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Hello! For background info: I am a 23 year old female who's been taking spironolactone 100mg since July of 2013. My severe acne cleared after 4.5 months on spiro.
I recently had an anorexia relapse from the months of december 2014-february 2015. That's when I started to break out around my cheeks and chin again, in (not many, but big) pustules and papules. Thankfully, no cysts yet.. But I spotted for an entire month, took vitex for 10 days and it stopped the bleeding. I stopped taking it, however, because i thought it was contributing to my breakouts.
also, during this time (jan-march 2015) I was going through the most extreme stressful time I've ever dealt with, where I felt under stress every waking minute for 3 months. I began smoking, stopped exercising completely, drinking excessive coffee to try and stay up, bad sleeping habits, etc. All of this has slowly dwindled down and I now feel like the situation is under control, and I no longer feel stressed about it, but I DO feel stressed about my increasing acne.
I've also gotten my period back and i'm experiencing symptoms of estrogen dominance: painful cramps, tender breasts, brain fog, BAD breakouts during ovulation and the last 2 weeks of cycle, heavy bleeding, migraines, all PMS symptoms basicallymy skin clears up while i'm on my period.
I should mention that I'm not on BCP (never have been) and my skincare regimen has stayed the same for years (tretinoin cream .5% at night, I use an all-natural cleanser, I eat lots of fruits and vegetables, no dairy, good carbs.
My questions are
1. could the increased acne be caused by some sort of delayed stress response to the situation/anorexia relapse?
2. can I take DIM with spironolactone?
3. has anyone had increased breakouts during ovulation and the rest of your cycle, just mild acne? If so, how did you fix this?
Thank you for reading this long essay! Hah. I'd greatly appreciate any insight into this problem I'm having.
Anorexia (and severe stress) greatly alters your hormonal balance, sometimes permanently. There have been studies on how messed up a woman's hormones can get after anorexia. It is especially bad later in life. Anorexia in the teenage years sometimes doesn't affect girls as much because the body is already on a hormonal path from puberty to adulthood. Once you are an adult, your body is at a hormonal setpoint until menopause. The signals no longer exist to bounce back if you change that setpoint with anorexia or stress.
Not to be a downer, but there is not an easy answer for you at this point. You need to get a full hormone panel done and you might also want to test some things like stomach acid level, H.pylori, candida, etc. There is really no clue what your body is doing right now. If spiro has stopped working then likely you are not a simple high androgen case anymore.
Anorexia (and severe stress) greatly alters your hormonal balance, sometimes permanently. There have been studies on how messed up a woman's hormones can get after anorexia. It is especially bad later in life. Anorexia in the teenage years sometimes doesn't affect girls as much because the body is already on a hormonal path from puberty to adulthood. Once you are an adult, your body is at a hormonal setpoint until menopause. The signals no longer exist to bounce back if you change that setpoint with anorexia or stress.
Not to be a downer, but there is not an easy answer for you at this point. You need to get a full hormone panel done and you might also want to test some things like stomach acid level, H.pylori, candida, etc. There is really no clue what your body is doing right now. If spiro has stopped working then likely you are not a simple high androgen case anymore.
Hi GreenGables, thank you for your answer. Indeed, it's not the easy answer I wanted, but it's probably what I need to hear.
I just wanted to add, that I too started to get moderate-severe acne after having anorexia or an eating disorder. I used to eat 300-500 cals a day. I had a BMI about 16-17. It was a psychological thing. My periods stopped, or would come maybe once every year or six months. I went on low dose accutane, and went off early. Now, I have my periods back and no oily skin and no acne. (I have always had dry skin though but it was oily while it was very bad). But, it might as well just have been Accutane. But, the eating disorder definitely made it bad back then. One thing though, I have my painful periods and tender breasts (just before period) back that I have had all my life. Also, they are becoming a bit more irregular, that is, they come every 32-34 days, sometimes every 14-20 days. But, no acne. So, maybe PMS is not as important as you think? Maybe body is adjusting again after relapse? Takes about 2-3 months for acne to form. I juice veggies everyday (or at least 5 days a week). Maybe you could try that? I think it is helping a lot, gives you a lot of energy too.
Just FYI, don't go down the restrictive diet road. I started eating dairy and stuff about 2-3 months ago, and it isn't even affecting me. I think it was the stress + eating disorder that caused it for me. So yes. It will take time for your body to readjust. Just remember that this is the cause so you should always focus on your stress level and that you are getting enough food daily. I get some small papules when I am stressing, but they go away after a bit. Try to take it easy on yourself.
I would suggest like Differin or something. I use it at most ONCE weekly. Yeah, that is all you need. The rest of the time I use nothing but vaseline or raw honey.
Good luck.
