Hormonal Acne: Stop the Breakouts Now

The monthly dread of hormonal acne – I know what that’s like!

But it’s not easy to get rid of, either. As you probably know, your hormonal acne has a vast array of potential causes.

This is why it can be so difficult to clear up!

For some people, simple dietary changes may clear up their skin (hooray!), but for others it can be a long an arduous journey, stumbling around in the dark with a lot of trial and error to achieve clear skin.

However, it doesn’t have to be a long struggle for clear skin if you can pinpoint the underlying triggers. Hormonal imbalances are a very common cause of acne, and I’m going to delve into this topic in detail so you can understand why this can occur, and how you can treat it!

Hormones are abundant in the body, constantly involved in complex and far-reaching processes. No hormone acts in isolation, so when one is out of balance, it will disrupt the whole endocrine system. This article will discuss hormonal imbalances related to pre-menstrual acne.

A brief overview of the menstrual cycle and its hormones.

In order to understand hormonal imbalance, it’s important to first know what hormonal balance is and what should occur ideally.

Your period is really a monthly report on your health, and if everything is in balance you should expect to have a normal length cycle, with little-to-no PMS symptoms and a painless period without heavy bleeding. You might be thinking ‘As if that actually exists?!’ right now, but unfortunately so many women experience hormonal imbalances, stress, nutritional deficiencies and general ill-health, that things like PMS and period pain have become the norm. PMS is common, but it’s not normal.

So, let’s get into it:

A menstrual cycle starts at the first day of your period bleed, right until the first day of your next period. A normal cycle length is anywhere between 23 and 35 days in length, and varies from woman to woman. Although the ‘text-book’ menstrual cycle is based on 28 days, this is not always the case. Anything outside this 23-35 day cycle length is considered abnormal and will most often indicate hormonal dysfunction somewhere along the line.

There are many hormones involved in regulating the menstrual cycle, but (so it doesn’t get too confusing!) the main ones are:

  • Estrogen
  • Progesterone
  • Luteinizing hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • Testosterone and other androgens (Androstenedione, DHEA-s)

The purpose of the menstrual cycle is ovulation (the release of an egg), so a baby can be made! If fertilization of an egg occurs, the above hormones kick in to promote all the necessary requirements for a healthy pregnancy. If fertilization does not occur, after ovulation the uterus lining will shed (your period bleed), to make way for a new ‘spritzed-up’ uterine lining for next ovulation (the body is always hoping!).

Ovulation is meant to occur smack-bang in the middle of your menstrual cycle- at text-book day 14 if you have a 28 day cycle. You will generally get your period 14 days after ovulation, so if your menstrual cycle is 25 days, you may ovulate on day 11.

Ovulation divides the menstrual cycle into 2 phases: the first phase is when estrogen is the star, and the second phase focuses on progesterone. Progesterone is mostly secreted from the ovarian follicle after ovulation (a tiny bit is secreted from your adrenal glands), which develops into a sac called the corpus luteum.

Therefore, in order to have adequate levels of progesterone you need to have ovulated.

This is central to the discussion of hormonal balance, because many women don’t ovulate every menstrual cycle due to stress, illness and nutritional inadequacies. Estrogen and progesterone like to work together in balance, and the ratio between the levels of these hormones is extremely important. Estrogen is ‘proliferative’, meaning it promotes cells growth (things like breast and hip development in puberty), and promotes smooth, plump skin, healthy bones and arteries. Progesterone is ‘secretory’, meaning that it promotes vascular development and the maintenance of the uterine lining after ovulation.

Hormonal imbalance can occur when:

  • Estrogen levels are high, and progesterone is normal
  • Estrogen levels are high and progesterone is low
  • Estrogen levels are normal and progesterone levels are low

Pre-Menstrual Acne and Estrogen

Pre-menstrual acne can occur anywhere in the 1-2 weeks before your period. This acne is related to the hormonal fluctuations of a woman’s menstrual cycle, and involves the hormones estrogen, progesterone and the androgens.

After ovulation, in the second part of the menstrual cycle the amount of hormones increases, because we now have estrogen and progesterone. Estrogen will naturally start to decline now while progesterone begins to rise. But how do estrogen levels drop?

Too high or too little estrogen can cause disruption to the menstrual cycle, and can impact progesterone levels by impairing ovulation. So, we want estrogen to be at just the right amount- not too high and not too low. Estrogen is broken down (metabolized) through the liver and eliminated via the kidneys and intestines (in your pee and poop). If estrogen is not metabolized properly, then the levels build and build which can result in estrogen excess. Too much estrogen, and certain metabolites of estrogen can cause inflammation. This is where high estrogen levels can trigger pre-menstrual acne.

The cause? Too much re-circulating estrogen and/or not enough good liver detoxification going on.

Pre-Menstrual acne is a sign that your liver needs some love!

Higher amounts of hormones place a greater burden on the liver’s detoxification pathways. Don’t forget, the liver has to metabolize every single substance that enters our bodies- food, environmental toxins, metabolic waste products, red blood cells and much more. It also metabolizes our hormones, especially estrogen (and all the estrogen metabolites).

Signs your liver needs some support

  • Headaches and migraines
  • Constipation
  • Acne
  • Eczema
  • Irritability
  • PMS
  • Nausea and indigestion
  • Sinus congestion (sinusitis, rhinitis)
  • Allergies
  • Insulin resistance and metabolic syndrome

How can you support your liver and make sure you’re excreting excess hormones?

  • Make sure you’re pooping at least once per day. If you’re bowels are congested, this increases your overall toxic load, which has to get processed in the liver.
  • Eat enough fibre- we require at least 30 grams per day, and many of us reach about half of this. Fibre binds to metabolized hormones and cholesterol (in bile) and moves them out of the body via the intestines. Up your intake of veggies, beans, legumes, nuts, seeds and gluten-free grains.
  • Cruciferous vegetables contain glucosinolates, which are broken down to indole-3-carbinol. This compound support the detoxification of estrogens. So eat more broccoli, cauliflower, cabbage and kale every day.
  • Eat bitter foods- bitter greens like rocket (arugula), endive and bitter lettuces stimulate the production of digestive secretions, such a bile in the liver. Bile contains metabolized hormones and waste products, so we want to make sure it leaves the body so the liver can continually process new fresh bile.
  • Include rosemary and turmeric in your diet as much as possible. These reduce inflammation in the liver and support detoxification pathways.
  • Make sure you’re don’t have hidden food intolerances. These will cause inflammation in the GIT and place an extra burden on your liver.
  • Balance your gut bugs! Your microbiota (intestinal bacteria) also play a large role in metabolizing estrogens. Consume fermented foods with each meal: yogurts, kefir, sauerkraut, fermented veggies and kombucha, and feed your bugs with probiotic fibres: green bananas, cold potatoes, wholegrains, legumes, fruits and veggies.

Pre-Menstrual Acne and Progesterone

If your progesterone levels are out of balance this can also lead to hormonal acne, as well as many other symptoms related to PMS and infertility. Adequate progesterone levels have been shown to block the activity of DHT, the most potent of androgens, that is present in the skin and contributes to the formation of acne.

As we discussed earlier, progesterone is mainly produced once ovulation has occurred. The egg is released from a structure called the follicle, and once ovulation has occurred, the follicle forms the ‘corpus luteum’, which is a secretory endocrine structure that produces most of our progesterone.

Progesterone and estrogen work in a balanced ratio, and when this occurs there will be no PMS symptoms and fertility will be optimal. Issues arise when a woman fails to ovulate (progesterone is not produced), or her body does not have the requirements to maintain the corpus luteum adequately, and therefore her progesterone levels are insufficient.

Reasons why women fail to ovulate:

  • High estrogen levels block the hormonal cascade that triggers ovulation
  • Polycystic ovarian syndrome (PCOS)
  • Nutritional insufficiency
  • Low body fat percentage
  • Stress
  • Ovarian failure and menopause

Reasons why women may have corpus luteum insufficiency and produce inadequate progesterone:

  • Insufficient nutrients require to maintain the corpus luteum and produce hormones
  • Stress
  • Inflammation

So, how can these issues be addressed to ensure we make and maintain progesterone?

  • Ensure your nutritional needs are being met. The corpus luteum requires sufficient levels of magnesium, zinc, iron, B vitamins, vitamin A, vitamin C and iron (for a start). We also need fats to make our hormones, so it is vital to include healthy fats in your diet.
  • Manage your stress! Stress responses burns through nutrients faster than anything else, so if you are chronically stressed you will be depriving your reproductive system of the nutrients it needs to perform. Stress also inhibits the HPO axis (hypothalamic-pituitary-ovarian axis). The hypothalamus (a master control centre in your brain) needs to be convinced that you are safe and nourished in order for you to reproduce (which is the ultimate function of your reproductive system). If it thinks you are in danger (any type of chronic stress will trigger this-emotional, physical or nutritional depletion) it will shut down your reproductive capacity because it is not essential for survival. This is an old, primitive response and still governs hormonal balance.
  • Address disease states like insulin resistance and PCOS. PCOS is a complex condition which I will discuss in further detail in another post. There are many forms of PCOS, making it a complex condition to treat. Acne associated with insulin resistance and PCOS will primary be due to impaired glucose metabolism, so this is the key area to address. Insulin promotes androgen production, which is a driving factor in the production of acne. Basic but effective strategies to combat this include eliminating all refined and added sugar from your diet, and eating more protein, fats and complex carbohydrates. Supplementing with chromium, magnesium and B vitamins will also support proper glucose metabolism and insulin function.

So, to summarize the main points involved in reducing cycle-related hormonal acne:

  • Ensure your hormones are balanced
  • Ensure your liver is functioning well so adequate detoxification can occur
  • Make sure you move your bowels at least once per day
  • Ensure your blood sugar and insulin levels are balanced (quit the sugar!)
  • Ensure your nutritional status is optimal
  • Manage your stress (easier said than done, we know!)
  • For details on how to do all this, check out our comprehensive program on how to fix the root causes of your acne with diet and lifestyle changes. Read more here.

