Hormonal Imbalance Acne: Causes and Treatments

Jenna Hilton
March 23, 2023

Hormones are chemical messengers that send vital information through the bloodstream to regulate the activity of cells, tissues, and organs. Among other things, they influence the quality and health of the skin, the body’s largest organ. When hormones are out of balance, skin can flare up and break out in acne.

This article explains what causes hormonal imbalance acne and offers solutions to treat this problem.

What is Hormonal Imbalance Acne?

Hormone fluctuations can cause acne or aggravate existing acne conditions, such as skin inflammation, excessive oil (sebum) production, and breakouts. Hormonal imbalance acne is a problem that occurs during puberty but can also affect adults. Women battle with it more frequently than men due to naturally occurring hormonal shifts (menstruation, pregnancy, menopause).

How to Tell if Acne Is Hormonal or Bacterial?

Hormonal acne occurs when there is a change on a hormonal level. One way to assess if acne is hormonal is to observe when it happens.

This type of acne typically occurs as a symptom of premenstrual syndrome (PMS), ovulation, polycystic ovary syndrome (PCOS), pregnancy, and menopause. It tends to reappear in the same area, in the lower parts of the face, such as the chin, the jawline, or the neck.

While hormonal acne can cause sebum overproduction and clogged pores, bacteria can worsen this skin condition by causing inflammation that manifests as red, swollen, cyst-like spots. If topical skin treatments don’t clear the breakout, the bacterial issue might require the use of oral antibiotics.

Consult a dermatologist to determine the root cause of your acne and decide on your next step.

Types of Hormonal Imbalance Acne

Hormonal imbalances can stimulate sebaceous (oil) glands to produce excess sebum and clog pores, creating bumps on the skin called acne vulgaris. There are inflammatory and non-inflammatory types of hormonal acne.

Non-inflammatory acne is a mild skin lesion that over-the-counter (OTC) medications treat well:

  • Blackheads – Open bumps (comedones) filled with excess oil or dead skin; dark-colored.
  • Whiteheads – Closed bumps (comedones) on the skin; white or yellowish.

Inflammatory acne is a severe skin condition that requires a medical treatment and supervision:

  • Pustules/Pimples – Small, painful bumps on the skin with white-yellow fluid (pus).
  • Papules – Red, swollen bumps with no pus.
  • Nodules – Red, flesh-colored lumps, sore and painful to touch; can leave scars.
  • Cystic acne – White painful lumps filled with pus; most likely to leave permanent scars.

Note: Each type of hormonal acne requires a different treatment. Learn more about types of acne, their triggers, and the best treatments for each.

Facial treatment for hormonal imbalance acne.

Who Is Most Affected by Hormonal Imbalance Acne?

The rise of testosterone in puberty activates excess sebum production, increasing the chances of hormonal acne in teenagers. Teenage boys are more likely to develop hormonal acne because their bodies naturally produce more of this androgen (sex hormone).

In adulthood, acne affect both men and women due to hormonal fluctuations at different stages of life. However, women are more likely to experience flare-ups because their hormones naturally fluctuate more. These breakouts usually happen around their periods, during pregnancy, perimenopause, menopause. They can also appear as a side effect of birth control pills with progestin, a synthetic version of progesterone.

What Causes Hormonal Imbalance Acne?

Acne appears when extra oil clogs the pores (hair follicles) and interacts with bacteria found in the skin micro flora. The following causes of hormonal imbalances can speed up this process:

  • Puberty – Overactive androgens produce excess sebum which results in clogged follicles and all types of acne (whiteheads, blackheads, papules, pustules, or cysts). It is essential to learn how to treat teenage acne to prevent potential scarring.
  • Menstruation – Period-related breakouts are common before (PMS) and during menstruation because testosterone levels rise while progesterone and estrogen naturally dip in the middle of the cycle.
  • Polycystic Ovary Syndrome (PCOS) – Different types of acne lesions appear on the chest, face, and back due to higher levels of testosterone and lower levels of progesterone and estrogen.
  • Perimenopause and menopause – Perimenopausal and menopausal acne typically occurs due to hypersensitivity to normal levels of androgens (male sex hormones) or a hormonal imbalance where there is an increase in testosterone and a decline in progesterone and estrogen.
  • Thyroid conditions – Post-adolescent acne is statistically more likely to appear in patients with a thyroid-related disorder. However, there isn’t enough scientific evidence to fully explain this association.
  • Increased levels of androgens - Androgens (male sex hormones) are the primary hormonal cause of acne. This is because testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) stimulate sebum production, leading to clogged pores and acne.
  • Birth control pills - Birth control pills with progestin can cause acne because of the androgenic effect of this synthetic form of progesterone. Nevertheless, most birth control pills reduce androgen levels and alleviate skin flare-ups and hormonal breakouts.

Note: Learn more about what causes acne to appear.

How Is Hormonal Imbalance Acne Diagnosed?

Self-diagnosis is not a good idea and is potentially harmful, too. Expert medical advice is crucial when it comes to diagnosing the root cause of hormonal imbalance acne.

