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)

{ 16 Comments }

  1. Kris says

    Hi Devin,
    Great research, thank you for linking the sources. I’ve suffered with back acne for years. I eat a mostly plant based diet, so I’d call myself a flexitarian (95% plants, 5% grass fed-organic animal). Before that I did mostly Paleo, therefore lots of fresh plants, but still a lot of organic meat/poultry.
    From recent testing, I have low iron stores (ferritin), normal iron (since I suppliment), and low iodine (I now supplement—-boyfriend has shellfish allergy…). I take vitamine A and Magnesium as well.
    I’m game to try anything thats humane and organic even if its not a plant based suppliment, but I would be interested in the Frankin-rice you mentioned since I try to avoid dairy due to an intolerance (causes me inflammation and IgG testing shows markers). If the colostrum is derived from cows or colostrum is from humans, wouldn’t in theory the human one be closer to what we need? Albeit odd to consider!!
    I’ve also looked for a non-bovine ferritin supplement, but it seems I may need to take the bovine one as the plant ones are just more iron (leading to excess). I just want to be humane in my choices, with no added hormones from the cows, etc. With all that said—I’m open to anything—as my skin and other health issues are the number one priority! Any product tips would be greatly appreciated. I use Pure Encapsulations too. 😊 Thank you!

    • Devin Mooers says

      Hey Kris! Sorry for the epic delay on this, I haven’t checked blog comments in a long time. My fault!

      How low is your ferritin? Did you get liver enzymes checked? It’s quite possible to have low ferritin, but also have an overload of unusable iron stored up in your liver. Taking additional iron supplements on top of that, if that’s the case, isn’t a very good idea. Liver enzymes (and/or GGT) can help point to iron overload in the liver. (See my iron article for more info on tests.)

      What kind of iron are you supplementing with?

      Doubt you’ll find human-sourced colostrum, though it’s an interesting idea! 🙂

      Are you interested in lactoferrin for reducing your iron levels, or for boosting your ferritin? There are definitely other, more effective ways of modulating ferritin, I think (see the iron article linked above for way more info on all the iron stuff, including why I think many people may have an iron overload problem even if ferritin levels don’t show it). I’d target the iron-utilization-boosting nutrients listed in the iron article, personally.

      Also, how much iodine are you taking? What form?

      Finally, have you thought about A2 milk as a skin-safe dairy option, that would give you some lactoferrin in a whole food form?

  2. Donna says

    I actually test low for iron. My Tibc, Total Iron, Iron Saturation, and Ferritin are all low.
    It was recommended for me to take Lactoferrin with an iron supplement to properly increase my iron.
    I’m confused about your article because it makes me second guess my situation. You don’t believe ANYONE is actually low in iron?

    • Devin Mooers says

      Hey Donna! How low are we talking on these numbers?

      I definitely think there are a small number of people who are actually low in iron, but I think it’s probably a lot fewer people than most doctors think. Often, if you have iron dysregulation, excess iron gets stored up in your liver, which doesn’t show up one these blood tests. If you’re lacking in one of the co-factors necessary to use iron properly (vitamin A, molybdenum, vitamin C, copper, ceruloplasmin, vitamin B12, etc.), you can get excess iron deposits in the liver combined with low circulating iron. When you add a plain iron supplement on top of that, without addressing the deficient co-factors, you can worsen the problem. Did you happen to get your liver enzymes and/or GGT tested? That can sometimes indicate excess iron storage in the liver. But keep in mind I have zero clinical experience in all this and just going based on the all the research I’ve read (and my own iron overload problem).

  3. jay,s says

    hi, suffering from acne for 20 years and a rediculolus amount of money spent on “solutions”i tried a newer supplement that’s called acne block that contains lactoferrin,found it on amazon.. it actually was/is one of the only supplements I have tried that actually helped..

    • Devin Mooers says

      Great to hear you got good results from lactoferrin! The science is sound behind why it works, helping to reduce iron overload. Good stuff.

  4. Sara says

    Would eating liver or taking a dessicated liver supplement cause iron overload? I would like to get more vitamin A, but am concerned about the extra iron I would be getting.

