You have just blown out your 25 candles, you have finally moved beyond adolescence and its torments... and yet, the spots come back every month like a punishmentAlways in the same place, always at the same time of the cycle. Always so painful. You've tried creams, miracle lotions, changed your diet, but nothing works.
What you're probably experiencing is hormonal acne, and no, it's not in your head. 50% of women aged 20 to 29 currently suffer from it, and 25% continue to suffer from it between the ages of 40 and 49. This acne isn't inevitable, but it requires a different approach than classic acne. In this article, we'll analyze the real causes, the unmistakable signs, and, above all, the solutions that really work, without selling you a dream.
The main thing to remember
- Typical location : Chin, jaw, neck (the U-shaped area of the lower face)
- Type of buttons : Painful cysts, inflammatory microcysts rather than blackheads
- Timing : Appear 7-10 days before menstruation or at ovulation, every month in the same place
- Main cause : Imbalance between androgens (testosterone, DHEA) and estrogens
- 55% of women with acne have at least one elevated androgen, but 45% have normal levels (skin hypersensitivity)
- Food : Refined sugars and dairy products significantly worsen hormonal acne
- Treatments : Anti-androgen pill, spironolactone, isotretinoin, and natural approaches (chasteberry, zinc)
How to Know if You Have Hormonal Acne
Hormonal acne has very specific characteristics that help differentiate it from classic acne. If you check several boxes below, you probably have it.
The 3 Telltale Signs
1. Your pimples appear cyclically
Every month, like clockwork. A week before your period or during ovulation, pimples appear. They last 8 to 10 days, then disappear... only to return the following month. This is the most telling sign of hormonal acne.
2. The location is always the same
The buttons focus on the U-shaped area: chin, jaw, lower cheeks and neck. Rarely on the forehead or nose (unlike teenage acne which affects the T-zone). Pimples return even in places where pores have been enlarged by old lesions.
3. These are deep and painful cysts
Not little white or black dots. They are red, inflammatory microcysts, sometimes under the skin that are painful to the touch. Some form large nodules or cysts that take time to disappear and leave marks.
The Real Causes of Hormonal Acne
Hormonal acne isn't just a vague "hormone imbalance." Behind the term lie specific mechanisms that science has well documented.
Androgens, Culprit Number 1
On androgens are so-called "male" hormones (testosterone, DHEA, DHT) that women also produce, normally in small amounts. These hormones stimulate the sebaceous glands that produce sebum. When androgens are too high or your skin is too sensitive to them, it's a runaway.
The hormonal cascade that creates acne
- The adrenal glands and ovaries produce DHEA and DHEA-S (precursor hormones)
- Your skin has enzymes that convert DHEA into Testosterone
- Another enzyme (5-alpha reductase) then converts testosterone into DHT, 5 to 10 times more powerful
- DHT massively stimulates sebum production in the sebaceous glands
- Excess sebum clogs the pores, bacteria proliferate, inflammation sets in: the pimple appears
What is surprising: Most women with hormonal acne have normal hormone levels in the blood. A 2013 study of 835 women with hormonal acne found that only 55% had at least one elevated androgen. The remaining 45%? Perfectly normal levels.
The explanation: It is your skin itself that produces the hormones responsible for acne., from precursors such as DHEA. Conventional blood tests do not necessarily detect this local production. Another possibility: your sebaceous glands are simply hypersensitive to androgens, even at normal doses.
The Role of Estrogen and Progesterone
Estrogens (female hormones) have the opposite effect of androgens, they slow down sebum productionDuring the first half of your cycle (days 1-14), estrogen dominates and your skin often looks better and is less oily.
But after ovulation, the progesterone takes overThis hormone slightly stimulates sebum production. A few days before your period, estrogen and progesterone levels drop sharply... leaving testosterone to reign supreme. The result: a spike in sebum and an outbreak of acne.
Risky Moments
Certain periods of life concentrate the risks of hormonal acne, because hormonal upheavals are massive.
- Stopping the pill : After years on the pill (which masked acne), the return of natural hormones can trigger a severe outbreak. This is often when we discover that we have hormonal acne.
- Polycystic ovary syndrome (PCOS) : 8 to 13% of women suffer from it. This pathology causes an overproduction of androgens and acne is one of the major symptoms, along with hirsutism and irregular cycles.
