An estimated 68% of women are put on birth control for reasons other than contraception; one of those reasons being hormonal acne. (1) Often times, this results in toying with different birth controls, going through multiple adjustment periods where cycles change, side effects come and go, skin gets worse, eventually skin gets better. What I see is women coming off the pill for various reasons, and then seeing a huge relapse in the acne they’d deemed “cured”. Luckily, Homeopathy can help treat hormonal acne, and post-pill acne, naturally.
What is Hormonal Acne?
Let's start at the basics: Hormonal Acne is acne that is affected by, or caused by, hormones. Arguably, all acne is hormonal, but today we will focus on the acne that you connect to the ebb and flow of your menstrual cycle.
Throughout the ~28 day menstrual cycle, Estrogen and Progesterone fluctuate in a certain rhythm.
(Image source: Amanda Laird, author of: Heavy Flow: Breaking the Curse of Menstruation)
While research on hormone levels and acne are limited, some studies have shown that sebum production was at it’s lowest in the second week of the cycle (when estrogen is at it’s highest), but hormone levels at those times haven't been measured. That being said, with what we do know, we can extrapolate theories about the role a balanced cycle has on skin health.
Role of Estrogen, Progesterone, and Testosterone in Skin
1. Estrogen is very important for skin health as it supports skin thickness, increases collagen production, contributes to hydration, wound healing, and has anti-sebum effects. (3)
2. Progesterone is less well known for its effect on skin, but it can help reduce inflammation in the body.
3. Testosterone, an androgen, is converted to Dihydrotestosteron (DHT) by an enzyme called 5-alpha reductase. DHT is responsible for the increase of sebum production in skin. Sebum clogs pores, dead skin cells and bacteria fester within, and acne is produced.
How does testosterone fluctuate in the menstrual cycle?
Mostly, it doesn’t.
Some studies show that Free Testosterone does increase at certain point of the menstrual cycle, but it isn’t statistically significant. Androgens in general also show variable research, with some women experiencing peaks around mid-cycle, others prior to ovulation, but the general fluctuation of androgens throughout the cycle leaves too much variability for a solid conclusion. (2)
Simply put: everyone is different.
What we know does fluctuate, fairly reliably, is our friends estrogen and progesterone. When they drop, particularly during menstruation, testosterone becomes the dominant hormone. Given estrogens aptitude to sebum reduction, and testosterones knack for sebum production...a very simplified overview of this might say:
Less estrogen/progesterone = more unopposed testosterone = more DHT = increased sebum production = acne
So what do we do about all that?
Birth Control for Hormonal Acne?
Birth control affects skin by suppressing natural ovulation using synthetic hormones. Suppressing ovulation reduces the general increase of ovarian androgens and reduces sebum production, therefore reducing acne (if it all goes as planned…). Certain hormonal birth controls also work by inhibiting and suppressing that tricky 5-alpha reductase, to reduce the conversion of DHT...to reduce sebum production. (6)
It is recommended to only be used in cases of hyperandrogenism (high levels of androgens), when other therapies have not proven effective, and when acne flare-ups are confirmed to occur premenstrually. (4)
Why Not Use Birth Control for Acne?
Birth control wreaks havoc on the body and interrupts the crucial process of ovulation. The risks of birth control is a whole other post, and there are many other resources that can guide you as to why ovulation is a crucial part of our health – but let’s talk about why it’s not the best route for acne.
Lara Briden offers a great overview of post-pill acne, so I encourage you to read it for her insight as well
The body’s goal is homeostasis. Whether it's adapting to the cold of the winter, keeping us safe in a scary situation, amping us up for a big speech, or regulating the ever-changing fluctuations of our reproductive system – the body has one goal: balance.
It’s pretty good at it too, in fact everyday our body is balancing and straightening out whatever we throw at it, but sometimes it gets confused. When it gets confused, it gets knocked off balance deep within, and it produces symptoms on the surface to let us know that something is not right.
So when we simply suppress the sebum production (or suppress ovulation, or inhibit 5-alpha reductase) we are ignoring the deeper issue: hormonal imbalances, stress, hygiene, diet, or bacterial imbalances.
The acne may get better, but the cramps might get worse, or the acne might move from the face to the back, or our anxiety flares up – because the root cause is still there and the body needs you to know that.
So you stop the birth control and all of a sudden sebum production sky rockets, breakouts everywhere. What’s going on?
The root cause is still there.
The birth control is removed, the body is free to express the imbalance after being suppressed for so long. Like a kid on Halloween indulging in forbidden candy until he’s sick to the stomach, the body is making up for lost time. The hormones are still out of whack, and the kid still loves candy.
What can homeopathy do differently?
Homeopathy uses personalized treatment to rebalance the system and heal the root cause of illness. We aren’t looking at the symptoms as the problem, we’re seeing them as the indicators of a deeper issue.
We will start by looking at how your body expresses imbalance:
What are the symptoms associated with your acne?
How is your menstrual cycle? Are there symptoms associated with it?
How is your mental health?
Do you have a history of thyroid issues? Have you had a thyroid panel done?
How is digestion? Diet?
Have you been on birth control in the past?
And then we seek out a remedy that best matches your symptom picture, following the theory of like cures like. We personalize your treatment based on your sensitivity, your case history, and lifestyle factors.
How long does it take for acne to heal?
Remember, acne is a symptom of a deeper issue so until that deeper issue is resolved, the acne will sit comfortably. Six months tends to be when skin starts to clear, when patients are committed to healing. Homeopathy can do it on its own, but it sure loves some external support.
Areas I focus on when working with hormonal acne:
Diet low in dairy, processed foods, sugar, and alcohol (coffee if you’re committed!)
Proper skin care routine that gently nourishes the skin
Stress reduction (exercise, therapy, healthy relationships, spirituality, work/life balance)
At first we may see a worsening of the acne while the body sorts it out. We may see a shift in your cycle, your energy, your mood.
When treating hormonal imbalances, in the long term we will aim for: lighter periods, a more comfortable cycle, less mood swings, better energy, and, if you’re reading this article: healthier, brighter, acne free skin.
If this resonates with you, or you’re worried about post-pill issues, send me a message and let’s talk about how homeopathy can help support that process. My goal is always to help your body operate in balance, relieve symptoms naturally, and treat the root cause of illness.
In good health,