The menstrual cycle influences acne. Many women experience an acne flare approximately 7-10 days before their period, and then see improvement in their acne once menstruation starts. These cyclical acne flares result from the fluctuation of hormones during the menstrual cycle.
First let's look at the hormones that fluctuate over a woman's monthly cycle. Each of these hormones plays a different role in acne:
- Estrogens: As a whole, estrogens reduce acne. They reduce the amount of skin oil that the body produces, which can in turn reduce acne. They can also reduce the production of androgens (male hormones present in both males and females), which also typically results in less acne. Lastly, estrogens possess anti-inflammatory properties. Since acne is an inflammatory disease, this means estrogens can reduce acne in this way as well.
- Androgens: As a whole, androgens increase acne. Higher levels of androgens increase skin oil production and tend to lead to more acne.
Progesterone: Scientists are still not certain how progesterone might affect acne. It might be responsible for fluctuating levels of skin oil throughout the menstrual cycle. However, this has not been proven in the research.1,2
The Science: Why Does Acne Spike in the Premenstrual Window?
The primary reason why acne may occur in the premenstrual window is due to fluctuating hormones. A 2011 systematic review published in Clinical Biochemistry looked at many studies in order to examine the role that hormones play in acne and found that:
When acne was present, blood levels of estrogen were low, and blood levels of progesterone were high. The review did not specifically look at menstrual cycles, however, they do tell us about the relationship between changing hormones and acne. The authors noted that:
- Since estrogens reduce skin oil production and probably reduce androgen levels, low estrogen levels in the blood most likely contributed to acne.
- Since estrogens may provide an anti-inflammatory effect, and acne is primarily an inflammatory disease, lower levels of estrogen might contribute to acne inflammation.
- It is unclear what effects, if any, progesterone had on acne.2
Another reason why acne occurs in the premenstrual window may be due to skin pores contracting at this time, which in turn allows them to become more easily clogged, trapping sebum (skin oil) inside, and leading to acne. A small 1973 study in The Lancet measured the diameter of skin pores in 23 women who had mild-to-moderate acne and found that:
Pore openings were smallest between the 15th and 20th days of the menstrual cycle. Smaller pores allow for skin oil to get stuck in the skin oil gland and clog the pores. Clogged pores can lead to acne. The authors also interviewed the women and found that their acne was worst on the 22nd day of the menstrual cycle, just a few days after pore openings got smaller. The authors concluded, “Obstruction of the [pore] is almost certainly one of the earliest changes needed for the development of an individual acne lesion.”3
The Evidence: Women Experience More Acne During the Premenstrual Window
What is clear is that acne does in fact flare in the premenstrual window, and this is backed up by several studies.
A 2001 study in the Journal of the European Academy of Dermatology and Venereology had 3394 French women complete a questionnaire about their acne. This study found that 78% of the women reported having premenstrual acne flares.4
Another 2001 study in the Journal of the American Academy of Dermatology interviewed 400 American women who had acne. This study found that 44% of the women experienced premenstrual acne flares.5
A 2004 study published in Archives of Dermatology counted acne lesions during two menstrual cycles in adult women. This study found that in 63% of the women, inflammatory acne lesions increased by 25% during the premenstrual phase. The authors concluded, “[W]e believe that our observational data complement and confirm the results obtained by questionnaire that a significant number of adult women have a premenstrual flare of acne.”6
A 2009 study of 503 female high school students published in the Journal of Investigative Dermatology found that acne was more severe during the premenstrual period. They concluded, “The premenstrual phase in female high school pupils…[was] positively associated with the severity of…acne.”7
From these studies, we can see that premenstrual acne flares are common, and many women experience them.
So What Can Be Done About It?
Proper topical treatment of acne is normally strong enough to keep acne at bay during the premenstrual window, and comes with very few, manageable side effects.
Sometimes, doctors will prescribe birth control pills called combined oral contraceptives (COCs) when acne flares are especially severe, or when an oral contraceptive is desired or necessary for other reasons.
Combined oral contraceptives contain a combination of synthetic estrogen and synthetic progesterone. Certain forms of synthetic progesterone, notably cyproterone acetate, dienogest, drospirenone, and chlormadinone acetate, are able to suppress androgens. However, research has shown that all COCs are effective in treating acne, so when it comes to premenstrual acne, there is no one proven birth control pill that is better than another.7,8
Oral contraceptives, while effective for reducing acne (on average by about 66%), come with a plethora of side effects, so be sure to have a serious conversation with your doctor before you embark upon this kind of hormonal therapy.