(I have also thought about trying herbs for that but decided against it, I take NAC and triphala though)
1. It would be difficult to accurately give an answer. Do you have a full hormone panel as well as an ESTF prior to the anorexia incidence and post-recovery? It's a rather subjective matter to say how much damage occured from having that incidence with anorexia, or if one could accurately calculate the threshold by which the damage went too far for the body to successfuly regenerate.
You did experience it in your later years which can be positive/negative. Theoretically speaking from an endocrinology standpoint...the HPTA/HPOA (males-hypothalamic-pituitary-testicular-axis/females-hypothalamic-pituitary-ovarian-axis) is undergoing changes that inititate substantially during puberty and gradually level out at the generalized age of 25. With that being said you may have avoided a possible catastrophic alteration to the development and regulatory mechanisms associated with sustained homeostasis, but it is difficult to say what could have been altered at this late in the stage. Generally issues with the endocrine system don't display themselves as an acute physical symptom immediately, but progessively add to issues later on in your life.
2. By DIM I'm assuming its Diindolylmethane? It has an affinity for coupling with so many various receptors its hard to accurately describe the pharmacokinetics associated with it...
Spiro acts on the following proteins..
-Androgen Receptor
-Progesterone Receptor
-Glucocorticoid Receptor
-Cytochrome P450 11B2 (mitochondrial activity)
-17 Alpha-Hydroxylase
-17,20-desmolase
-3-oxo-5-alpha-steroid-4-dehydrogenase
-sex hormone binding globulin (the antiestrogen activites are heavily involved here)
-voltage-dependant calcium channel
-dihydrotestosterone (DHT)
DIM acts on the following proteins...
There could be an instance of competition for androgen receptors. However the mechanism at which it displays agonist/antagonist affinity is selective. You could almsot label it a SARM (selective androgen receptor modulator) Its a partial agonist, but it expresses its activity in a selective manner.
They both express acitivty on estrogen receptors. However, spiro is more radical in the approach. I'll try to simplify this...
DIM can compete for ER against oestrogenic compounds (E1-estrone,E2-estradiol,E3-Estriol) and once bound inhibits the transcription of the gene. Essentially gene regulation. (inhibition of estrogen dependant gene expression) This also allows for modulation of oestrogen mediated metabolic markers. Now...this regulation isn't exactly "mutual" in regards to E2's activity. Spiro adds a whole new complexity due to its binding of SHBG to an extremely high affinity that results in displacement of estrogens with weaker binding capabilities (estradiol, estrone) BUT, it mitigates the conversion of estradiol to estrone...
which is good because estrone is an extremely powerful hormone....
DIM isn't on the list of validated interactions in regards to pharmacology. Just ask your doctor.
I just wanted to add, that I too started to get moderate-severe acne after having anorexia or an eating disorder. I used to eat 300-500 cals a day. I had a BMI about 16-17. It was a psychological thing. My periods stopped, or would come maybe once every year or six months. I went on low dose accutane, and went off early. Now, I have my periods back and no oily skin and no acne. (I have always had dry skin though but it was oily while it was very bad). But, it might as well just have been Accutane. But, the eating disorder definitely made it bad back then. One thing though, I have my painful periods and tender breasts (just before period) back that I have had all my life. Also, they are becoming a bit more irregular, that is, they come every 32-34 days, sometimes every 14-20 days. But, no acne. So, maybe PMS is not as important as you think? Maybe body is adjusting again after relapse? Takes about 2-3 months for acne to form. I juice veggies everyday (or at least 5 days a week). Maybe you could try that? I think it is helping a lot, gives you a lot of energy too.
Just FYI, don't go down the restrictive diet road. I started eating dairy and stuff about 2-3 months ago, and it isn't even affecting me. I think it was the stress + eating disorder that caused it for me. So yes. It will take time for your body to readjust. Just remember that this is the cause so you should always focus on your stress level and that you are getting enough food daily. I get some small papules when I am stressing, but they go away after a bit. Try to take it easy on yourself.
I would suggest like Differin or something. I use it at most ONCE weekly. Yeah, that is all you need. The rest of the time I use nothing but vaseline or raw honey.
Good luck.
(I have also thought about trying herbs for that but decided against it, I take NAC and triphala though)
There is definitely validity to the anorexia/ eating disorders - acne connection. My first acne breakouts coincided with a recovery from anorexia, but because it also coincided with getting my period for the first time & being a teenager, it was difficult to pinpoint to what extent anorexia caused some imbalances. I even read that anorexia can trigger PCOS symptoms, such as hirsutism and hormonal imbalances.
I use yogurt and honey topically, and might try azelaic acid as recommended by an integrative dermatologist. I also pay a lot of attention to a healthy , low histamine diet, and avoid harsh chemicals and too many cosmetics. Most importantly, I try to be as mentally healthy as possible, which, if you are bouncing back from anorexia nervosa, it is just as important in the healing process as physical recovery.