Period acne: Why you get it & what to do about it

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Battling hormonal breakouts throughout your menstrual cycle

TL/DR: Period acne is a real thing, though it usually crops up about a week or two before your period arrives (blame it on all those hormonal changes). Thankfully, there are plenty of ways to counteract premenstrual breakouts, ranging from pharmaceutical treatments to skincare products and basic lifestyle changes. 

No, you’re not imagining things. Your acne can definitely get worse when your period is just around the corner. As if the mood swings, cramps, and sore boobs weren’t enough, 65% of menstruators get more breakouts on the days leading up to their periods.1 And those who already experience adult acne might notice that their symptoms get even worse around the time of their period. 

Why does it happen? And what can you do about it? We’re here to answer those questions and help you guide your skin towards a healthier, chiller reaction to hormonal fluctuations. And while we’re here: If you’re thinking about popping that pimple, DON’T DO IT. Wash your face. Dab on a little spot treatment. Stop touching it. Trust us on this one – popping your zits can lead to infection or, worse, permanent scarring. 


How your menstrual cycle affects your skin

During the menstrual cycle, our hormones take us through a wild ride. Our skin serves as a map to all these different changes, getting smoother, drier, and calmer at the beginning of the cycle – and then getting angrier towards the end. 

Here’s a quick recap of how your menstrual cycle works: The first two weeks involve menstruation and then the follicular phase. Ovulation marks the halfway point, after which the luteal phase begins. Distinct hormonal fluctuations happen during each of these four phases.

At the beginning of the menstrual cycle, as estrogen ramps up, skin usually begins to clear and take on a healthy glow. Once your period starts, you may notice some dryness while estrogen works its magic. Estrogen peaks right before ovulation, which is when your skin will look its best and, if you’re lucky, remain clear, smooth, and blemish-free.2

Evolution really did that: Your skin is most radiant during your 2-3 most fertile days of the month, also known as the fertile window. Thanks, mother nature, for throwing us a bone (maybe literally?). Just keep in mind that your pores could appear larger and more noticeable than usual (a side effect of drier skin) during this time. 

So, what changes after ovulation that leads to period acne? 

It’s (mostly) thanks to progesterone. As long as you don’t get pregnant, progesterone kicks in right after ovulation, when your reproductive system displays its annoyance that you didn’t fertilize the egg it so kindly gave you. Sorry, ovaries, not this month! 

Progesterone stimulates the oil glands, which activates the production of more sebum (sebum is the oil you get on your face that blocks pores). During this phase, your skin may also swell, compressing the pores and causing sebum to build up underneath the skin’s surface.3

For some lucky individuals, sebum creates a healthy glow – but for others, it wreaks havoc. Sebum is the perfect food for the bacterium P.acnes, the culprit behind the breakouts and inflammation that take place during the couple of weeks leading up to your period. 

In the last few days of the luteal phase, your skin is about ready to throw a fit. Both progesterone and estrogen drop dramatically; meanwhile, testosterone over-stimulates the oil glands, causing even more intense breakouts.4


How to tell the difference between hormonal & non-hormonal acne

How do you know if the acne that pops up during the second half of your cycle is a result of crazy hormones? Usually, it’s pretty easy to tell the difference between hormonal acne and “regular” acne: Hormonal pimples tend to show up around the chin and jaw line because those areas are closer to the oil glands. 

Hormonal acne may also show up under the skin’s surface (called cystic acne), looking  a bit different from your standard blackheads and whiteheads. If you see red bumps that feel tender and painful, they’re probably evidence of cystic acne. The discomfort occurs because a few days’ worth of oil buildup causes an inflammatory reaction.5      

Individuals with certain health conditions may experience more severe hormonal acne: Polycystic ovary syndrome (PCOS), for example, increases androgen levels (a.k.a. steroid hormones) in the body. Excess androgens boost sebum production, making skin more prone to breakouts.6

Those diagnosed with PCOS often struggle with chronic acne that even the most rigorous skin care routine can’t control – in these cases, the best path forward may be to seek help from a dermatologist. 

Hormonal acne can also impact those who undergo hormone replacement therapy (HRT) to encourage their body to develop in a way that aligns with their gender identity. Testosterone injections or topicals may cause oil production in the skin to increase dramatically, leading to breakouts.7 In addition, it’s not uncommon to see breakouts around the vulva and mons pubis, often in the form of ingrown hairs. 


How to get rid of period acne

It’s the million-dollar question: How do you *reliably* get rid of hormonal acne? Is there any way to prevent it before it turns your face into some sort of polka dotted war zone? 

The short answer is, it depends. Ugh. 

Your body’s chemistry is totally unique, so your hormonal acne might not respond to the same treatment that worked for your BFF. Remedies that tend to be successful for many acne sufferers include full-strength benzoyl peroxide, topical retinoids, and low-dose antibiotics (these require a prescription from your dermatologist). Your doctor or OB-GYN may also recommend hormonal birth control to regulate hormonal fluctuations.8

Of course, you can also try over-the-counter treatments like low-dose benzoyl peroxide, glycolic acid, salicylic acid, AHAs, and tea tree oil: Many of these have also been found to successfully combat period acne.9 And don’t forget to apply sunscreen (an oil-free formula is best) to protect your skin outdoors – this is an especially important step if your skin is already inflamed or under stress. 

