control at the sebaceous gland level, a combination of acne-fighting topicals with a hormonal effect, stress reduction techniques, and following a healthy diet can help prevent mild to moderate hormonal acne.

Sticking to an acne-fighting skincare routine will help remove excess oil and clear clogged pores. Dr. Zenovia's Clear Complexion Collection is a complete acne complexion-correcting line consisting of five breakthrough products specifically curated to treat blemishes, balance sebum production, and help reduce the appearance of acne scarring while keeping the skin calm. Dr. Zenovia's products are the only dermatologist-developed topical, over the counter skincare products on the market scientifically formulated to address hormonal acne at the skin level.

Consult a board-certified dermatologist for treatment if you are experiencing moderate to severe acne. A dermatologist can determine if prescription treatments will help.

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