- Pregnancy : Progesterone levels skyrocket, which can trigger acne in some women (while others see their skin improve, hormonal lottery)
- Postpartum : Sudden drop in all hormones after childbirth, high-risk period
- Premenopause and menopause : Estrogens decrease while androgens remain stable, creating an imbalance favorable to acne
Hormonal Acne by Location
Although hormonal acne is most common in the lower part of the face, it can also appear elsewhere. The location sometimes provides clues as to the cause.
🎯 Chin and Jaw
It is the most classic areaThe sebaceous glands are particularly sensitive to androgens. According to "face mapping" (facial mapping used in Chinese medicine), the lower part of the face is linked to the reproductive organs, which would explain this location.
💭 Front
Less common for pure hormonal acne, but can occur. Forehead acne is more associated with stress (cortisol, the stress hormone, also stimulates the sebaceous glands) and digestive problems.
👤 Cheeks
Can be hormonal, especially if the pimples are concentrated on the lower cheeks near the jawline. But be careful: acne on the cheeks can also come from bacteria (dirty phone held against the cheek, dirty hands touching the face).
🔄 Back
Men are more affected than women. The back has many sebaceous glands sensitive to androgens. Acne often appears as inflammatory papules and nodules. Be careful not to confuse it with fungal acne (caused by a yeast infection), which requires antifungal treatment.
📍 Neck
The neck is a classic extension of hormonal acne that extends beyond the chin and jawline. Pimples there are often more discreet but just as painful.
Foods to Avoid with Hormonal Acne
Diet doesn't cause hormonal acne, but it can significantly worsen it. Two categories of foods consistently emerge from scientific studies.
Fast Sugars and High Glycemic Index
When you eat foods with a high glycemic index (white bread, sugar, pastries, sodas, potatoes), your blood sugar spikes. Your pancreas releases insulin to lower it. The problem: Insulin stimulates the production ofIGF-1 (Insulin-like Growth Factor), which in turn increases androgen production. Double jeopardy.
Foods to limit
- White sugar, honey, excess agave syrup
- Pastries, Viennese pastries, industrial biscuits
- White bread, white rice
- Sodas, fruit juices (even "no added sugar")
- Potatoes in all their forms
- Sweet breakfast cereals
- Alcohol (especially sweet cocktails and spirits)
Dairy Products
The link between dairy products and acne is one of the most scientifically documented. Cow's milk contains natural bovine hormones (growth factors intended for the calf) which can influence our hormonal balance.
Several mechanisms are involved: lactose (milk sugar) stimulates insulin, milk proteins (casein, whey) stimulate IGF-1, and certain milk hormones can directly stimulate the sebaceous glands.
Not all dairy products are created equal, Skimmed milk is paradoxically more problematic than whole milk (it contains more insulin-stimulating proteins). Fermented products (yogurt, cheese) seem less harmful than liquid milk. Goat and sheep milk are generally better tolerated.
Foods to Favor
Rather than talking about an "anti-acne diet" (which doesn't really exist), let's focus on what actually helps your skin.
Hormonal Acne Treatments: What Really Works
Let's be honest, hormonal acne is difficult to treat. Creams alone aren't enough, because the problem comes from within. Several approaches exist, with varying levels of effectiveness.
Hormonal Treatments
Since the cause is hormonal, acting on hormones makes sense. This is often the most effective approach, but it comes with limitations.
The anti-androgen pill
How it works : Combined estrogen + progestin anti-androgen pills (such as Diane 35, Jasmine, Yaz) increase estrogen and inhibit androgen production. They also increase SHBG, a protein that "captures" free testosterone and renders it inactive.
Efficiency: Excellent in 70-80% of women. Results appear after 3 to 6 months.
Disadvantages: Diane 35 has been associated with an increased risk of thrombosis (blood clots). Cases of meningiomas (benign brain tumors) have also been reported with high doses of cyproterone acetate. Possible side effects include weight gain, decreased libido, and cardiovascular risks.
The trap : Acne often returns after stopping the pill, sometimes worse than before (rebound effect).
Spironolactone
How it works : This medication blocks androgen receptors. Originally designed for hypertension, it has proven effective against hormonal acne. Doses range from 50 to 100 mg per day.
