How are acne and hormones related?

Hormonal fluctuations or the altered sensitivity of the sebaceous gland to circulating androgenic hormones (e.g. during puberty or the menstrual cycle) lead to an increase in horny cell production (hyperkeratosis) and sebum production (seborrhoea). This forms the basis for the growth of bacteria, which eventually lead to visible inflammation (pimples).

Hormonal differences between men and women

Despite all the differences between men and women, there are also some similarities:

During puberty, testosterone levels rise in both sexes. Testosterone is an androgen, a sex hormone. In men, it causes the growth of the penis and testicles, and in women, it contributes to muscle and bone strength. An undesirable side effect is the high probability of developing acne during puberty. More than 70% of all adolescents experience blemished, acne-prone skin during puberty.

Hormonal fluctuations during puberty, in particular, make teenagers susceptible to acne.

For most, acne significantly subsides after puberty. However, up to 40% of all adults (aged 25 and over) are affected by acne at least temporarily.1 The surprising thing is that 75-85% of these are women.2

And this is where the differences begin.

While hormone levels in men stabilize over the years, they continue to fluctuate in women. Especially between the ages of 20 and 40 and then again during menopause, women are particularly susceptible to hormonally induced acne. There are three factors behind this:

• The menstrual cycle
• Possible pregnancy(ies)
• Menopause

Acne before and during menstruation

According to a dermatological study, over 60% of all women affected by acne experience a regular premenstrual worsening of their symptoms³.

The reason for this is that the female menstrual cycle causes continuously rising and falling hormone levels. As a result, the skin can be affected differently in the various phases.

The menstrual cycle usually lasts 28 days. It begins on the first day of menstruation and ends one day before the next bleeding – and each day is hormonally different:

• Day 1 to 14:
  FSH and LH, two hormones secreted by the pituitary gland, control the function of the ovaries, i.e. hormone production (oestrogens, progesterone) and the menstrual cycle with ovulation. Oestrogen dominates over progesterone at this time.

• Day 14 to 28:
  Oestrogen levels drop again, and progesterone (a corpus luteum hormone that stimulates the growth of the uterine lining and prepares it for the implantation of the fertilised egg) becomes dominant – this increase in particular stimulates sebum production.

Menstrual acne usually flares up seven to ten days before bleeding – i.e. around day 18 to 21. During the period itself, the condition of the skin usually improves.

Shortly before bleeding begins, both oestrogen and progesterone are at their lowest levels. At this time, testosterone levels (always lower in women than in men) are actually higher than those of female hormones, which leads to more sebum production.