Hormonal Acne — Causes, Patterns, and Solutions

If you’ve noticed your breakouts follow a predictable pattern — appearing right before your period or around ovulation — you’re likely dealing with hormonal acne. Let’s dive into why this happens and what you can do about it.

What is Hormonal Acne?

Hormonal acne is acne that’s directly linked to fluctuations in your hormones. Unlike teenage acne, which is often related to puberty, hormonal acne typically affects adults and follows your menstrual cycle.

How to Identify Hormonal Acne

Location

Hormonal acne typically appears on the:

Jawline
Chin
Lower cheeks
Neck
Sometimes the back and chest

Timing

Breakouts often occur:

7-10 days before your period (luteal phase)
Around ovulation
During times of stress
With PCOS or other hormonal conditions

Type of Blemishes

Hormonal acne tends to be:

Deep, cystic nodules
Painful to touch
Slow to heal
Likely to leave marks or scars

The Hormone-Skin Connection

Androgens

Testosterone and other androgens increase sebum (oil) production. More oil means clogged pores and acne.

Estrogen and Progesterone

During your cycle:

Week 1-2: Estrogen rises, skin often looks best
Ovulation: Brief testosterone spike may trigger breakouts
Week 3-4: Progesterone rises, increases oil production
Pre-period: Both hormones drop, inflammation increases

Cortisol

Stress raises cortisol, which can:

Increase oil production
Trigger inflammation
Worsen existing breakouts

Conditions That Cause Hormonal Acne

PCOS — elevated androgens
Perimenopause — fluctuating estrogen
Coming off birth control — hormonal adjustment
Thyroid disorders — can affect hormone balance
Insulin resistance — increases androgens

Evidence-Based Treatments

Topical Treatments

Retinoids — gold standard for acne, regulates cell turnover
Benzoyl peroxide — kills acne-causing bacteria
Niacinamide — reduces oil and inflammation
Azelaic acid — antibacterial and helps with marks

Oral Treatments (Prescription)

Spironolactone — blocks androgens at the skin level
Birth control pills — regulates hormones (if appropriate)
Oral antibiotics — for severe inflammatory acne

Lifestyle Changes

Diet:

Reduce high-glycemic foods
Limit dairy (especially skim milk)
Increase omega-3s
Consider zinc supplements

Stress Management:

Regular exercise
Adequate sleep (7-9 hours)
Meditation or relaxation practices

Skincare Routine:

Gentle, non-stripping cleanser
Non-comedogenic moisturizer
Consistent routine (don’t over-treat)
Weekly exfoliation (gentle)

Natural Approaches

Supplements (Consult Your Provider)

Zinc — may reduce acne by 50%
Omega-3s — anti-inflammatory
Spearmint tea — may reduce androgens
DIM — supports healthy estrogen metabolism
Berberine — helps with insulin resistance

Seed Cycling

Some women find seed cycling helps balance hormones:

Days 1-14: Flax and pumpkin seeds
Days 15-28: Sesame and sunflower seeds

When to See a Dermatologist

Consider professional help if:

Over-the-counter treatments aren’t working
You’re developing scars
Acne is affecting your mental health
You suspect PCOS or another condition

Track Your Breakouts

Understanding your acne patterns is the first step to treating it. Use Ona to:

Log breakouts and their severity
Correlate with your cycle phase
Track which treatments help
Identify food or stress triggers

Knowledge is power when it comes to hormonal acne. Once you understand your patterns, you can take targeted action.