Hormonal Acne and Women's Health: When to See a Gynecologist

In short: Acne in women can be a sign of a gynaecological problem, mainly polycystic ovaries and raised male hormones, or starting or stopping the contraceptive pill, or stress. Take note if it comes with irregular periods, excess hair in a male pattern or difficulty conceiving, or appears suddenly and severely. Treatment includes changes to diet, weight and sleep, and hormonal medicines such as the pill, spironolactone (with effective contraception, never in pregnancy) and metformin.

Struggling with breakouts that just won’t clear up, no matter what creams you try? Many people assume acne is only a dermatologist’s concern, but in this article we’ll explain the important role a gynecologist can play in understanding and treating acne.

Hormonal acne is usually linked to fluctuations or imbalances in female sex hormones (especially androgens, which are male-type hormones that a woman’s body also produces naturally).

Causes of hormonal acne:

• Increase in androgens
• Estrogen fluctuations
• Progesterone fluctuations
• Oil glands overstimulation
• Pores clogging

At what stages of life does hormonal acne appear or worsen?

• Puberty
• Premenstrual
• Pregnancy
• Postpartum
• Perimenopause
• Right after stopping birth control pills

What are the body parts that are most affected by hormonal acne?

• Chin
• Jawline
• Lower cheeks
• Neck

Characteristics of hormonal acne:

• Deep
• Painful
• Cystic
• Occurs in the same spot
• Worsens before menstruation

Gynecological causes of hormonal acne:

• Polycystic ovary syndrome:
• irregular cycles
• hirsutism
• weight gain
• hair thinning
• infertility

In this syndrome, the production of androgens is increased, leading to more oil production and cystic acne.

• High androgen levels:

Some women’s skin is simply more sensitive to androgens, even when hormone levels are otherwise normal.

• Changes caused by birth control pills:
• starting or stopping them
• some OCPs help treat acne (they have anti-androgenic properties)
• some OCPs contain androgenic progesterone components, which can worsen acne
• Stress:
• it increases cortisol levels, which leads to increased adrenal production of androgens

When should a woman with acne be referred to a gynecologist?

When she has:

• Irregular cycles
• Severe premenstrual syndrome symptoms
• Infertility
• Sudden severe acne
• Hirsutism
• Deepening of the voice

Assessment conducted by the gynecologist:

• total and free testosterone
• hormone produced by adrenal gland
• LH/FSH ratio
• prolactin level
• thyroid function tests
• pelvic ultrasound

How is hormonal acne treated?

• Lifestyle changes:
• low sugar diet
• weight loss
• get good sleep
• stress management
• Hormonal medications:
• combined oral contraceptive pills
• spironolactone
• metformin, especially in cases of insulin resistance

Treating hormonal acne is not only about achieving clearer skin — it can also be a sign that the body’s hormonal balance is being restored.

If you’re dealing with persistent or unusual acne along with other symptoms like irregular periods or difficulty conceiving, it may be worth discussing your concerns with a gynecologist who can look at the bigger picture of your reproductive health.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist