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.
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:
- 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 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.
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).
- Headaches and migraines
- Nausea and indigestion
- Sinus congestion (sinusitis, rhinitis)
- Insulin resistance and metabolic syndrome
- 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.
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
- Ovarian failure and menopause
- Insufficient nutrients require to maintain the corpus luteum and produce hormones
- 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.
- 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! 🙂