Causes & Treatment for Hormonal Acne

Do you suffer with hormonal acne? Or perhaps you have acne and you are not sure whether it is hormonal or not? And you are wondering why you get it & how to treat acne naturally?

Hello, I am so thrilled to be here.

For those of you that don’t know me, my name is Michelle Cooke, Period & Hormone Naturopath, Natural Fertility Educator & Naturopathic Emotional Release (NER) Practitioner. I help women struggling with their menstrual cycles, have easy, pain-free periods, balanced hormones & emotional wellbeing. I’m the Founder and Director of Reproductive Wellness, a clinic located in Melbourne. I see patients online and face-to-face.

Hormonal Acne

Acne otherwise known as Acne vulgaris, is a chronic inflammatory disease of the skin. Acne can occur for a multitude of different reasons. One of those reasons which we will be speaking about today is due to hormonal imbalances and fluctuations. Some women have flare ups prior to their period or during their period. This is because in the second half of the cycle, the luteal phase (oestrogen & progesterone will drop prior to your next period). Others may have it consistently hanging around (thanks for that!).

 Symptoms of hormonal acne

During puberty: the acne will appear in the T-zone aka forehead, nose & chin.

During adult years: jawline and lower cheeks and / or chin


This is not set in stone how it would appear for you, but it is just typical patterns noticed through various life stages.

There are different variations of how the acne may appear on your skin:

  1. Comedones:

Two types are

  • Whiteheads (closed comedones) – they look white and are closed beneath the skin surface

  • Blackheads (open comedones) – they look black and appear that way because the sebum (oil on your skin) interacts with the air.

  1. Cysts – Large painful lumps that contain pus

  2. Papules (or affectionately known as pimples) – Infection or inflammation of the hair follicles which results in red, raised, small bumps.

Note: If you pick or touch comedones this may lead to the follicle wall breaking, but also spontaneous ruptures can happen too. Then this happens, bacteria and sebum (which is an oil on your skin) spills out and spreads to the area surrounding it, arising in inflammation. This then will present as papules (pimples) an inflammatory acne.

  1. NodulesThese are similar to papules, but larger in size, it is situated deep in the skin as is painful.

  2. Pustules: Pus-filled small red pimples

Hormonal acne causes

Situations or conditions that impact hormone balance can trigger acne:

  • Polycystic Ovarian Syndrome

  • Polycystic Ovaries

  • High levels of androgens (male type hormones): High androgens especially testosterone arise in an increased production & section of sebum.

  • Low Progesterone: Adequate levels of progesterone is required to inhibit 5 alpha-reductase needed to convert testosterone into DHT (dihydrotestosterone). DHT is another androgen but more potent. DHT is 5-10 times more potent than testosterone. Low progesterone > more DHT being produced > increased sebum on the skin and acne.

  • High insulin: This can cause a rise in insulin > increase in androgens such as testosterone, decrease in SHBG to bind up excess androgens > more sebum and acne + can stop ovulation. You need to ovulate to produce progesterone. Yet another compounding problem.

  • Post-pill: this is caused when stopping a combined oestrogen method of contraceptive, particularly one that contains an anti-androgen progestin such as cyproterone or drospirenone. Or just an anti-androgen progestin. This is due to a temporary surge in androgens, however this ‘temporary’ can stick around for a couple of years for some women. It can result in temporary post-pill PCOS (Polycystic Ovarian Syndrome). This form of PCOS is when you didn’t have PCOS symptoms prior to being on the pill.

  • Puberty: during this time there are fluctuations in hormone levels as the ovaries have their training wheels on.


Medical Approach


Typically, this will be when oral contraceptives like  anti-androgen progestins or the combined oral contraceptive containing an anti-androgen progestin are used to reduce the production of sebum that is being prompted by the high androgens. It will also increase sex hormone binding globulin which binds up excess hormones such as testosterone.

This is not a good strategy because it is not addressing the reason why you have hormonal acne in the first place. If it is due to PCOS – you need to look at managing insulin & glucose (both contribute to high androgens), reduce high androgens (male hormones) address any gut dysbiosis arising in hormone imbalance and acne.

Additionally, once you stop taking the pill there is a high probability that you will end up with rebound acne and it will come back with vengeance because your sebum has been suppressed to that of a young adult. Your body then realises that you are in fact an adult and your sebum doesn’t match that of what it should be as an adult. Then there will be an overproduction of oil (sebum) & androgens because your body is trying to catch up to your age. Post-pill acne commonly starts about three months after stopping the pill (just when you thought the coast was clear).

Antibiotics can be another port of call medically to try and kill the bacteria causing acne. But again this is not a great strategy because you are killing off both bad and good bacteria in the gut involved in hormone balance and inflammation management.


What are some natural treatments for hormonal acne?


It is important to remember that skin is an internal job, popping on creams, gels, ointments etc externally is not going to cut it as you are not treating the cause. But it is a good addition to an internal treatment.

Here are a few tips I would recommend for the external presentation of acne:

  1. Use an antimicrobial cream or oil – Use either tea tree oil or golden seal (found in Botani Phytoseptic cream) directly on the acne spots only, not the whole face – they are both antimicrobial, anti-inflammatory & have been shown to decrease the amount of acne lesions.

  1. Don’t pick or squeeze your acne – as tempting as it is. This can increase arise in inflammation & spread infection.

  1. Don’t use harsh products to wash your face with – gel cleansers for example will strip your skin of natural oils and your skin will dry out, be more irritated and in response your body will make more oils to try and lubricate it. More oil on skin > acne production. Try a nice natural cream cleanser such as Antipodes or Botani.

Can a Naturopath help with hormonal acne?

Yes, absolutely. I would suggest seeing a Naturopath that specialises in Periods & Hormones like myself; to help support you. To help address the causative factors behind your acne from a holistic perspective.

Treatment wise, we would be using Natural medicine: including herbal medicine & nutritional medicine based on the reasons why it is occurring for you, along with diet & lifestyle. I also use NER (Naturopathic Emotional Release) to look at underlying emotional contributors. I find there are always underlying emotions / stress with disease and physical presentations. For acne there are always plenty.

There can be several contributing factors as to why you have hormonal acne:

  • Can be due to hormone imbalance e.g. girly hormones – oestrogen, progesterone, testosterone), pancreatic hormones (insulin, glucose)

  • Stress (stress can delay ovulation)

  • Gut Dysbiosis – impacts clearance of hormones

  • Poor digestion (liver function, digestive secretions such as inadequate hydrochloric acid)

If you would like support with hormonal acne, I would love to help you, go ahead and book a FREE 15 min discovery call below to find out more about how we would work together and if we are a good fit. 

If you have any questions or comments, pop them in the comments box below 🙂