  • Routine physical examination – An appointment with your primary care physician is a good start with moderate skin flare-ups.
  • Visiting a dermatologist – Your doctor will refer you to a dermatologist in case of persistent, severe acne breakouts.
  • Assessing frequently used skincare products – Some ingredients in cosmetic products can clog pores and worsen acne. Discuss your skincare routine with a medical expert to find the best skin care products for acne-prone skin.
  • Saliva and blood hormone testing – Hormonal dysfunction can impact the skin and provoke acne when left untreated. At-home saliva testing kits and in-office blood tests can determine the hormonal interaction of testosterone, estrogen, progesterone, dehydroepiandrosterone (DHEA), luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, sex hormone binding globulin (SHBG), and cortisol. Most providers will suggest testing on day 21 of the menstrual cycle and the results of the tests may indicate a hormonal imbalance that needs to be further examined by a professional.

Note: Seek professional medical care to avoid further complications and scarring. Read about types of acne scars for more information.

When Should I Start Treating Hormonal Imbalance Acne?

If preventive measures don’t help, early treatment of hormonal acne is the next-best approach. Consult a dermatologist to keep acne under control and avoid post-inflammatory hyperpigmentation (PIH) or deep cysts that may leave permanent scars. Adequate and timely treatment can save years of futile struggling with hormonal imbalance acne.

Note: Prevention starts with a top-quality skincare routine. Get more information in the ultimate skin care guide and create the perfect routine for your skin.

treating hormonal acne

How Do I Get Rid of Hormonal Imbalance Acne?

A holistic skin care approach increases the likelihood of finding a lasting solution to hormonal imbalance acne. Consider these options with a dermatologist to secure a satisfying result:

  1. Reduce sebum production – Oily, acne-prone skin requires gentle cleansers and exfoliators, as well as over-the-counter topical solutions with salicylic or mandelic acid.
  2. Pick the right ingredients – Acne-prone skin requires the application of skin care products with anti-inflammatory ingredients, such as niacinamide, retinol, benzoyl peroxide, and azelaic acid.
  3. Try a chemical peel – This skin resurfacing treatment is a good solution for some types of acne and acne scarring. Learn more about chemical peel treatments before you discuss them with your doctor.
  4. Photodynamic therapy (PDT) – This treatment uses a photosensitizer with oxygen and a light source to reduce inflamed lesions.
  5. Light therapy – Blue and red-light therapy get rid of acne-causing bacteria and decrease skin irritation, leaving the skin soothed.
  6. Female hormone replacement therapy – This treatment can be an effective solution for menopausal acne, as it replaces the female hormones that are naturally low at this stage in life.
  7. Anti-androgen medication – Anti-androgen agents block the effect of androgen hormones, such as testosterone, reducing the clogging caused by oil overproduction.
  8. Antibiotics – Doctors prescribe oral antibiotics to alleviate the symptoms of a hormonal flare-up accompanied by a bacterial infection.
  9. Birth control pills – This type of oral contraceptive decreases the circulation of androgens if it contains both estrogen and progesterone. It decreases sebum production and is therefore used as a treatment for acne.

Note: Our Acne Eraser Facial combines several of the techniques mentioned above and includes an aftercare regimen to help you say goodbye to acne for good.

If the root cause of your acne is that you are entering menopause, and you are looking for female hormone replacement therapy in Phoenix, don't hesitate to contact Vibrant Vitality Clinic. Our team of medical professionals will assess your skin's condition and design a solution tailored to your needs.

When Will I See the Results?

Results vary depending on the severity of hormonal acne and the chosen treatment. Acne with bacterial inflammation takes longer to heal. Some therapies, such as light therapy, photodynamic therapy, or chemical peels, require multiple sessions spread across several weeks. Topical OTC acne treatments take time and patience, while prescribed medications yield results within four to eight weeks.

Note: The battle against acne does not end with acne treatment. Even after successfully getting rid of acne, many people are left with visible scarring, which takes a toll on one's confidence. If you are considering acne treatment, prepare for the aftermath by learning about the best acne scar treatments.


Hormonal fluctuations, notably higher levels of androgens, cause both inflammatory and non-inflammatory acne in teenagers and adults. Clogged hair follicles or pores interact with dead skin cells and bacteria to create bumps and lesions on the skin’s surface.

There are multiple acne treatments at your disposal, from over-the-counter topical solutions to hormonal therapies. Schedule an appointment at Vibrant Vitality Clinic for a more comprehensive assessment of your skin type and treatment options.

Jenna Hilton
Jenna Hilton has been a practicing PA since 2009, specializing in Family, Internal Medicine and Medical Aesthetics. She attended Arizona State University where she received her Bachelor's Degree and graduated magna cum laude. She received her Master of Science degree in Physician Assistant Studies from A.T. Still University.

Jenna has been injecting neurotoxin and dermal filler since 2013. She received certification as a Master Injector in 2017 through Empire Medical in Los Angeles, California. She is currently working on a Fellowship Program in Anti-Aging and Regenerative Medicine through the American Academy of Anti-Aging Medicine. Her special interests include use of PLLA, Ablative/Non ablative skin resurfacing, PDO threads, hormone therapy and nutritional therapies to improve cellular regeneration and medically supervised weight loss.

Jenna Hilton believes in a multi-factorial approach, considering internal factors that accelerate aging and disease development. She always enjoys teaching. She co-founded Vibrant EDU courses at Vibrant Skin Bar and regularly performs one-on-one training with fellow injectors. She teaches Aesthetic and Advanced Injectable Courses at National Laser Institute. She has been named Preceptor of the Year and is an Adjunct Faculty Member at Midwestern University. She was born in Iowa, and lives with her husband and three children in Phoenix, AZ.

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