Acne is a frustrating condition that is often associated with adolescence and puberty, despite affecting an increasing number of Australian women.
Skin health, including acne, is often affected by hormonal changes, with many women prescribed the oral contraceptive pill solely to address skin concerns.
Sheridan Rollard, owner and principal therapist of Shine Skin and Body, a Melbourne-based skin clinic that specialises in acne treatments, shares her insight into the relationship between hormones and skin health, and how to transition off the pill without your skin going haywire.
How do hormones affect our skin?
At the start of each menstruation cycle, estrogen levels rise, peaking during ovulation. If no pregnancy occurs, estrogen levels taper off, which is when breakouts or hormonal acne often occur.
Rollard explained that the location and type of acne can give valuable insight into the drivers of your breakout.
Acne caused by elevated estrogen can be indicated by cystic pimples or spots occurring on the sides of the chin and around the mouth.
Testosterone dominance often manifests as acne from the cheekbones down onto the neck, sometimes accompanied by irregular or missed periods or an increase in facial hair.
Where progesterone is low, often due to stress or menopause, more whiteheads and blackheads are often seen.
How does the pill help control acne?
Hormones can cause acne by affecting oil production in the skin’s pores.
“If you have an overabundance of hormones within your body, the enzyme 5α-Reductase responds by creating a ‘super-hormone’ called DHT, causing the production of a thicker, stickier and more abundant oil that clogs the pore leading to acne,” said Rollard.
“Because the pill balances hormones, it regulates 5α-Reductase, reducing oil flow and reducing blocked pores and acne”.
Hormonal imbalances can also create inflammation, which may exacerbate skin conditions, including acne.
“Skin cells have estrogen receptors that enable hormones to function. If too much is taken in by these receptors, it causes inflammation in the cell which then swells and pushes up against the skin,” Rollard said.
This type of pimple isn’t in a pore, so it will not produce a head, but once the hormone levels regulate it will calm down, so resist any temptation to pick them.
The synthetic hormones in the contraceptive pill control hormonal imbalances, avoiding the surges in estrogen and progesterone associated with breakouts.
The pill is often prescribed for hormonal acne as it is the least invasive yet effective treatment, with alternatives like antibiotics and Roaccutane having a greater risk of side effects.
“The problem is that the pill doesn’t fix hormonal imbalances – it simply masks them. When you come off the pill, your issues may still exist,” said Rollard.
Not everyone’s skin will react negatively to coming off the pill, and for most women any skin changes will happen within three months of their final dose.
Fortunately, there are simple changes you can make to keep skin calm and healthy during the transition period.
“Before coming off the pill, make sure your diet is low in sugar and alcohol, which can increase natural hormone levels and inflammation, and rich in whole grains and proteins,” said Rollard.
Being a healthy weight, and specifically not being underweight is also important for clear and vibrant skin.
“Body fat tissue is a storage site for excess hormones, therefore having too little body fat can leave the hormones nowhere else to go but to the skin’s surface,” said Rollard.
Managing acne without the pill
Many of Rollard’s clients struggling with stubborn spots are simply in need of a skin care regime overhaul.
“Most people, when struggling with acne, will reach straight for AHAs and BHAs, which are acidic exfoliation ingredients, but these can cause even more problems and lead to heightened sensitivity, flaky skin, and redness, without reducing acne,” she said.
“It is best to use gentle products that are non-comedogenic (meaning they don’t clog your pores) and 5α-Reductase inhibitors such as Vitamin B, azelaic acid or green tea.”
If you are struggling with acne or concerned about how your skin will react to coming off the pill, it’s best to find someone you trust to guide you in the right direction.
“Don’t wait for it to become a big issue,” advised Rollard.
“It is much easier to keep skin clear if you intervene early. Finding a knowledgeable skin therapist is a great way to keep on top of any issues before they interfere with your confidence or your life.”
When in doubt about what to do about random or persistent spots, resist the urge to touch them.
While professional, sterile extractions can be helpful for stubborn acne, the bacteria that lives on our hands and in our environment can infect the skin, spreading or prolonging the breakout.
If you have been on the pill because of acne, or you or your doctor suspect a hormone imbalance, Rollard suggests getting a blood test, remembering that this provides only a small snapshot.
“To fully understand any issues, seeing a female healthcare specialist or a naturopath to test your hormones can be useful,” she said.
“One option I love is the DUTCH test which provides a 24-hour overview of your hormone levels and fluctuations. However, if you are on the pill, these tests are inaccurate due to the synthetic hormones and balancing effect the contraceptive pill has on the body.”
Naturopaths and hormone specialists are also useful in helping you manage your transition away from the pill, without experiencing unnecessary hormonal side effects, including pesky acne or other skin conditions.