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Hormonal Acne, Is It Really A Thing?

Yes, it really is a thing! A thing that no woman wants, but sadly is commonly popular. The American Academy of Dermatology estimates that 50 million people struggle with acne per year. This makes it a rather big deal. Per Medscape, only 20% of acne sufferers will have a severe case, but even that seems like too many.

We tend to associate zits and pimples with puberty. This is partially true, but not entirely. There is a rise in the male sex hormone, testosterone, during adolescence. This rise in androgens causes a higher production of sebum, oil. This gives teenagers that overall greasy, blemished appearance some of us remember and would like to forget. Most of my acne was on my face, but I knew other girls who had blemishes on their neck, back, and chest. When I went my Dermatologist at the age of 13, I vividly recall my dermatologist saying, “Don’t worry Dina you should only have acne for about 7 years or so. Eye roll, try 25 years! I learned the hard way that acne isn’t so predictable.

When I started perimenopause, I started taking birth control to replace my decreasing estrogen. However, within the first month, I started noticing large, deep cysts in my chin. Having suffered for years with acne, I ditched the idea to stick with hormone replacement. Through research, I learned that during perimenopause there is a faster decline of estrogen then testosterone, leaving the latter in power and precipitating breakouts. Many women seek out hormone replacement for adult acne which may help in the long-term, but in the short term the sudden onset or return to these pills or creams can send your hormones out of whack and into acne flares.

Let’s also not forget that perimenopause and menopause come with a not-so-goody bag of some gnarly treats. Hot flashes, night sweats, insomnia, brain fog, and weight gain can leave a middle-aged woman feeling chronically stressed out. This resulting increase in Cortisol fires up the sebaceous glands, leaving us feeling like a hormonal swamp thing. Even with routine washing, acne scars and break outs may take longer to heal because the natural cell turnover slows down.

Women in their first and second trimesters, with a peak of 6 weeks, are also more susceptible to pimples. The reason for this is a large surge in progesterone which causes a pregnant woman’s glands to secrete more oil. Post-partum hormone fluctuations may stick around and cause acne to remain. In addition, caring for a newborn, can also increase stress and Cortisol levels which makes the vicious cycle continue.

Treatments usually utilize a variety of techniques. Antibiotics, steroids, Benzoyl Peroxide, Retinoids (form of Vitamin A), and Spironolactone are just a few used in combination to target unwanted inflammation and infection. Women who are pregnant may want to steer clear of creams and medications that can cause harm to the growing fetus and speak to their doctor about chemical-free, natural remedies. Most pregnancy hormones calm and settle in time. Hormone replacement, with the right dose, can help balance hormone fluctuations and clear problematic skin. Regardless of our phase of life, the good news is that people who suffer with acne tend to age better, and who doesn’t love that?


MacGill, M. (2018, July 23), “Hormonal Acne: What you need to know” Reviewer Cobb, C., <>

Migala, J. “Best Acne Treatments for Pregnancy.” Medically reviewed by Wu, J. (September 18, 2021), <>


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