Thanks for reading! 🙂

Sources (click to expand)
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  1. kaleigh phillips says

    Starting to use the “teccino” chicory root based coffee replacer and let go of the coffee drinking. What are your thoughts on this ? Different sources I found state it as good for the gut because the chichory fiber is a prebiotic. Any thoughts?

    • Devin Mooers says

      Hey Kaleigh! Prebiotic fiber can provide great food for beneficial gut bacteria for sure. It’s essentially a root brew decoction, which have been used medicinally for ages. I’ve started making herbal tea in the mornings from bulk herbs (goldenrod, calendula, chamomile, pine needles, fir tips, etc.), many of which we’ve collected ourselves (but many of which we get from the co-op). I definitely feel way better when I wake up, and am not so stressed out later, since dropping coffee!

  2. Sam says

    Hi Devin,

    How low PUFA diets do you recommend? Do you think you can get all the PUFAs you need from eating beans, whole grains and whole milk? I have always felt terrible every time I have eaten seeds, fish oil and other EFA supplements.

    • Devin Mooers says

      Hey Sam! Yeah, definitely. Very low PUFA is good. It’s all about quality and freshness with PUFA – most fish oils, seeds, supplements, etc. are totally rancid by the time you ingest them. Yes, the Inuit traditionally eat tons of seal blubber (high in PUFA), but it’s extremely fresh and non-oxidized when ingested, and they also eat thyroid glands of seals, which provides loads of iodine and thyroid hormone to block lipid peroxidation of that PUFA.

      How do you feel with raw oysters, have you tried that? They’re a prime acne-busting food, with lots of zinc and also super-fresh DHA.

  3. Brooke Turley says

    Ok, you’re officially talking crappy science, in light of this article about marigolds and chickens. Apparently it very much does indeed improve eggs to have marigolds in the chickens’ diets.


    I certainly hope that no one has gone and altered either their own diet or that of their poultry, just because of your half-baked scare tactics. Good grief. “ Fake orange” in nature, indeed.

    • Devin Mooers says

      Hey Brooke! Wow, color me (majorly) wrong. Thanks for pointing this out! That was really sloppy – I don’t know what I thought that marigold color would not be related to an antioxidant carotene. Sloppy, sloppy, sloppy. I’m sorry about this carelessness – I have removed this from the post after following up on the articles you linked! I will try to be more careful next time.

  4. Brooke Turley says

    Hi, I hate to burst your anti-marigold bubble, but the thing is, marigolds are orange themselves due to caratenoids! They’re full of nutrients, actually, and there’s no such thing as “fake orange” in nature.

    (Unless I count the time that my dad consumed massive quantities of beta-carotene in his heroic search for a natural “fake tan”. That time, “fake orange” definitely fit the bill.)

    Here’s an article that details the nutritional profile of marigolds:


    • Devin Mooers says

      Hey Brooke! (Just duplicating the response here to your other comment) Wow, color me (majorly) wrong. Thanks for pointing this out! That was really sloppy – I don’t know what I thought that marigold color would not be related to an antioxidant carotene. Sloppy, sloppy, sloppy. I’m sorry about this carelessness – I have removed this from the post after following up on the articles you linked! I will try to be more careful next time.

  5. tom hennessy says

    Researchers in a recent study took 60 women with hyperandrogenemia which has cystic acne as a major symptom, and reduced the iron in 30 by phlebotomy, and gave the ‘standard of care’ to the other 30, found, phlebotomy to reduce iron levels was as effective as the drugs used in the ‘standard of care’.

    Effect of phlebotomy versus oral contraceptives containing cyproterone acetate on the clinical and biochemical parameters in women with polycystic ovary syndrome: a randomized controlled trial. J Ovarian Res 12, 78 (2019).


    There seems to be more to the iron than we fully realize ..

    • Devin Mooers says

      Hey Tom – whoa, that’s fascinating! Great find! Amazing that phlebotomy brought on normal menstruation in 44% of subjects – I bet if they also added 3,000 IU of retinol, it would have improved results even more (vit. A boosts ceruloplasmin production to bind excess free iron).

    • Sean says

      Hey Rey, do you consume Magnesium through supplements or are you making an effort to eat Magnesium rich foods?

      (just curious)

  6. Luo says

    Stress can induce a series of negative effects on the human body. Many people are easily depressed under pressure, which has a bad influence on the treatment of acne.
    Some people overeating under pressure, too much sugar can easily induce acne.
    And stress can make people unable to sleep, and lack of sleep has too much effect on the skin.

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Master your acne in 4 weeks or less
  • Fix the root causes of your acne: fluoride, diet, sleep, stress & more
  • Exclusive forum access with 4,000+ members
  • Food Explorer App with skin safety ratings of 450+ foods
  • 96% of customers satisfied