Your menstrual cycle is controlled by several hormones within the body. The average cycle lasts about 28 days and on each one of those days, your hormone levels can change. The changes your body goes through in the first “half” of your cycle are predominantly controlled by estrogen and the second “half” is influenced by progesterone.
If you are one of those women that experience menstrual acne, you have probably realized that you will typically get breakouts about 7-10 days before your period begins. It is during this time that these two hormones fall to their lowest levels throughout the menstrual cycle. This drop in hormones is what triggers the breakdown of the uterine lining and ultimately the bleeding that you experience each month.
Period acne is different than the typical acne you may experience during other weeks of your menstrual cycle. These breakouts of pimples are usually on the lower half of your face (chin, cheeks), jawline and neck. They are usually red, inflamed, raised bumps (papules) that rarely develop into a white head. They can be very frustrating but try to resist squeezing them. This may only make them worse and take longer to go away.
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The hormonal changes that you experience during the second part of your cycle not only influence mood but cause physiological changes that are a perfect “habitat” for the pimples to grow in. At the same time, you may experience PMS symptoms and the last thing you need is a big ugly pimple on your chin!
Around mid-cycle, the progesterone levels in your body rise. This, in turn, causes the sebaceous glands in your skin to produce more sebum. Sebum is a thick, oily substance that will collect in the pores and on the surface of the skin, making it a little oilier than normal. This oil is a perfect place for bacteria to collect and multiply.
At the same time, your body is retaining water. This is why some women may feel bloated at this time as well. Now, for some women, this increase in fluid in the skin gives it a little more fullness and combined with the extra oil the look like their skin is “glowing”. For other women, this process causes the pores to swell and close off, trapping the extra sebum and bacteria in place. This leads to period acne.
By the time that you reach an age that you may start experiencing the signs and symptoms of menopause, you surely don’t expect that acne will be one of them. However, let’s stop here for a moment. Acne during your period is caused by changes in the sexual hormones associated with your menstrual cycle and as you approach menopause these same hormones are making some drastic changes as well.
The term “menopause” simply means the ceasing of the menstrual cycle and consists of the 12 months following a woman’s final period. However, according to the National Institute on Aging, the time leading up to menopause (perimenopause) can last from 7 to 14 years! During this time, the levels of estrogen are dropping. This can cause hot flashes, sleeping difficulties, mood swings, and skin changes.
During perimenopause, estrogen levels in a woman’s body decline, but testosterone levels remain consistent. This shift in hormones combined with a decrease in skin cell regeneration can lead to clogged pores and can cause women to experience acne for the first time in years. This is just one more “bonus” that goes along with the phase in your life! These outbreaks are usually located on the cheeks, chin, jawline, neck, and back.
If you are not at the typical age that most women experience symptoms of perimenopause (mid-40s) and are experiencing a sudden outset of severe acne, this may be due to a more serious health condition related to hormonal imbalance. These symptoms are usually not related to normal hormone changes during your menstrual cycle and you should consult your medical care provider.
Acne is most common during the adolescent and teen years. However, acne can continue into adulthood and can be severe. According to recent studies, physiological acne in adults can be seen in 54% of women.
Cystic acne can occur as a result of the menstrual cycle as well as during other events in your life, like pregnancy and perimenopause because of hormonal changes.
This form of acne can be far more difficult to treat, due to the fact that lesions are deeper in the skin, causing severe inflammation, pain, and scaring or pitting of the skin. These lesions can be found on the face, neck, chest, and back. There isn’t just one cause of cystic acne though. For some women, it is strictly hormonal, and they respond well to oral contraceptives or low-dose spironolactone. Others experience cystic acne because of genetics or they are just acne-prone. For these women, a more aggressive approach may be necessary with an oral form of vitamin A called isotretinoin. This is considered to be the best form of treatment for resistant cystic acne.
Isotretinoin works by targets all the sources of cystic acne. It kills the acne-causing bacteria, unclogs pores and decreases excess oil and inflammation. The course of treatment with this prescription medication usually takes 4 – 5 months and can have some serious side effects, particularly for women.
It is necessary for women taking isotretinoin to consent to a premedication pregnancy test to confirm that you are not pregnant and others while you are taking the medication. In addition, you must use at least one form of effective contraception in order to prevent pregnancy. Studies have shown that this medication is considered to be teratogenic, causing developmental malformations (birth defects).
There are several different options available today for women to treat those mild to moderate monthly breakouts. The more common treatments options include the following:
Topical creams, gels, ointments, and washes
These can be both over-the-counter (OTC) and by prescription. The most common OTC brands contain benzoyl peroxide or salicylic acid. There are far more options that are available by prescription and are typically prescribed by a dermatologist. They include:
- Azelaic acid. This medication kills bacteria and reduces inflammation. In addition, it has been found to significantly diminish the appearance of skin blemishes, help fade post-acne marks and other discolorations, refine skin’s surface, and even skin tone.
- Retinol. Made from vitamin A, promotes new skin cell production to push oils and dead skin out of blocked pores. By doing this it helps to prevent blackheads and whiteheads.
Only three variations of the pills have been approved by the FDA for treating acne. All three are COCs that contain both estrogen and progesterone. In fact, progesterone-only can make acne worse.
Treating acne can be a true trial and error process to find the right one that works for you. This can be especially difficult for women because of the continuous hormonal changes that are experienced throughout their lifetime.
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Kronemyer, B. (2017). Spironolactone safe and effective for adult female acne. Dermatology Times, Retrieved from http://www.dermatologytimes.com/dermatology/spironolactone-safe-and-effective-adult-female-acne
National Institute on Aging (NIA). (2018). What is Menopause? Retrieved from https://www.nia.nih.gov/health/what-menopause.
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