Do you get a monthly dose of pimples along with your period? At best, period acne is annoying, and at worse, it’s downright distressing.
It doesn’t need to be a monthly sentence. This article covers why period acne happens (spoiler alert: it’s not just your hormones) and how you can tackle it naturally.
What is period acne?
Period acne location
What causes period acne?
Side question: Should I get a hormone test?
When does period acne go away?
Period acne treatment
How to avoid pimples during periods naturally
Period acne is what it says on the tin: breakouts that appear or get worse around your period .
It seems that this monthly treat afflicts a whole lot of us. The lowest estimation is that 44% of women get some form of period acne, while other studies suggest that it’s closer to 85% [1, 2]. You can safely assume that every second woman you know has dealt with unwanted period pimples.
Post-inflammatory hyperpigmentation—acne scars, to you and me—is common too . This means that even when the pimples are gone, you can deal with residual marks and redness for the rest of the month. Again, what a treat!
Period acne often appears on the lower third of your face, around your mouth and along your jawline. It can creep onto your neck too, like in the ‘Adult female’ image below:
This is the typical presentation, but it’s not the only presentation. Period acne can appear anywhere on your face, and also on your chest and back [7, 8]. It likes to keep you guessing and can change from month to month.
That’s the short answer. For the longer but more illuminating answer, keep reading.
Still with me? Great! Let’s start with your hormones:
Oestrogen (or estrogen to our American friends) helps to support clear skin by reducing sebum production.
Androgens, another group of hormones that includes testosterone and DHEA, increase sebum production and can promote breakouts.
When these hormones are in balance, your skin is happy. But as you approach your menstrual cycle, levels of oestrogen plummet—which leaves lots of unopposed androgens hanging around .
The androgens dock onto receptors in your sebaceous glands, making your skin more oily and more acne-prone . Throw stress and a high-sugar diet into the mix, and your sebaceous glands go even further into overdrive .
But I’ve got dry skin, you’re thinking. Why do I still get period acne?
Here’s where things get interesting. As well as hormone activity on your skin, studies show that period acne can be driven by activation of your immune system . And amongst many other things, your immune system can be activated by reactive oxygen species .
Now you’re thinking, Reactive oxygen species?! I just want to know what’s causing this acne!
Bear with me, because this part is often the key that unlocks clear skin.
Your liver is responsible for breaking down all the unsavoury substances in your body. These include:
– external substances, such as pollution and chemicals
– internal substances, such as used hormones and products created by gut bacteria
It’s a big job. In the process of breaking down these substances and getting them ready for excretion, your liver creates reactive oxygen species (ROS)—just like a factory producing smoke.
Your liver has in-built mechanisms to deal with these ROS, but sometimes—if your liver’s workload is high or it doesn’t have enough of the nutrients it needs to carry out its job effectively—ROS can escape . They get around your body, activating your immune system and irritating your skin .
So, at the end of the month when your liver is busy processing all those used reproductive hormones, it needs the right nutrients to help it do its job. Put more simply:
Low nutrients = struggling liver = more ROS = period acne.
To be clear, there are no research papers that directly prove this mechanism, as it would be incredibly difficult (not to mention unethical) to study. But we do know that acne sufferers have more ROS hanging around , which suggests that this chain reaction is playing a critical part.
So, let’s sum up. A combination of factors likely drives period acne:
– Unbalanced hormones
– An activated immune system
– An overloaded liver
To help alleviate period acne, you need to address these. And don’t worry, it’s simpler than it sounds!
Even though we know that androgen hormones party drive acne, studies show that women with acne often show normal androgen levels on blood tests . This may be because the way androgens behave around your skin cells—rather than the total amount you have in your blood—is the critical factor in developing pimples .
Think of it like this: measuring androgens in the blood is like observing cars driving on the road. It only tells you so much. What you really want to know what people get up to at their destination.
A hormone test won’t shine much light on your period acne, but it can give you clues about other conditions such as polycystic ovarian syndrome, which can also cause acne. Speak to your doctor if necessary.
Some lucky people find that period acne goes away on its own. A 2013 study found that 77% of women noticed a reduction in their pimples one week after their period .
But it may not go away completely. If that’s you, those monthly breakouts may feel more like persistent female adult acne—otherwise known as ‘hormonal acne’.
The good news is that whether you’re dealing with period acne or female adult acne, the strategy to clear your skin is the same. Before we get to that, let’s take a quick look at the most common conventional treatments.
The standard acne treatments don’t work as well for period or hormonal acne. Eight out of 10 women find their acne comes back after antibiotics, and up to 1 in 3 women even find isotretinoin (Roaccutane) fails eventually too .
For this reason, you’re more likely to receive hormonal treatments to combat period acne. These take one of two forms:
Oral contraceptive pill (OCP). Some OCPs, such as the popular Yaz pill, can calm period acne by stopping your ovaries from making androgens . This only works while you’re taking the pill—once you stop, your ovaries will fire up again and acne can return.
Some OCPs, which contain first-generation progestins, can also cause acne . Check with your doctor if you’re unsure.
Spironolactone. This is an anti-androgen drug. It isn’t approved for acne treatment, but it can be used ‘off-label’ and can be very effective at minimising breakouts (again, only while you’re taking it). Side effects include breast tenderness and irregular periods .
Whatever the treatment, acne responds slowly and relapses are common . If you’ve suffered from acne for some time, you know how soul-destroying this can be.
