For some of us, it happens like clockwork. Your skin is relatively clear for most of the month and then—bam—a week or so before your period, you get a big, angry pimple (or maybe even a few), somewhere on the lower half of your face. In fact, a study of 400 women published in the American Academy of Dermatology found that 44 percent of them said they get a flare up of acne before their period. [1]

The reason this happens is fairly obvious: hormones. But experts don’t know exactly why. It’s thought that the rise in progesterone during the second half of your cycle may contribute to acne, especially in those already prone to pimples. Also, while you’re menstruating, testosterone, a male hormone (that, yes, women have too) is a little higher than female hormones. And we know that male hormones also play a key role in the formation of acne: Testosterone may increase sebum (oil) production from the sebaceous glands. All that oil can join with dirt and dead skin and clog your pores. Also, excess oil creates a hospitable environment for Cutibacterium acnes (or c acnes), the bacteria that causes acne. Suddenly, the conditions are right for period acne to erupt on your skin’s surface.  

So, we know a little bit about why it happens, but what can you do about those period breakouts? We asked Julie C. Harper, M.D., founding director of the American Acne and Rosacea Society and an Acne Store advisory board member to tell us how to prepare for, prevent, and treat those premenstrual breakouts.  

1. Consider oral contraceptives as an acne treatment

These monthly hormonal fluctuations are going to continue until menopause, but oral birth control tweaks your hormone levels and can also change the way your skin behaves during your cycle. “If a patient tells me that their acne gets worse at a certain time of the month, I am more inclined to use what I would call hormonal therapy,” says Harper. 

A study of 400 women published in the American Academy of Dermatology found that 44 percent of them said they get a flare up of acne before their period.

There are four oral contraceptives that are FDA-approved for acne: Yaz, Ortho Tri-Cyclen, Beyaz, and Estrostep EE. These all include a combo of estrogen and progesterone. (Progesterone-only pills can actually make acne worse, so those should be avoided if you’re acne prone, says Harper.) 

2. Take an anti-androgen, off-label

If you’d rather not take hormonal birth control or it doesn’t work well, your dermatologist can also prescribe an anti-androgen medication called Spironolactone. It’s not FDA approved for acne, but doctors often use it off-label because it lowers the levels of male hormones in your body—and the excess oil that may come with them, giving them the chance to stop hormonal acne. “There’s also a product on the horizon that’s FDA approved already,” says Harper. Called Clascoterone, it will act like a topical spironolactone, and is FDA-approved for acne.  

3. Get on a good skincare regimen to prevent period breakouts

Getting hormonal fluctuations under control is half the battle of stopping hormonal acne—the other half is a good skincare routine, says Harper. And you want to be consistent and use it all month long—not just when period acne strikes. “The goal is to get your acne under control, and then stay the course to prevent future breakouts,” she says. 

What does a good regimen look like? A gentle cleanser to wash away excess oils, dirt, and makeup without stripping skin of its essential moisture, a basic non-comedogenic moisturizer that will hydrate without clogging your pores, and acne medications—either over the counter (OTC) or prescription. Keep reading for Harper’s picks. 

4. Try OTC medications for mild acne

For mild-to-moderate period breakouts, you can treat with proven ingredients sold at your drugstore. Think benzoyl peroxide or salicylic acid, says Harper. “They’re both excellent for acne,” she says. You can find these in both cleansers as well as leave on treatments. Benzoyl peroxide kills acne-causing bacteria and takes down inflammation. Salicylic acid works by dissolving the dead skin that’s clogging your pores, clearing acne from the inside out. 

5. Consider prescription retinoids for menstrual acne

For moderate-to-severe menstrual acne, topical retinoids can be a game-changer. Topical retinoids work by increasing cell turnover, so dead skin doesn’t hang around long enough to clog pores, and they can also decrease the inflammation involved in acne. But there are also systemic retinoids that you take orally, which also affect the amount of oil produced by your sebaceous glands. 

6. Try an antibiotic to reduce inflammation

An oral antibiotic can stop the spread of acne-causing bacteria and calm inflammation. “We can use antibiotics as long as we’re using them wisely, which means for short periods of time. We also try to prescribe those that are narrower in spectrum, so we know we’re not inducing resistance or having a negative effect on the gut,” says Harper.

7. Use all of the above to prevent period acne

If one of these therapies alone doesn’t do the trick, your doctor may suggest using a combination of them. “We may use a topical retinoid here, an antibiotic there, plus a benzoyl peroxide cleanser,” says Harper. “Often it’s about using a combination of things to get the skin clear,” she says. “People don't want to be 70% better. They want to be clear.” 

References:

[1]: https://pubmed.ncbi.nlm.nih.gov/11712049/