While there are an abundance of over-the-counter and prescription treatments, you can also make simple lifestyle changes to help prevent period acne. Practicing good skin hygiene is an easy place to start. To improve your skin hygiene,

  • Avoid touching your face
  • Clean your cell phone regularly
  • Wash or replace face towels more frequently
  • Wash your face daily with a gentle cleanser
  • Use oil-free skincare products when possible
  • Quit smoking 

All these external factors could be contributing to your period acne.10 11

You might also want to stay away from sugar, dairy, refined grains and fast food — these four are high on the list of foods that irritate the skin 12 and tend to cause more frequent breakouts (OF COURSE these are also the foods we crave the most before our periods – so, no judgment if that slice of pepperoni looks too good to resist). 

Another way to give your skin a boost? Get in a workout or two whenever you sense that acne is about to strike.

Working out is great for your skin because it reduces stress and promotes better sleep, which your skin needs to restore itself. Cortisol, the hormone produced when you’re stressed out, can cause hormones to fluctuate and breakouts to persist.13 Physical activity significantly decreases cortisol levels in the body – so you’ll sleep better, feel better, and look better. It’s basically a win-win.


Period acne takeaways

Period acne is a major pain – but nearly all of us experience it at some point, no matter how much kale we eat or how many skin care products we buy, so it’s nothing to be embarrassed about. It’s best to let go of the illusion of skin perfection and instead appreciate the incredible things your body is doing behind the scenes to keep your reproductive system functioning. 

And, thankfully, there are plenty of treatments to experiment with if period acne just won’t subside. Start with OTC remedies and lifestyle changes – if those don’t make a difference, you may want to reach out to a dermatologist for some professional advice. Either way, the next time those pesky breakouts come knocking, treat it as a signal to slow down, pamper yourself a little bit more, and practice self-love for your body in all its premenstrual glory.  

References (Click to open/close)

  1. Geller, L., Rosen, J., Frankel, A., & Goldenberg, G. (2014). Perimenstrual flare of adult acne. The Journal of clinical and aesthetic dermatology, 7(8), 30–34.
  2. Hall, G., & Phillips, T. J. (2005). Estrogen and skin: The effects of estrogen, menopause, and hormone replacement therapy on the skin. Journal of the American Academy of Dermatology, 53(4), 555-568. https://doi.org/10.1016/j.jaad.2004.08.039
  3. Zouboulis, C., Jourdan, E., & Picardo, M. (2013). Acne is an inflammatory disease and alterations of sebum composition initiate acne lesions. Journal of the European Academy of Dermatology and Venereology, 28(5), 527-532. https://doi.org/10.1111/jdv.12298
  4. Lawrence, D. M., Katz, M., Robinson, T. W., Newman, M. C., McGarrigle, H. H., Shaw, M., & Lachelin, G. C. (1981). Reduced sex hormone binding globulin and derived free testosterone levels in women with severe acne. Clinical Endocrinology, 15(1), 87–91. https://doi.org/10.1111/j.1365-2265.1981.tb02752.x
  5. Marynick, S. P., Chakmakjian, Z. H., McCaffree, D. L., & Herndon, J. H. (1983). Androgen excess in cystic acne. New England Journal of Medicine, 308(17), 981-986. https://doi.org/10.1056/nejm198304283081701
  6. McAvey, B., & Lieman, H. (2013). Managing the PCOS-related symptoms of hirsutism, acne, and hair loss. Polycystic Ovary Syndrome, 223-242. https://doi.org/10.1007/978-1-4614-8394-6_13
  7. Thiboutot, D. (2004). Acne: Hormonal concepts and therapy. Clinics in Dermatology, 22(5), 419-428. https://doi.org/10.1016/j.clindermatol.2004.03.010
  8. Arowojolu, A., Gallo, M., Grimes, D., & Garner, S. (2003). Combined oral contraceptive pills for treatment of acne. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd004425
  9. Acne and cosmetics. (2011). Cosmetics and Dermatological Problems and Solutions: A Problem Based Approach, 3-11. https://doi.org/10.3109/9781841847412.002
  10. Draelos Z. D. (2006). The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne. Cutis, 78(1 Suppl), 34–40.
  11. Klaz, I., Kochba, I., Shohat, T., Zarka, S., & Brenner, S. (2006). Severe acne vulgaris and tobacco smoking in young men. Journal of Investigative Dermatology, 126(8), 1749-1752. https://doi.org/10.1038/sj.jid.5700326
  12. Bowe, W. P., Kessides, M. C., & Shalita, A. R. (2011). The relationship between acne and diet. Acne Vulgaris, 57-69. https://doi.org/10.3109/9781616310097.002.2
  13. Goulden, V., Clark, S., & Cunliffe, W. (1997). Post-adolescent acne: A review of clinical features. British Journal of Dermatology, 136(1), 66-70. https://doi.org/10.1046/j.1365-2133.1997.d01-1144.x