So, what else can you do?
The best results come when you address your skin from both the inside and the outside. For period acne, the inside tweaks can make a dramatic difference.
Here’s what to do:
1) Make fibre your friend
Once your liver has broken down unsavoury substances, it packages them up so your body can get rid of them. The main ways your body gets rid of them is through your breath, sweat, pee and—you guessed it—your poop .
There’s no delicate way to say this, but it’s so important that we have to mention it: you need to poop at least once a day. A good bowel movement enables you to eliminate toxins, which lightens the load on your liver and soothes your skin.
Fibre helps to keep things moving—so fill your diet with vegetables, fruits, pulses, nuts, seeds, legumes and wholegrains. As a bonus, these foods are full of the nutrients that help your liver carry out its work too.
You can also up your fibre by following the next step…
2) Eat ground flaxseed daily
Not only flaxseed a valuable source of soluble and insoluble fibre, but it also encourages your body to make a special protein that stops testosterone from running amok . As you learnt above, testosterone is an androgen hormone.
Controlled androgens = clearer skin.
For best effect, eat two tablespoons of freshly ground flaxseed daily. You can whizz it into smoothies, stir into soup or sprinkle over salads.
3) Cut back on the sweet stuff
Remember how we said a high-sugar diet could exacerbate skin oiliness? Cutting back on sugar is another powerful tactic to calm your period acne .
This doesn’t mean you can’t ever have dessert again—it just means you should be mindful of when you’re eating or drinking sugar. As a general rule, it’s best to avoid any food that’s white, sweet or fluffy while you’re trying to help your skin rebalance.
Fizzy drinks and other sugary beverages (including juices) are especially aggravating, so forgo those in favour of filtered water. Pop some fresh herbs and chopped fruit in the water if you fancy a bit of flavour.
4) Reduce your dairy intake
Dairy has a complicated relationship with acne. While it doesn’t deserve all the blame that’s levelled at it, there’s no denying the fact that it can exacerbate skin issues in some people.
Rather than being full of pus and cow hormones (as the internet would have you believe), the main issue is that it makes your own hormones behave in a way that can promote acne .
Milk is particularly good at toying with your hormones , so try swapping to plant-based milk and see if it makes a difference. Some people may need to eliminate cheese and yoghurt too, while others will be fine with eating the odd portion.
5) Try milk thistle
A special phytonutrient in milk thistle boosts enzyme function in your liver, helping it to deal with its workload . A more efficient liver means fewer ROS and, as you learnt above, fewer ROS means happier skin.
One study from 2019 compared silymarin (milk thistle’s special phytonutrient) to an antibiotic. Silymarin wasn’t quite as potent as the drug, but it did help to clear skin . Pretty cool, eh?
You can take milk thistle in supplement form, and it usually comes in a formulation with several other liver-supporting nutrients. If you’re pregnant, breastfeeding or taking any medication, make sure your talk to your doctor before starting any supplements.
There’s more you can do on the inside—including optimising your gut bacteria and sleeping well—but these steps will set you firmly in the right direction.
Moving on to the outside:
1) Protect your skin’s pH
Studies show that acne is worse when your skin barrier is out-of-whack . This is because a disrupted skin barrier alerts your immune system, leading to irritation and inflammation.
A foundation of a healthy skin barrier is an acidic skin pH . To protect yours, use pH-balanced cosmetics and don’t over-wash. To learn more about this, head to Skin pH (25+ Studies): How pH Balance Creates Clear Skin.
2) Try azelaic acid
When you have a pimple—especially a throbbing one on your jawline—it can be so tempting to pick and squeeze it. More often than not, this winds up making things worse and can lead to stubborn scars.
Instead of picking, turn to azelaic acid. This organic acid is derived from grains such as wheat, barley and rye. When applied to your skin, it can help to soothe inflammation, unclog pores and fade acne scars .
Now, let’s be frank: by the time azelaic acid has been made stable in cosmetics, it’s hardly a ‘natural’ product. But it is an effective one.
You need a prescription for higher strength (15–20% concentration) azelaic acid products, but you can find 10% azelaic acid products in regular skincare lines. Even at this lower concentration, it can make a big difference.
Bear in mind that you’ll need to wear sun protection (at least SPF 30) if you use azelaic acid.
Consider these outside approaches as the final steps in your period-acne-free journey. The inside approaches are what will take you the distance, so master these first.
Period acne is frustrating, but you don’t have to dread it month after month. Here’s what we know:
– Period acne is when you have breakouts that appear or get worse around your period. Most women get period acne at some point.
– Period acne often appears on your lower face, but it can also crop up on your forehead, cheeks, chest and back.
– The exact mechanism behind period acne is unknown, but it’s likely a combination of unbalanced hormones, an activated immune system and an overloaded liver.
– Period acne can settle on its own, usually a week after your period ends. But not everyone finds it goes away completely.
– Conventional treatment for period acne includes oral contraceptive pills and anti-androgen drugs.
– You can tackle period acne naturally through upping your fibre intake, eating flaxseed, cutting down on sugar, minimising dairy and supplementing with milk thistle.
– You can further help period acne by protecting your skin’s acidic pH and applying azelaic acid.
Fiona Lawson is a former national magazine editor turned registered nutritionist and skin specialist. She holds an MSc in Nutritional Medicine and a BANT-registered post-graduate qualification in Nutritional Therapy.