Hormonal acne is closely related to the menstrual cycle and many women experience a worsening of their acne just before the onset of their period. This is supported by a study which showed that 63% of women had a premenstrual worsening of their acne condition. During the menstrual cycle, if no fertilization takes place, there will be a sudden loss of estrogen and progesterone – the female sex hormones. This sudden decrease in female sex hormone levels causes the lining of the uterus to no longer be maintained and it breaks down to cause menstrual bleeding.
Hence, the levels of estrogen and progesterone are the lowest just before the onset of menses and it is at this point when androgen levels in the woman are relatively higher than the female sex
hormone levels. It is important to note that androgens are always present in females but at a lower level than in males. Therefore, this relatively high level of androgens and low level of estrogen will stimulate sebum production and hence may lead to hormonal acne before menses.

Pregnancy is another time when women may experience hormonal acne due to fluctuations in hormone levels. Higher levels of androgens are present during pregnancy and this causes an increase in sebum production, leading to acne which can strike pregnant mothers in any trimester. Therefore, this explains why more than 50% of pregnant women battle with acne issues during pregnancy especially those who are already acne-prone. If you suffer from acne during your
pregnancy, it is of utmost importance to first consult your dermatologist before starting any treatments or medications as some acne medications may affect your pregnancy.

Acne is a common complaint of many women going through menopause and it tends to strike the chin, jaw and mouth area but can also present on the chest and back. During menopause, there are sudden changes in hormone levels and the levels of the female sex hormone – estrogen decreases while the androgen levels in the body remain constant. Therefore, this causes the level of androgens to be relatively higher in the body, leading to overproduction of sebum and hence the recurrence of acne during menopause.

There are certain medical conditions that can cause excessively high levels of androgens which do not correspond to the normal hormonal fluctuations in women. One such condition is polycystic ovary syndrome which accounts for more than 90% of excessively high androgen levels in women. In polycystic ovary syndrome, the levels of androgens and insulin in the body are elevated and both hormones play a role in contributing towards acne as explained earlier. Therefore, patients with polycystic ovary syndrome tend to have severe acne that extends beyond puberty and does not respond to conventional treatments. Furthermore, the hormonal changes associated with polycystic ovary syndrome may result in symptoms such as irregular menses, excessive male pattern hair growth as well as weight gain. Therefore, if you suffer from acne that is associated with the above symptoms, it is important that you consult your dermatologist for advice and follow up investigations.

Hormonal acne in women is extremely common due to the fluctuations in hormone levels during the menstrual cycle, pregnancy, menopause as well as underlying medical conditions such as polycystic ovary syndrome. If you are currently battling with severe hormonal acne, it is important to seek professional help from a doctor as there are many treatment plans available to help correct the hormonal changes and reduce the severity of your acne. Your dermatologist can advise on the appropriate treatment plan catered to your acne condition and may also refer you to do further investigations to assess your hormone levels.