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Premenstrual syndrome is no joke – moodiness, cramps, and bloating are usually accompanied by acne flare-ups, swollen and painful, only further spoiling the mood. According to research, about 65% of adult women aged 18 to 49 reported worsening of their acne symptoms seven days before their period.
In this article, we'll explore what the research says about the possible causes of premenstrual acne breakouts and how you can treat and prevent them.
What Causes Premenstrual Acne?
Acne is a widespread skin condition that is usually associated with adolescence. However, recent studies show that acne becomes more and more prevalent among adults and affects mostly women older than 33 years due to the underlying hormonal fluctuations.
The AAD (American Academy of Dermatology Association) states that adult-onset acne in women is often the result of hormonal imbalances due to their periods, stress, pregnancy, menopause, or starting or discontinuing oral contraceptive pills.
So, without any doubt, hormones are to blame. But what exactly happens with them before period, and why is the outcome stubborn and painful acne?
Well, although extensively investigated, the link between acne and hormonal disbalance is still unclear. However, some research suggests that during the week leading up to the period, progesterone and estrogen levels drop while androgens (male sex hormones, like testosterone) rise or stay the same, leaving them predominant. Excess amounts of androgens stimulate androgen receptors in our sebaceous glands, leading to the overproduction of pore-clogging sebum and providing a favorable environment for the growth of acne-causing bacteria.
In addition, these PMS acne flare-ups are a whole other beast than your regular breakouts. They usually occur as red and deep-seated papules and pustules located in the lower part of your face, including lower cheeks, chin, jawline, and neck. Some women report them getting worse 7 to 10 days leading up to or during their periods, with the overall skin condition improving when their periods are ending or after they are over.
Still, more research is needed to determine the exact mechanism and effect of the menstrual cycle on acne and the skin condition in general.
How to Treat Premenstrual Acne
As we already said, PMS acne can be pretty stubborn and painful, but luckily, they are treatable. There are certain medications, skincare, and tricks that are proven effective in this fight:
- Prescription oral and topical medication – If you suffer from hormonal acne, our best advice would be to visit a dermatologist. They will assess your skin condition and the severity of your acne and prescribe you certain medications accordingly. Some of the possible treatments you may expect are birth control pills (regulating testosterone levels), low-dose topical or oral antibiotics, isotretinoin (vitamin A derivative), spironolactone (a steroid drug most commonly used for the treatment of kidney or liver diseases but can also reduce testosterone levels and oil production in the skin);
- Benzoyl peroxide – The well-known anti-acne ingredient available over-the-counter in different concentrations for fighting mild to moderate breakouts. It comes in the form of spot treatments, gels, and cleansers and acts as a mild exfoliant, getting rid of dead skin cells that may clog pores and cause breakouts as well as killing acne-causing bacteria;
- Salicylic acid - This beta-hydroxy acid is also a mild exfoliant with anti-inflammatory and antimicrobial properties. Besides getting rid of the pore-clogging dead skin cells, it also deep cleanses the pores of oils;
- Topical retinoids - Retinoids are vitamin A derivatives in skincare that promote cell turnover and have anti-aging and anti-acne effects. More potent forms of retinoids, like tretinoin, are only available with a doctor's prescription. However, other less potent forms of retinoids are available over-the-counter, such as retinol, adapalene, or retinaldehyde;
- Sulfur – This is one of the oldest topical acne treatments, most commonly used as a spot treatment. Sulfur has antibacterial and antifungal properties. It also works by drying out the skin, helping get rid of mild to moderate breakouts, but it won't do much for cystic and more severe acne. Bear in mind that sulfur also has a very distinct smell that can linger on your skin after prolonged use.
How to Prepare Your Skin For the Next Period
There are steps you can take to help your skin in the long run. With a couple of tweaks in lifestyle habits, you can cut the problem in its bud and treat causes rather than deal with consequences later on. Here are some tips on healthy lifestyle changes you can try to help your skin better deal with PMS:
- Exercise – Hormonal fluctuations during your period can be triggered by stress as well. With regular physical activity, you will decrease stress hormones in your body, such as cortisol. In the long run, there will be fewer breakouts as well;
- Diet – Foods with a high glycemic index (GI) can worsen the inflammation processes in the body, and therefore, make your acne worse. In addition, high-GI foods cause a spike in blood sugar levels as well as insulin. Excess insulin, in turn, causes our sebaceous glands to produce more oil, leading to clogged pores and acne. Therefore, if you are struggling with PMS acne, try to avoid eating sugary foods, sodas, white bread, pastry, as well as other heavily processed foods or eat them in moderation;
- Skincare – If you haven't paid much attention to your skincare, now would be the time to start. Proper skin hygiene – cleansing your face in the mornings and evenings, washing after working out and sweating, and always removing your makeup before bed – is a must. In addition, you might greatly benefit from exfoliating your skin at least once a week. Exfoliating with glycolic or lactic acid will lead to a quicker cell turnover and remove the dead skin layer from the skin's surface, unclogging the pores and preventing acne;
- Dietary supplements – If you suffer from acne, you need to make sure you're getting enough vitamins and minerals through your diet. If your diet lacks some of these micronutrients, rest assured your skin will show. Therefore, to keep your skin healthy and acne-free, try dietary supplements, including zinc (vegans and vegetarians are more likely to have zinc deficiency which has a major effect on acne), vitamins C and E (important antioxidants with anti-inflammatory effects), and vitamin D (this vitamin is essential for regulating numerous physiological processes in the skin).
Some Parting Words of Advice...
Acne before or during the period is a phenomenon that affects a huge number of women, primarily due to a stressful and hectic lifestyle, with unhealthy diet and lifestyle habits. Some women are more prone to cycle-related pimples than others, but fortunately, they can be treated.
All in all, if you suffer from hormonal acne, it would be best to consult with your dermatologist or health care provider. They will best assess your skin condition and give you adequate treatment. Or they might recommend you to see your endocrinologist (hormone specialist) or gynecologist (female reproductive system specialist) for further analyses.
How do I prevent breakouts before my period?
Regular exercise and a diet rich in foods with a low glycemic index can help your skin better deal with hormonal acne. In addition, proper skincare can be of tremendous help - cleanse your face twice a day and after workouts, apply moisturizer and sunscreen regularly, and exfoliate once a week.
What does period acne look like?
Period acne, also called hormonal or adult acne, usually occurs in the lower face area, including lower cheeks, chin, neck, and jawline. They are often inflamed, painful, and red pustules and papules, sitting deep under the skin.
What part of menstrual cycle causes acne?
Hormonal acne usually occurs during the second half of a menstrual cycle. This is about seven to ten days before the period when estrogen and progesterone levels become lower.
Why am I getting hormonal acne all of a sudden?
There are many potential causes of hormonal acne. Dermatologists claim that many women get it due to stress, pregnancy, hormonal imbalances due to the menstrual cycle, or menopause. In addition, you may notice inflamed and painful acne breakouts right when you're beginning to take or discontinuing contraceptive pills.