Hormonal Acne

When pimples appear or increase on a woman's face as she approaches menstruation, she is suffering with 'hormonal' or 'premenstrual' acne. While some only get one or two pimples and don't find them much of a burden, other women's acne can be deep, painful, and widespread, covering their entire face, chest, and back. Besides the risk of permanent scarring from picking pimples, the emotional stress associated with their appearance tends to be the hardest on women. Being more than skin deep, pimples that fluctuate with the menstrual cycle signify an underlining hormonal imbalance and even problems related to a women's fertility.

Hormonal acne is mostly due to the elevated androgen (male hormone), testosterone, stimulating the sebaceous glands in the face to produce more sebum (oil). This increases the possibility of glands becoming plugged and inflamed, causing pimples to form. Since the majority of the testosterone produced in a woman's body is from cells within her ovaries, signs of excessive testosterone, like acne, can signify that the ovaries are not working properly. One condition hormonal acne may point to is polycystic ovarian syndrome (PCOS). Women are diagnosed with PCOS when they have two out of three conditions: anovulation/ amenhorrhoea (lack of monthly ovulation or menstruation), elevated androgens, or ovarian cysts visible via ultrasound.

Both diet and lifestyle are linked to acne flare ups. Studies have shown that acne sufferers improve when they eat foods that are lower on the glycemic (sugar) index so that their digestion takes longer to assimilate the sugar within them and thus keeps insulin levels within a normal range. The reason for this is that excess insulin inhibits testosterone regulation, leading to excessive testosterone. In another study researchers who originally set out to prove that acne was not aggravated by stress were surprised to find the opposite. College students were monitored during exam time, an undeniable stressful event, and their acne increased as they approached exams. Hormonal imbalances triggered by the stress were postulated as the main cause.

Chinese medicine (CM) has diagnosed and treated pre-menstrual acne for thousands of years. It has always seen issues such as eating an improper diet of overly sweet and greasy foods and excessive emotional and mental stress as some of the main causes of acne. CM believes that these poor lifestyle habits block regular blood and energy flow, particularly to the reproductive organs, creating stagnation. Stagnation leads to heat (or inflammation), which rises in the body and manifests as acne. When menstruation begins, this stagnated heat drains out of the body through the menstrual blood and the acne improves. Until the root cause of the stagnation is addressed, the hormonal acne cycle will continue.

Chinese medical theory says, "for acne in men treat the intestines, in women regulate the menstrual cycle." Signs of stagnation related to the menstrual cycle are short, delayed, or painful cycles and thick, clotted, or darker coloured flow. To relieve stagnation, treatment includes lifestyle counseling with an emphasis on stress reduction and dietary adjustment. The recommendations are aimed at increasing vegetable intake and limiting foods such as dairy, wheat flour products, concentrated sugars, and deep fried or greasy foods. Herbal medicine and/ or acupuncture is often necessary to resolve the deep stagnation and inflammation it causes. A typical treatment for hormonal acne can be anywhere from 12 to 20 weeks long. Since so much attention is paid to regulating the menstrual cycle, acne treatments can also optimize a woman's fertility. This is a welcome bonus to the relief a woman feels with the improvement of her acne.

As a practitioner of Chinese medicine, I have always enjoyed observing the regained confidence women experience when they are relieved of the emotional stress associated with acne. To me, mind and body are united and, as one heals so does the other, revealing what is on the outside of the body is only a reflection of the inside.

Trevor Erikson, R.TCMP