The duration of an average menstrual cycle in a woman is about 28 days and the hormones fluctuate continuously throughout the cycle. During the first half of your menstrual cycle, the levels of estrogen hormone rise, whereas during the second half of the cycle there is a rise in the levels of progesterone hormone. But as your period approaches, the levels of both these hormones fall. Meanwhile, the level of testosterone, which is a male hormone and is made in small quantity by women, stays constant. This implies that before and during your periods, the level of testosterone is relatively higher in comparison to the female hormones (estrogen and progesterone).
Due to these hormonal shifts, all sorts of changes happen to a female’s skin. The rise in progesterone hormone during the middle of your menstrual cycle stimulates the secretion of sebum from your sebaceous glands. Sebum is an oily, thick substance that naturally lubricates your skin. The increased level of progesterone may also cause swelling of your skin and compression of your skin pores. Due to this sebum is build up beneath the surface of the skin.
Furthermore, increased testosterone levels before and during menses may stimulate the sebaceous glands and they secrete more sebum. The effects of increased sebum may vary in different women. For some women, it may produce a healthy glow on the skin, whereas in others it may cause premenstrual acne as the skin pores become clogged due to the excess oil along with dirt, debris, and dead skin cells.
Increased sebum or oil forms a perfect breeding ground for the acne-causing bacteria Cutibacterium acnes. Your immune system produces a reaction to the bacteria and its metabolites and results in inflammation accompanying pimples before period.
The lesions that form on your skin by premenstrual acne may include comedones that are of two types- whiteheads and blackheads. The blackheads are the open comedones as they are open at the skin surface. They appear black due to the oxygen’s effect on them. The whiteheads are the closed comedones as they are closed beneath the surface of the skin.
Apart from whiteheads and blackheads, the other symptoms of acne before periods may include:
Papules: small raised red bumps that occur due to infection and inflammation of hair follicles.
Pustules: small red pus-filled pimples.
Nodules: solid lumps that are often painful and are present underneath the skin surface.
Cysts: large lumps that are present underneath the skin surface. They contain pus and are generally painful.
The areas of the chin and jawline are more prone to get premenstrual acne.
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Yes, premenstrual acne is a form of hormonal acne as it occurs in response to fluctuation in the levels of hormones during your menstrual cycle.
You may prevent and manage acne before period by doing the following:
Birth control pills. If you feel that you are breaking out before period on a regular basis, then taking birth control pills may help you. Anything that increases your estrogen levels may lessen the effects of testosterone. Birth control pills increase a protein known as sex-hormone binding globulin (SHBG) in your blood. This protein acts as a sponge and may soak the free testosterone present in the bloodstream. This implies that there is less amount of testosterone available for causing acne before period.
Birth control pills may also work by reducing the production of oil. You should be patient while using birth control pills to manage premenstrual acne. In some women, acne may increase for the initial three to four months after they start taking these pills in response to hormonal changes. But this may subside as the body adjusts to the pills.
Spironolactone. If you don’t get a response to birth control pills, your physician may add medicine to reduce your levels of testosterone. This medicine is known as Spironolactone and it reduces production of oil in the skin related to testosterone. The side effects of taking Spironolactone may include irregular periods, breast tenderness, fatigue, and headaches. Spironolactone may not suit all women; hence, you should discuss its benefits and risks with your physician.
Weight loss. Anything, which reduces SHBG, may result in increased acne. Obesity is one of the major factors that reduce SHBG and increase testosterone. Thus, eating a well-balanced and healthy diet and maintaining an optimum and healthy weight may help in controlling acne before periods.
Practice skin hygiene of high quality. Any extra bacteria that you bring to your face may aggravate premenstrual acne. You should keep the skin as clean as possible to prevent acne before periods. Don’t touch your face too often as your hands may introduce bacteria and dirt to the skin. Clean your phone regularly as it’s a breeding ground for bacteria. Furthermore, you keep it against the area that is most vulnerable to premenstrual acne; your chin and jawline. While working out at a gym, you should cover all the mats using a towel. This way you will avoid putting your face in the germs of other people. Avoid smoking as smoking contributes to all kinds of acne.
For severe premenstrual acne, you should visit a dermatologist. They may prescribe one of the following medicines to relieve your symptoms of acne before period:
Isotretinoin. If other treatments haven’t worked for you or you suffer from severe cystic acne, then you may try isotretinoin. It is a vitamin A derivative. The drug may cause various side effects including birth defects in pregnant females and increased risk of suicide. Thus before using this drug, discuss all the risks and side effects with your physician.
Antibiotics (low-dose). If you suffer from deep-seated acne lesions, your doctor may prescribe low-dose tetracycline for five days, which you may start a few days before the beginning of your periods.
Your dermatologist may ease acne before periods by performing certain in-office treatments including cortisone injections, a chemical peel, and laser therapy or acne surgery.
You may also take some general steps to prevent acne before period. Some of these are:
- Wash your face two times per day with a cleanser that doesn’t contain oil.
- Use an over-the-counter anti-acne cream to remove excessive oil.
- Avoid makeup containing oil.
- Remove makeup and clean your skin before going to bed.
- Take a shower after exercising.
- Avoid wearing tight-fitting clothing.
- Reduce your stress levels.
- Eat a well-balanced and healthy diet that contains a minimal amount of refined sugars and fats.
Acne before period is a very common symptom of premenstrual syndrome (PMS). It may occur due to the hormonal fluctuations that happen during the menstrual cycle of every woman. The increased progesterone during the middle of the cycle may stimulate the secretion of sebum from the sebaceous glands. The secretion of sebum is also stimulated by increased levels of testosterone during and before menses. This may lead to the occurrence of premenstrual acne as the pores are clogged with excess oil, dirt, and dead skin cells. The bacteria breed in the clogged pores and produce infection. The characteristic symptoms of premenstrual acne are the presence of whiteheads, blackheads, papules, pustules, nodules, and cysts. You may prevent acne before periods by taking birth control pills and medicine known as Spironolactone. Obese females are more prone to suffer from acne before period; hence, they may benefit from losing weight. You should practice good skin hygiene to prevent premenstrual acne. Your physician may prescribe isotretinoin or low-dose antibiotics for the severe form of acne.