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By: Megan Kelly (CNP)

So you’re bloated, moody, cramping, and now on top of all of that you’ve got a big red pimple on your chin!? What the heck is going on!?

Unfortunately, premenstrual acne is very common. According to a study published in the Archives of Dermatology, more than 60 percent of acne-prone women develop acne before their period. These flares tend to strike about 7-10 days before the onset of a woman’s period and then subside as soon as the period begins.

THE SCIENCE BEHIND PREMENSTRUAL ACNE

The average menstrual cycle is about 28 day from beginning to end, following a pattern of hormone fluctuation. During the first half of your cycle, estrogen levels rise. During the second half of the cycle, progesterone levels rise. Then, just before your period, both of these hormones drop. Meanwhile, your testosterone levels stay constant. This leaves us with higher ratios of testosterone in comparison to estrogen and progesterone.

Each of these hormonal shifts can create changes to the skin. The rise of progesterone during the second half of your cycle stimulates the secretion of sebum from your sebaceous glands. Sebum is a thick, oil substance that naturally lubricates the skin. You may also experience swelling of the skin and compression of the pores. This traps sebum under the surface of the skin and promotes build-up.

Then, when testosterone become dominant just before and during menses, this hormone promotes even more sebum production. This can go one of two ways for women. Generally, either it will produce a healthy glow on the skin or it will provoke that acne flare that so many of us experience. I know. Who are these people who get that lovely glow, right?! No fair!

The exponential increase in sebum production right before and just as your period begins creates an ideal environment of acne causing bacteria to breed. Your immune system, then, produces a reaction to the bacteria and its metabolites and this results in inflammation and… you guessed it… that pesky premenstrual acne.

HOW DO I KNOW IF MY ACNE IS HORMONAL?

As an adult female, the big giveaway is if it happens once a month right before and into the first days of your period and then clears up. But there are a few other things to look out for or expect if it is hormonal.

  • Hormonal adult acne typically forms on the lower part of your face. This includes the bottom of your cheeks and around your jawline.
  • Typically, breakouts will occur in the form of blackheads, whiteheads and/or small pimples that come to a head.
  • You may also experience cysts that form deep under the skin and don’t come to a head on the surface. These bumps are often tender to the touch.

If your acne does not follow that once a month pattern, that doesn’t necessarily mean it doesn’t have anything to do with hormones. Hormonal acne may also be cause by influxes of hormones due to an underlying condition, such as:

  • Polycystic ovarian syndrome (PCOS)
  • Menopause
  • Increased androgen levels

When experiencing adult acne, it is wise to check in with your naturopathic doctor to determine if there are any underlying conditions.

SO, WHAT CAN I DO ABOUT IT?

Since the causes of premenstrual acne are a cascade of hormonal fluctuations, sebum accumulation, bacterial growth and inflammation, these are the things we want to address directly.

Nutrition

Working with your nutritionist to determine dietary triggers could be an important part of balancing hormones, reducing inflammation and supporting overall skin health.

Fruits and vegetables high in antioxidants and skin-fortifying nutrients like berries, cherries, carrots and beets, may help reduce inflammation and promote clearer skin.

Omega-3 fatty acids may also decrease skin inflammation.

Anti-inflammatory herbs such as turmeric, ginger, cinnamon, parsley, garlic and cayenne may also provide some benefit.

Green tea is also known for decreasing inflammation in the body due to the particularly high levels of unique antioxidants. Consider incorporating a few cups a day. You may also find some skin care product contain green tea extracts! Studies suggest that lotions and gels containing at least 2 percent of the extract may be beneficial. 

You may also consider limiting sugar, refined carbohydrates and dairy products.

Supplementation

The research supports that targeted supplementation may also ease acne.

For example, studies have linked low vitamin D levels to more severe acne symptoms. Since vitamin D interacts so closely with your hormonal systems and influences inflammation, this could be a key nutrient to consider. However, you should not start supplementing without the guidance of a health care practitioners. There are tolerable upper levels of vitamin D, beyond which you may experience symptoms of toxicity. Always test where your levels are at and work with a practitioner to determine the dose that is right for you.

Supplementation goes and hand in hand with nutritional therapy. Other nutrients such as B-vitamins and zinc, may also be key in reducing acne flares. However, once again, it is best to work both with your nutritionist and ND to determine what you need and how much.

Additionally, your ND may be able to suggest some herbal supplementation for hormonal balance and anti-inflammatory action such as vitex and barberry. Once more, please consult with your health care practitioner before trying these therapies as they can have dramatic effects and need to be professionally monitored.

Topical Applications

Although the greatest effect is from the inside out, once the acne is present some topical treatments may be effective at minimizing the acne flare.

Tea tree oil works by decreasing inflammation and reducing bacteria that can contribute to acne. One study found that 5 percent topical tea tree oil relieved symptoms in participants with mild to moderate acne.

You can find tea tree oil in many skin care products, such as cleansers and toners. The essential oil can also be used as a spot treatement. However, be weary that you should always dilute the essential oil with a carrier oil before use. The general rule is to add about 12 drops of carrier oil to every one to two drops of essential oil. Coconut, jojoba and olive oil all make fantastic carriers.

Alpha hydroxy acids (AHAs) are plant acids derived mostly from citrus fruits. AHAs can help remove excess dead skin cells clogging pores. They may also help minimize the appearance of acne scars. Aha!

AHAs can be found in many over-the-counter masks and creams. A word of warning, however, that as with retinoids, AHAs can increase your skin’s sensitivity to the sun. Avoid direct sunlight and wear a natural sunscreen when using products containing AHA.

Other Considerations

You may also want to consider certain lifestyle tactics, including getting enough sleep. Our circadian rhythms help to regulate our hormonal cycles. Sleep is also a time for detoxification and repair, so the implications for both hormonal and skin health are significant.

Finding ways to reduce stress like incorporating meditation, breathing exercises and yoga can also significantly improve acne symptoms and reduce hormonal imbalances.

CONCLUSION

Premenstrual acne is all about those hormonal shifts and the build-up of sebum underneath the skin’s surface.  Reducing any hormonal imbalance and directly addressing any inflammation in the body is the most effective way to reduce premenstrual acne.

There are many natural therapies to consider. I encourage you to reach out to both your nutritional and naturopathic doctor to develop a holistic protocol that is right for you.

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