Long out of the woods in the puberty department, many of my 20, 30 and 40 year old patients complain about cyclical acne – the type of acne that crops up in the week or two leading up to your period. Breakouts after ovulation or before your menses have the ability to make us feel like we’re back in grade 9, with all the nervous awkward feelings of your body going through ‘the change.’
Why is it that, post puberty, so many women continue to struggle with acne? In the majority of cases, it’s not a hygiene problem. You can be a fanatic about washing your face, changing your pillow case, and not letting anyone come close to your chin unless they’re an esthetician, but those pesky little spots still show face once a month. This is because the hormonal changes associated with PMS affect not only how you feel internally (think moods, breast tenderness, and digestive changes) but also affect how your skin regulates sebum production.
Sebum is the oily/waxy substance that serves to lubricate and waterproof our skin. Sebaceous glands produce sebum all over our bodies (except on our palms and soles), but in the greatest concentration on our face and scalp. Adequate amounts of sebum are necessary to maintain hair and skin quality, but too much sebum can lead to excessively oily skin and hair, the perfect storm for inflammation and acne.
Sebaceous glands act under control of a few different mechanisms, but the most significant for this discussion is their control by the endocrine (hormonal) system.
A woman’s monthly cycle is controlled mainly by the two female hormones, estrogen and progesterone. During the first half of the cycle, estrogen is dominant as the follicles develop, and then after ovulation progesterone production is the strongest. Just prior to menstruation, both estrogen and progesterone levels drop significantly, which is what instigates shedding of the endometrial lining.
The relationship of estrogen and progesterone to testosterone is what’s responsible for a flare of acne right before menses. When estrogen and progesterone drop low just before your bleed, testosterone levels (which maintain pretty constant levels throughout your cycle) become higher in relation to the other two.
Both progesterone and testosterone influence the production of sebum from the sebaceous glands. In the second half of your cycle, when progesterone is king, you start producing more sebum than you did in the first half of your cycle. Then, relatively high levels of testosterone in your system are a further trigger for even more sebum production, and also cause inflammation. While sebum doesn’t directly cause acne, that extra oil becomes the perfect environment for the growth of Propionibacterium acnes, the bacteria that cause skin inflammation and acne spots. P acnes feeds on sebum, replicates, gets trapped in your pores, and voila! Adult acne.
What can be done?
Stabilize blood sugar: Blood sugar fluctuations in combination with the rise and fall of these hormones can worsen acne. When blood sugar spikes and falls, so does insulin – a hormone that directly influences the production of estrogen, progesterone and (most importantly) testosterone. Balancing your blood sugar by eating lots of fibre (50% of your plate should be multi-coloured vegetables, 3 meals a day), and snacking regularly with healthy fat and protein (avocado, nuts/seeds, good quality animal protein, pasture raised eggs etc), is extremely important throughout your entire cycle.
Consider skin superfoods: Several superfoods can help to regulate the inflammation in your skin, manage testosterone levels, and replete antioxidants that help repair skin damage and fight skin aging. Here’s a list of my 5 favourite skin superfoods:
- Pumpkin seeds: pumpkin seeds are rich in zinc, selenium, vitamin E and essential fatty acids. Zinc protects and maintains collagen production, and zinc deficiency has been associated with acne outbreaks. Selenium is a potent antioxidant, while the essential fatty acids and vitamin E in pumpkin seeds fight the inflammation associated with acne. A quarter of a cup of raw pumpkin seeds daily is an appropriate dose.
- Ground flaxseeds: not only is flax an excellent source of fibre (which balances blood sugar and assists in hormonal detoxification), but they contain great anti-inflammatory essential fatty acids too (omega 3s). A tablespoon of ground flaxseeds throughout your cycle is one of my favourite anti-acne remedies.
- Dark leafy greens: the darker the better! Dark greens are extremely rich in antioxidants like vitamin C and E, fibre, and vitamin A. The medication Accutane is a form of extremely high dose vitamin A, and reduces the amount of sebum released from those sebaceous glands. Instead of reaching for Accutane, which has some pretty negative side effects (including increasing birth defects), try increasing your vitamin A intake from dark greens. Eat dark green veggies as often as possible – in omelettes for breakfast, salads for lunch, stews for dinner. I put them in everything!
- Green tea: though technically not a food, green tea makes the list because it’s a potent inhibitor of inflammation and regulates testosterone production in women. In order to maximize the concentration of EGCG, green tea’s acne fighting ingredient, choose loose tea leaves (or powder like matcha) instead of tea bags, and steep for at least 5 minutes. Drink 2-3 cups per day.
- Water: Ok, I’m really losing you on the ‘foods’ thing, I know. But hydration is insanely important when we’re talking about your skin. Not only is hydration necessary for the detoxification processes that balance your hormones and flush out toxins, inadequate hydration leads to thicker sebum production. There’s a difference between dry skin and dehydrated skin – dehydrated skin, which happens when you don’t consume enough water, can cause increased sebum production to make up for the lack of lubrication. More sebum = more inflammation = more acne. Drink enough water so that each time you urinate (after your first morning urine), your pee is only slightly yellow in the bowl.
Test your hormones: While all of the above can be helpful to balance and stabilize hormonal production and improve your skin, sometimes the only way to know what’s truly causing that cyclical acne is to look at your hormone profile. A salivary hormone panel, which looks at the female, male and stress hormones, gives us the best overall view of those hormones in relation to one another. Sometimes, a very specific hormonal balancing treatment protocol is necessary to address adult acne.
If you have any questions about your skin, or want to chat with me about getting your hormones tested, call to schedule your free 15 minute consult with me through Acubalance.