Is acne caused by hormones? Often, yes. Hormones called androgens make the skin’s oil glands larger and more active, which is why acne starts at puberty. In adult women, shifts in hormones around periods, pregnancy and menopause are a common cause of flare-ups. Hormones are not the only factor, though: family history, some medicines and stress also play a part.
This guide explains how hormones cause acne, who gets hormonal acne, and which treatments work on it.
How hormones cause acne
Acne starts when a hair follicle becomes clogged with oil and dead skin cells. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains that bacteria then grow in the plugged follicle and cause inflammation.
Hormones act on the first step. NIAMS says an increase in androgens, which rise in both boys and girls during puberty, causes the oil glands to enlarge and make more oil. Hormonal changes in pregnancy can do the same.
When is acne caused by hormones in adults?
The American Academy of Dermatology (AAD) says adults can get acne into their 30s, 40s and 50s, and that women get adult acne more often than men. It lists fluctuating hormone levels as a leading reason. Women often notice breakouts:
- around their periods;
- during pregnancy, perimenopause and menopause;
- after starting or stopping birth control pills.
The AAD notes that acne appearing for the first time in adulthood is most common among women going through menopause. It also says acne along the jawline, lower face and neck tends to respond well to hormonal treatment.
Other causes that look similar
Not every adult breakout is hormonal. The AAD and NIAMS list other causes and triggers:
- Stress. In response to stress the body makes more androgens, which stimulate the oil glands.
- Family history. Some people appear to have a genetic tendency to acne.
- Medicines. Hormone-containing medicines, corticosteroids and lithium can cause acne.
- Hair and skin care products. Look for products labelled non-comedogenic, oil-free or “won’t clog pores.”
- An underlying medical condition. Sometimes acne is a sign of one, and clears when it is treated.
Acne together with irregular periods or excess hair growth can point to a hormonal condition such as polycystic ovary syndrome. See our guide to the symptoms of low and high testosterone.
Treatments for hormonal acne
The AAD describes two hormonal therapies that can clear acne in women. Both need a prescription.
Birth control pills. The AAD says the pill has been found effective for blackheads, whiteheads, pimples and deeper nodules and cysts, and that the FDA has approved some oral contraceptives for treating acne. Improvement usually takes two to three months. The pill raises the risk of blood clots, heart attack and high blood pressure, so it is not suitable for everyone.
Spironolactone. This is a blood pressure medicine that dermatologists also prescribe for acne in women, particularly deep, tender acne on the lower face, jawline or neck. The AAD cites studies showing a 50% to 100% reduction in acne. It can cause serious birth defects, so birth control is needed while taking it, and it is not prescribed for acne in men.
The AAD notes that dermatologists often use two or more acne treatments together. A dermatologist or other clinician can tell you which fit your skin and health history.
What you can do yourself
NIAMS lists things that do not cause acne but can make it worse: stress, pressure from helmets or tight clothing, squeezing or picking at blemishes, and scrubbing the skin too hard. Avoiding these helps whatever the cause.
On diet, NIAMS says some studies show certain foods may make acne worse, and that research is continuing. It does not name foods to avoid.
Frequently asked questions
Is acne caused by hormones at any age?
Hormones can contribute at any age. They drive teenage acne, and they are a common reason for acne in adult women.
Does hormone therapy for menopause cause acne?
NIAMS lists medicines that contain hormones among those that can cause acne. If breakouts start after a new medicine, tell the clinician who prescribed it.
When should I see someone about acne?
The AAD says to see a dermatologist if nothing clears your acne. It adds that with help and patience, virtually every case can be controlled.
Next step
You can read about acne and hormonal imbalances at Beauté Medical Aesthetics, or book a consultation.
Sources
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne. Reviewed July 2023.
- American Academy of Dermatology. Adult acne.
- American Academy of Dermatology. Stubborn acne? Hormonal therapy may help.
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Beauté Medical Aesthetics
