The Acne/Hormonal Imbalance Relationship
Hormones are chemical messengers that regulate body function which circulate in the bloodstream. Hormonal imbalance may occur at any time in oneâ€™s lifetime and usually starts at puberty and for women, occurs during the menstrual cycle, pregnancy and menopause. Increased levels of circulating Androgen hormones increase oil production which contributes to the acne cycle.
Monthly breakouts in women around the menstrual period is related to increased progesterone levels. Nearly 50% of all women experience monthly premenstrual acne flare ups. Progesterone causes fluid retention and puffiness. This rise in tissue swelling affects the skin compressing the pores shut leading to sebum build-up and blemish formation.
Hormones responsible for acne include Testosterone (an Androgen), Gonadotrophins, Anabolic Steroids, Coriticosteroids and Adrenocorticotrophic Hormone (ACTH). Stress leads to an increase in corticosteroids. Women with Polycystic Ovarian Syndrome (PCOS) produce too much Testosterone and are likely to have problematic acne and increased growth of facial and body hair (hirsuitism). Androgenic acne may be as a result of producing too much testosterone, producing too little oestrogen or a natural sensitivity to androgens which is the most common cause.
Oral contraceptive pills help in the treatment of acne by reducing the level of circulating androgens and blocking androgen receptors. The pill increases the level of Sex Hormone Binding Globin (SHBG) which binds to circulating androgens preventing them from reaching their targets. Depo-Provera (Medroxyprogesterone acetate) a long lasting injectable depot progesterone contraceptive occasionally has acne breakouts as a side effect.
Spironolactone (Aldactone), a diuretic used for the treatment of hypertension binds to androgen receptors blocking androgens and thus inhibiting their effects. It is often used in addition to oestrogen supplements for the treatment of PCOS. Yasmin, a new generation OCP containing the progestin Drospirenone, has a structure similar to spironolactone and its associated properties of androgen receptor blockade and diuretic properties making it a good choice for women who want to avoid the possible water retention associated with the use of other OCPâ€™s.