The ESK blog
Why do I break out around my period?
19 August 2024
Dr Ginni Mansberg
Why do I break out around my period?
Hey there! If you find yourself breaking out around your period, you're definitely not alone. It's super common with up to 85% of women with acne having a flare in the days before their period. There's some fascinating science behind it. Let's dive in and chat about why this happens.
The Hormonal Rollercoaster
Acne is heavily influenced by hormones. Hormones traditionally associated with men, AKA Androgens, like dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEA-S), play a starring role. These hormones stimulate the androgen receptors in your oil glands and hair follicles. This not only leads to the production of sebum (that oily stuff your skin makes) but also extra production of keratin (a protein). When these substances accumulate, they can clog pores, forming blackheads and whiteheads, and provide a perfect environment for acne-causing bacteria, Cutibacterium acnes, to thrive.
In prepuberty, a rise in your androgen levels combined with increased sensitivity of sebaceous glands to these hormones can kickstart acne. Fast forward to your menstrual cycle, and these same androgens can cause breakouts, especially just before your periods start.
What happens during your cycle?
Oestrogen Levels in the Premenstrual Period
- Menstrual Cycle Phases:
- Follicular Phase (Day 1-14): Oestrogen levels rise, peaking just before ovulation.
- Luteal Phase (Day 15-28): After ovulation, oestrogen levels initially drop slightly, then rise again, but not to the peak levels seen before ovulation. In the latter part of the luteal phase (the premenstrual period), oestrogen levels decline.
Impact of lower oestrogen on the skin
Oestrogen reduces inflammation, increases skin hydration, reduces oil or sebum production on its own. It also keeps a lid on androgen or ‘male hormone’ levels.
Impact on Changes in the Oestrogen-to-Androgen Ratio
- More Sebaceous Gland Activity:
- With less estrogen to counterbalance, androgens like dihydrotestosterone (DHT) and dehydroepianresterone (DHT) can exert a stronger efffect and stimulate sebaceous glands , leading to increased sebum production.
- More inflammation:
- Androgens can be pro inflammatory in the skin. This can exacerbate the severity of acne lesions, making them more prominent and painful.
- Oestrogens are anti inflammatory in the skin. Again that relative fall in oestrogen before the period can exacerbate inflammation in the skin. Hormonal acne is particularly inflammatory in nature.
Drier Skin
- Oestrogens enhance the skin's ability to retain moisture by improving the water-binding capacity of the outer layer (stratum corneum) and deeper layers (dermis), thereby optimizing skin hydration.
Progesterone’s Role: As you enter the luteal phase (post-ovulation and peaking just before the start of your period), progesterone levels increase. While progesterone is essential for preparing the body for a potential pregnancy, it increases sebum secretion. And it has been found to impair the skin barrier!
So, What Can You Do?
Skincare changes
If you’re breaking out around your period, consider adjusting your skincare routine.
Gentle cleansing, using non-comedogenic products, and incorporating ingredients like niacinamide, retinal and /or salicylic acid can help manage breakouts.
Ultimate A Night Cream contains 0.06% Retinal, the most gentle and effective form of Vitamin A, paired with Niacinamide to help maintain skin barrier function and support brighter, firmer and more even looking skin tone and texture. Well suited even for the most irritable skin. Usage: Apply at night after cleansing (and serum if being used) as part of your evening skincare routine.
Ultimate A
Key features:
Hormonal treatments
If your premenstrual breakout is severe, you may want to consider hormonal treatments. For this, the first step is seeing your doctor. You might be offered the combined oral contraceptive pill (“the pill”), and “anti androgen” medication like spironolactone or cyproterone acetate.
- Be patient. You might 3 months or more to start seeing any improvement
- Hormone treatments should never be used as the only treatment for acne. They need to be combined with other proven anti acne treatments.
- Newer treatments
Experimentally anti-inflammatory drugs used for things like arthritis have been tried for hormonal acne because of the inflammatory nature of the condition. It’s been successful but we need more larger trials.
Understanding the connection between your hormones and skin can help you better manage those pesky period breakouts. And hey, if you have any skincare questions or need advice, don’t hesitate to ask.