Efficiency: Improvement of 75 to 90% of cases in monotherapy.
Disadvantages: Reserved for women (feminization of the male fetus). Side effects: fatigue, low blood pressure, menstrual irregularities. Contraindicated if you are trying to get pregnant.
Isotretinoin (Roaccutane)
How it works : The most powerful, but also the most controversial, treatment. This vitamin A derivative completely blocks sebum production For many months.
Efficiency: Spectacular. 80-90% complete cure after 6 to 12 months of treatment. This is often the only solution for severe cystic acne.
Side effects to be aware of
- Extreme drought : skin, lips, eyes, mucous membranes. It's systematic
- Teratogenicity : causes serious malformations of the fetus. Mandatory contraception + monthly pregnancy tests
- Psychiatric effects : controversial but reported (depression, suicidal thoughts). Monitoring required
- Biological abnormalities : increased blood lipids, elevated liver enzymes
- Initial aggravation : possible “acne fulminans” at the start of treatment
Antibiotics
How it works : Prescribed for moderate to severe inflammatory acne, antibiotics from the cyclins (doxycycline, minocycline) reduce inflammation and limit bacterial proliferation.
Efficiency: Good in the short term (3 months maximum). But acne often comes back after stopping.
Major problem: Bacterial resistance develops with prolonged use. Antibiotics do not address the hormonal cause; they temporarily mask the symptoms. Beware of photosensitization (skin is very sensitive to the sun).
Local Treatments
Alone, they are rarely sufficient for hormonal acne. But when used in conjunction with systemic treatment, they can help.
- Benzoyl peroxide : Powerful antibacterial, reduces inflammation. May be drying and irritating.
- Topical retinoids (tretinoin, adapalene): Unclogs pores, accelerates cell renewal. Irritation common in the first few weeks
- Azelaic acid : Anti-inflammatory and antibacterial, better tolerated than others
- Local antibiotics (clindamycin, erythromycin): Never use alone (resistance), always combined with benzoyl peroxide
Natural Solutions for Hormonal Acne
Natural approaches alone are not enough for severe acne, but they can significantly help mild to moderate forms and support conventional treatments.
🌿 The Chaste Tree (Vitex Agnus-Castus)
This medicinal plant has been used for centuries to regulate the female cycle. It acts by increasing progesterone and slightly decreasing prolactin.
- Efficiency: Varies by woman. Testimonials are divided between enthusiastic and disappointed. It takes 3 to 6 months to see results.
- Dosage: 20 to 40 mg of standardized extract per day, preferably in the morning. To be taken in the second part of the cycle for some, continuously for others (advice from a naturopath recommended).
⚡ Zinc
An anti-inflammatory and antibacterial mineral, zinc helps regulate sebum production. Several studies show its effectiveness is comparable to antibiotics for moderate acne.
Dosage: 30 mg of elemental zinc per day (in gluconate or picolinate form, which are better absorbed). Take with food to avoid nausea.
🐟 Omega-3
EPA and DHA (omega-3 fatty acids) reduce overall inflammation in the body, including in the sebaceous glands. Choose dietary sources (oily fish) or quality supplements (wild fish oil).
⚠️ Beware of Overdosed Supplements
Paradoxically, some supplements can worsen acne because of a Excess vitamin B6, B12, or iodine. Check the dosages of your multivitamins and avoid overdosed "beauty" supplements.
Skin sensitized by treatments?
Acne treatments (isotretinoin, retinoids, benzoyl peroxide) often dry out the skin. For intimate hygiene during this time, choose gentle, irritant-free products.
Hormonal Acne Skincare Routine
Cosmetic treatments do not treat the hormonal cause, but a good routine limits the damage and avoids making the situation worse.
The Basics of an Effective Routine
- Clean only once a day (in the evening). In the morning, a floral water is sufficient. Excessive cleansing paradoxically stimulates sebum production.
- Avoid stripping products (aggressive foaming gels, micellar waters). Choose a gentle cleansing oil or a soap-free cleanser
- NEVER use scrubs on inflamed skinYou risk spreading bacteria and worsening inflammation.
- Moisturize even oily skinDehydrated skin produces more sebum to compensate. Choose non-comedogenic gel or fluid textures.
