This is going to be really long, to record what discoveries I've made in the last few months.
The TL;DR version: I'm now taking a low dose of spiro and supplementing with a dab of progesterone cream for the 2 weeks prior to my period. Also, I found a really good article that breaks down PCOS and acne and how to treat it holistically: http://ndnr.com/web-articles/dermatology/treating-pcos-acne-from-the-inside-out/
Last time I wrote I was frustrated with a breakout from supplements that left me with a strange, sebaceous hyperplasia looking lesion that lasted for almost a month. The rest of my skin was okay, but that one lesion really bothered me. Long story, short, for whatever reason, I experience abnormal wound healing whenever I get a very deep pimple which is far more distressing then any acne, because it's impossible to cover up and looks really strange, like a raised, round doughnut on the skin.
There is not a lot out there about sebaceous hyperplasia, but I did learn that scientists showed it can be induced when skin is injected with IGF. IGF is lowered when SHGB is raised - I thought about supplementing with green tea to raise my SHGB but quickly became discouraged by the evidence that green tea might raise testosterone.
Feeling depressed, I decided to try spiro since it has shown to be effective with SH, so I made the appointment with my derm.
Meanwhile, I have known that spiro can exacerbate estrogen dominance, so I thought, why not try to detox my body of the "bad" estrogen in preparation for spiro? My choices were DIM or Indole 3 Carbinol; the herbalist I go to had previously recommended I3C.
I took one pill a day for about 5 days during the week or so leading up to my period and experienced excruciating pain in my breasts, severe acid reflux and of course, a big breakout on my chin.
My theory is I flooded my body with phytoestrogen and released some of the "bad" estrogens and it was too much for me - maybe my liver needs more support - at any rate, I caused a major flare up of estrogen dominance.
I noticed something interesting, however. In the past, my main problem was noninflamed acne on my cheeks, with the occasional inflamed pimple that would resolve once the plug came out. Lately, my inflamed acne has gone way down and now my break outs are concentrated in my chin area and it always happens two weeks before my period like clock work.
The last two breakouts I had on my chin were weird - just these hard inflamed bumps that oozed clear liquid and a bit of watery puss - no real plug in them. Both have taken forever to heal. My theory is these are cysts caused by estrogen dominance.
So things have started to click for me. The two weeks leading up to my period is when I break out - before I never understood why, because everything you read says that's when your progesterone levels shoot up. But what I finally realized that is what a normal, healthy body is supposed to do, but if you have PCOS, then your ovaries get the message to create more estrogen and testosterone. I menstruate regularly, so I know I create progesterone, but I guess I'm a bit sluggish about it. Or maybe instead of just flipping one switch for progesterone, my body flips all 3 switches at once. Once my period comes and my estrogen and progesterone are at an all time low, my skin calms down and I convince myself I've beaten my acne only for it to get bad again in 2 more weeks.
I started taking 25 mg of spiro and for the last few days I'm taking 50 mg of spiro and I think this will be enough for me. I am at that 14 day mark of my period when I get my usual flare up, and sure enough two cysts popped up on my chin. They were smaller, but angry and painful.
I popped one and a tiny miniscule plug came out, but otherwise it was clear liquid, almost like a blister. Not like my usual pimples. And so strange that such a tiny plug would cause that level of pain/inflammation.
On the other one, I put a tiny amount of progesterone cream (Emerita sp?). Immediately, it became less inflamed. Today, it looks like there will be no need to extract the plug and that it will just go away.
So I am going to continue with spiro and take it along with vitex to encourage my body to produce progesterone/counteract any estrogen that is produced by the spiro. Days 14-26 I'll supplement with a small dab of progesterone cream - less than what is recommended because I want to be careful. According to articles on the internet, I may not have to take progesterone cream forever - I just need to retrain my body to make it on it's own at the correct levels. Progesterone inhibits alpha 5 reductase so maybe I won't have to take spiro forever either.
I'm going to keep taking the rest of my supplements that I know are good for me - like fish oil, chromium, etc. I'm also taking b-6, magnesium and zinc leading up to my period - this is supposed to fix the luteal phase defect, which is what I'm guessing I have (my ovaries produce more estrogen and testosterone instead of the right amount of progesterone to induce ovulation).
I'm going to keep taking milk thistle because it's good for my liver and fiber pills because it keeps me regular - all just to keep metabolizing and ridding my body of estrogen.
I'm going to keep treating my insulin resistance, for general health and well being. I've cut back on carbs and will keep eating better, for many health reasons.
I am not going to worry about blocking my body of estrogen for right now- my two experiments with that has not been good for me.
I feel like I've finally figured things out. I've known about spiro and progesterone cream for a long time, but didn't feel like I understood my body, cycle enough to take them. I am far from cured, but my gut is telling me that I finally found something that will work for me. I have read about horrible initial break outs from spiro and how progesterone can cause a flare up of estrogen dominance. But the truth is, if you're fiddling with your hormones, it's very unpredictable how your body will react. In the end, however, it's probably hormones that are causing your acne so it will take some trial and error to figure out what's going on.
So if anyone is reading this, my advice is this simple: know thyself. If you're a woman with acne, get a handle on your menstrual cycle. Experiment with one new supplement at a time to figure out how your body reacts. Consider that the two weeks leading up to your period, your skin might be more temperamental than usual and that might not be the best time to try something new.
And this article really is extremely helpful at explaining why women with PCOS deal with acne, and how to treat it, whether you're going for an all natural treatment or not: http://ndnr.com/web-articles/dermatology/treating-pcos-acne-from-the-inside-out/.
Best of luck to everyone out there!