Even though we often say, “hormonal acne,” did you know all acne lesions (bumps) are hormonal? However, it’s worth noting that blackheads and whiteheads are not acne.

What causes acne?

Notice that we said “hormones” rather than hormone imbalance. However, hormonal imbalances can be related to acne, and we'll cover that too. 

What hormones are involved in acne?

Androgens are the main hormone involved with acne. Androgens and estrogen are two reproductive hormones that interact with sebaceous follicles and produce sebum.

However,high levels of androgens are associated with increased sebum production, which can clog the pores and cause inflammation. Furthermore, certain conditions can cause androgen dominance, namely PCOS. 

As mentioned before, there can be underlying hormonal imbalances that cause acne, and one of the most notable causes of this imbalance is PCOS. 

What is PCOS?

“Polycystic ovary syndrome (PCOS) is a hormonal imbalance that occurs when your ovaries (the organ that produces and releases eggs) create excess hormones.”

With PCOS, the ovaries produce an excess of the reproductive hormones, androgens. This results in an imbalance. As a result, people with PCOS often have irregular menstrual cycles, missed periods, and unpredictable ovulation. 

Furthermore, the word “cysts” can sound so foreboding. And although they can impact the body, they are small fluid-filled sacs with immature eggs. They can even be visible on your ovaries or ultrasound due to lack of ovulation or “anovulation.” Anovulation is when your eggs do not travel down the fallopian tube to be fertilized or start your menses. However, the ovarian cysts aren’t dangerous or painful, and you can have cysts on your ovaries without having PCOS.

Despite the name "polycystic," you don’t need to have cysts on your ovaries to have PCOS. If you do have PCOS, you might have no symptoms, but some experience the following symptoms: body hair, hair loss, acne, and weight gain.But, to receive a diagnosis, you must meet two of the following criteria (as stated by Cleveland Clinic):

• Irregular ovulation, which is usually indicated by an irregular menstrual cycle or a lack of a cycle.

• Signs of increased androgen levels or a blood test confirming you have increased levels

• Multiple small cysts on the ovaries

Moreover, “research shows that people with PCOS show evidence of all-over inflammation.” As a result, this can cause a cycle of androgen overproduction. Because androgens are needed to regulate inflammatory cytokines, proteins that trigger inflammation, androgen dominance can be a symptom of inflammation. 

Two more common symptoms of PCOS are high blood sugar and acanthosis nigricans, a condtion that causes dark, velvety patches in areas like the groin, armpits, under the bust, and neck.Read more here. “About 1 to 3 percent of women with androgen dominance are thought to have this condition, with many cases remaining undiagnosed.”

To determine if a diagnosis is present, the best option would be to visit your OBGYN for a customized treatment plan. 

What helps PCOS?

Supportive nutrition as hormone therapy

Clinicians say that PCOS patients should avoid foods that are associated with inflammation. However, these types of foods may be individual to you.Here are a few foods that PCOS patients are recommended to avoid or limit.

• Fried foods, especially meat and highly 

• Saturated fats such as butter or margarine

• Red meat, luncheon meat, and hot dogs

• Refined carbs and sugary foods

On the other hand, PCOS patients do not have to be wary of all carbs. Doctors say that you can choose carbs that don’t hike the blood sugar. These include fiber-rich whole grains and non-starchy vegetables. Overall, you’ll want to keep blood sugar stable and “avoid big dips and spikes.” So, this means you’ll want to avoid feeling famished but also feeling stuffed. 

As for other supplements, a 2020 study demonstrated that a combination of flaxseed and spearmint extract improved the endocrine profile of some PCOS patients.

What are treatments for acne and PCOS?

Hormone Replacement Therapy 

Spironolactone

Spironolactone is an anti-androgen, which means it inhibits androgens such as testosterone. Spironolactone can help balance hormones and therefore the skin. 

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Metaformin and spironolactone 

“Metformin and spironolactone alone can be used for the management of polycystic ovarian syndrome (PCOS), and their combination could result in even better outcomes.”

“Metformin helps to control the amount of glucose (sugar) and insulin in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.” Insulin can elevate androgen production in the ovaries, thus metformin helps decrease it, thus resolving some PCOS symptoms. 

Birth control

Combined oral contraceptives (COC) are the most common treatment for polycystic ovary syndrome (PCOS). “Undisputedly, COC suppresses androgen production.” So, it can mitigate skin androgenic symptoms and menstrual dysfunction.