- Daily sun protection, especially under treatment (retinoids, isotretinoin). SPF 30 minimum, fluid texture
What You Should Absolutely Not Do
- Pop your pimples : Risk of permanent scarring and spread of infection
- Use pure essential oils on inflamed skin: Some (tea tree in particular) are very irritating
- Multiply anti-acne active ingredients : Benzoyl peroxide + retinoids + salicylic acid = burned skin and destroyed skin barrier
- Change your routine every 15 days : It takes a minimum of 6 to 8 weeks to see results
Should You Have a Hormone Assessment?
The question often comes up, should I have blood tests to confirm that my acne is hormonal?
In reality, not systematically. If your symptoms are typical (location, cyclical timing, painful cysts), clinical diagnosis is often sufficient.
A hormonal assessment is recommended in these situations
- Severe acne resistant to conventional treatments
- Signs of hyperandrogenism: hirsutism (excessive hair growth), hair loss (androgenic alopecia), very irregular cycles
- Suspected PCOS or other endocrine pathology
- Acne that appears suddenly in adulthood for no obvious reason
- Before starting hormonal treatment (pill, spironolactone)
Hormones to Dose
Important: For women of childbearing age, the assessment should be carried out in start of cycle (days 2 to 5), in the morning on an empty stomach. Stop all hormonal contraception 1 month before the assessment to obtain reliable results.
Neither Fate Nor Miracle
Hormonal acne isn't inevitable, but it's also not something that can disappear overnight with a miracle cream or a change in diet. It's a complex, multifactorial condition that often requires several combined approaches and a lot of patience.
The numbers are there: 50% of women aged 20-29 suffer from it. You're not alone. It's not your fault, it's not a hygiene issue, and no, you're not "dirty." It's your body dealing with a hormonal imbalance as best it can, and there are solutions.
Some will find salvation in hormone therapy, others in isotretinoin, and still others in a combined natural approach (diet, supplements, stress management). There is no hierarchy between these choices. The important thing is to find what works for you, without guilt.
And if the spots persist despite your efforts, consult a doctor. A dermatologist, a gynecologist, an endocrinologist if necessary. Your acne deserves serious treatment, not injunctions to "drink more water" or "stop stressing." You deserve better than guilt-inducing advice.
Sources & Scientific References
This article is based on published scientific studies and recent dermatological data.
Studies on androgens and acne
- Azziz R, et al. (2013). Serum levels of androgens in acne & their role in acne severity. PMC Journal. PMC6408631
- Arora MK, Yadav A, Saini V. (2011). Role of hormones in acne vulgaris. clinical biochemistry, 44(13):1035-40. DOI: 10.1016/j.clinbiochem.2011.06.984
- Uysal G, et al. (2017). Is acne a sign of androgen excess disorder or not? European Journal of Obstetrics & Gynecology, 211:21-25. DOI: 10.1016/j.ejogrb.2017.01.054
Hormonal treatments
- Koo EB, Petersen TD, Kimball AB. (2014). Hormonal Treatment of Acne in Women. The Journal of Clinical and Aesthetic Dermatology, 7(7):53-62. PMC2923944
- Zaenglein AL, et al. (2016). Hormonal treatment of acne vulgaris: an update. Clinical, Cosmetic and Investigational Dermatology, 9:241-248. DOI: 10.2147/CCID.S114830
Diet and acne
- Baldwin H, Tan J. (2021). Effects of diet on acne and its response to treatment. American Journal of Clinical Dermatology, 22:55-65. DOI: 10.1007/s40257-020-00542-y
- Melnik BC. (2011). Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Milk and Milk Products in Human Nutrition, 67:131-145. DOI: 10.1159 / 000325580
- Cordain L, et al. (2002). Acne vulgaris: a disease of Western civilization. Archives of Dermatology, 138(12):1584-90. DOI: 10.1001/archderm.138.12.1584
Epidemiological data
- French Society of Dermatology. (2018). Epidemiological study on acne in France. 3,3 million French people over 15 years old are affected. Link
- Roos N. (2019). Skin in great shape. Solar Editions. ISBN: 978-2263159251
Medical Warning: This article is for informational purposes only and is not a substitute for professional medical advice. For treatment tailored to your hormonal acne, consult a dermatologist.