    • Devin Mooers says

      Hey Sara! Wise to be cautious about this. Do you have reason to suspect you have existing iron overload? Curious about that, I’ve suspected that in myself for a while now, and have been avoiding liver for that reason. I’m taking Pure Encapsulations vitamin A instead.

    • Sarah says

      Suggesting vegans/Vegetarians have a greater risk of iron deficiency is incorrect. There are at least as many meat-eaters as vege people deficient in Iron. Meat is not an efficient source of iron for human beings. Cutting out animal products goes along way in clearing up acne.

      • Devin Mooers says

        Hey Sarah! I actually agree with your first point now, but differ in the second. I think many people, vegeterians and meat-eaters, have an iron overload problem. This is pretty new to me, but the research seems sound. Turns out you can have anemia AND iron overload, due to iron getting deposited in your liver, but a lack of nutrients that are required to put iron into hemoglobin, like vitamin C, vitamin A, molybdenum, and copper. I also think the research strongly points to heme iron from meat being an excellent source of iron – much more absorbable than plant iron – but I now think eating too much meat leads to iron overload, because your body can’t shut off absorption from heme iron like it can from plant iron. If you’re curious to learn more, I just posted a huge article on iron and acne two days ago:

        Iron and Acne

        I think this is really an unusual perspective, and the opposite of what most people will tell you! Curious to hear your thoughts! 🙂 (I’m actually eating mostly vegetarian these days, due to trying to reverse my iron overload problem, and, yes, the environmental impact.)

  5. Taylor says

    So if I maintain a Paleo/Whole 30 diet that includes high quality meats and seafoods and I do not eat any of the iron-fortified foods or foods that inhibit lactoferrin – my body should be creating lactoferrin on it’s own in a healthy manner and I likely do not need to supplement it, correct?

    • Devin Mooers says

      Yep, exactly! Historical iron overload can be an issue, less so for menstruating women due to the continual iron dumping outlet. Bloodletting was effective back in the day for many diseases due to iron removal! Men don’t have such a built-in iron removal system (perhaps explaining why men tend to live shorter lives than women – iron buildup!). I’m not 100% sure how effective lactoferrin supplementation is for addressing built-up iron overload. Morley Robbins (gotmag.org) is the guy to read about on all the iron issues.

  6. Christina says

    I’m confused. I was just about to purchase some FCLO for my teen daughter to help her with her acne and now I stumbled across your reply where you state you no longer recommend FCLO! Why the change?

    • Devin Mooers says

      Hey Christina! Sorry about the confusion here – I wish we could keep the same recommendations forever, but our knowledge (and the science, and reader experience, etc.) forces us to change our recommendations now and then, and it’s hard to change everywhere all at once! We changed this recommendation because FCLO is basically pure PUFA (polyunsaturated fat), which is more susceptible to lipid peroxidation than other fats, and this is a major contributor to acne, we now believe (lipid peroxidation). The vitamin A in FCLO tends to be very beneficial, but you can get that vitamin A from eating liver, taking desiccated liver capsules, or taking a vitamin A supplement such as this one by Pure Encapsulations. We now think it’s best to reduce the total body load of PUFA as much as possible, rather than trying to boost omega-3s, for instance. Does this make sense?

    • Devin Mooers says

      Hey Sam! That’s actually a really good idea. We currently do not recommend taking FCLO or cod liver oil – we’ve updated our book but haven’t found the time yet to update our cod liver oil blog post – we’ll do that soon! We recommend taking desiccated liver capsules or eating grass-fed liver regularly, or taking a vitamin A supplement like this one:

      Pure Encapsulations Vitamin A 10,000 IU

      Taking vitamin E is a great PUFA defense strategy when you’re eating out at restaurants or for some reason consume a large amount of PUFA. We’re working on a “PUFA Shield” supplement that incorporates full-spectrum E along with some other lipid peroxidation blockers to make it easier for travelers, folks who eat out a lot, etc. to avoid the worst PUFA effects on acne.

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