Acne mid-month could be high testosterone bc testosterone peaks mid month too. Most everything you read about women's cycles leaves that out for some reason. I only found out when my endo told me. I also never broke out mid month until I was in my 30s and think low progesterone could be a reason-- but -- estrogen declines at this age as well. If there's not enough estrogen to balance out the testosterone, then you can get acne. This is the reason that spiro works, bc it blocks the androgens.
You're right that progesterone should be rising mid month, but androgens do too,and you may not have enough estrogen to make it less of a problem. A somewhat reliable indicator of not enough progesterone is a short luteal phase.
I had all normal labs, even progesterone and androgens...
If its true that progesterone affects androgens, then being a little low can make them take over. I still don't think this has to do with estrogen levels, but androgen levels. Estrogen doesn't cause acne, it helps it, IMO. Supplementing with progesterone is dicey, bc it's so easy to go too high and that's also bad, and an cause major acne as well.
It's all very confusing and annoying that in this day and age they don't have better understanding of women's hormones.
If you have excess estrogen it has a "competing" factor with progesterone. Your progesterone is so busy regulating your excess estrogen that it can't regulate your androgens as well. The science is a little fuzzy but it appears that progesterone will downregulate estrogen before androgens. Many people have more estrogen exposure in this day and age because of xenoestrogensin synthetic products. (Remember when sunscreens started saying BPA-free? BPA is a xenoestrogen that was found to cause endocrine problems because the body treats it as a foreign estrogen. Xenoestrogens occur in plastics, fabric softener, tons of things.)
So if we're going to be technical, your progesterone may not actually be LOW but unable to deal with xenoestrogen exposure. Your actual estrogen may not actually be HIGH, but the xenoestrogen mimic estrogen effects in your body, your progesterone thinks it's real estrogen it has to deal with, and then your androgens may not actually be HIGH but just binding to receptors too often because progesterone isn't doing its job. So you may have "normal" labs and still have hormonal symptoms.
As I said, a lot of this research is still in a fuzzy stage, but it makes sense with the evidence we've seen so far. I should make another post on xenoestrogens, but with the amount of PMs I get on these topics, I feel like I confuse people often enough as it is...
Testosterone is higher mid-month, but acne takes a week or so to form under the skin, so you wouldn't necessarily see acne coming up the same week when your testosterone shoots up.
I agree that progesterone supplementation is an art and not a science. Part of the problem is that synthetic progesterone < natural progesterone, but doctors are afraid to use natural progesterone (see Dr. Lee's quote I posted earlier), so we simply don't have a lot of practicing doctors figuring out this stuff.
Also many women forget that progesterone is stored in fat cells, which is why it is more effective to apply a cream and get the progesterone transdermally than to swallow a pill. You can max out the progesterone level in a certain area of fat, so you have to switch where you apply it periodically.
Edited by Green Gables, 03 October 2012 - 03:42 PM.