Hormonal acne is one of the most common (and frustrating!) types of acne women experience. Unlike the occasional breakout, hormonal acne is deeply tied to imbalances in your body’s hormones – particularly reproductive and metabolic hormones.

The good news? Once you understand the root causes, you can start addressing them naturally and finally see clearer, healthier skin.

What Is Hormonal Acne?

Hormonal acne is caused by imbalances in key hormones, often involving:

· Estrogen

· Progesterone

· Androgens/Testosterone

· LH (Luteinising Hormone) & FSH (Follicle-Stimulating Hormone)

· Insulin & blood sugar regulation

These hormones influence oil (sebum) production and quality, skin cell turnover, and inflammation – all major drivers of acne.

How Hormones Trigger Acne

1. Estrogen Imbalances

· Low estrogen can heighten testosterone’s effect, leading to excess oil production and clogged pores.

· High estrogen may point to poor liver detoxification or toxin overload, which disrupts clear skin.

2. Ovulation-Related Breakouts

Breakouts often appear around ovulation due to:

· Increased inflammation (prostaglandins).

· A rise in luteinising hormone (LH), which boosts androgen production.

· Progesterone-related constipation, which can worsen toxin build-up.

· Progesterone increases from ovulation which increase sebum/oil production – this can cause breakouts NOT due to the increase in oil, but from the quality of our sebum/oil (if it is thick/sticky/poor quality) then the increase in oil flow can lead to breakouts.

3. Progesterone Levels

Progesterone plays a role in skin:

· It blocks the enzyme that converts testosterone into DHT (a stronger androgen strongly linked to acne).

· Low progesterone allows DHT to trigger more breakouts.

· Without enough progesterone, estrogen’s effects become dominant (“estrogen dominance”), worsening acne.

Why You Breakout Before Your Period:

In the luteal phase of your cycle, progesterone is highest. Progesterone increases sebum/oil production – this can cause breakouts NOT due to the increase in oil, but if the quality of our sebum/oil is poor (thick/sticky/poor quality) then the increase in oil flow can lead to breakouts.

This can explain why not all women will experience breakouts before their period.

The focus is on correcting the QUALITY of your sebum and oil so that it flows freely and doesn’t block your pilosebaceous unit (your sebaceous gland and hair follicle) which causes a pimple to form.

The Pill, Hormonal Contraceptives & Acne:

Since progesterone is only produced after ovulation, women on the pill or other contraceptives (like the Mirena or Implanon) aren’t ovulating – meaning they aren’t producing their own hormones, and their cycle is ‘flat lined’ which can temporarily stop their hormonal acne. However, the pill doesn’t correct hormonal imbalances, it simply suppresses our hormones without fixing them and it does not optimise our sebum/oil quality either so isn’t treating the root cause for clear skin long term.

The pill and other hormonal contraceptives also come with many serious side effects such as anxiety, depression, mood changes, weight gain, depletes your nutrient status, cardiovascular/stroke risk, bone health risks, breast cancer and more.

To learn more about how to heal your acne without the pill, watch my free mini-masterclass here.

Signs Your Acne May Be Hormonal:

If you notice these patterns, your hormones could be driving your acne:

· Menstrual cycles shorter than 25 days or longer than 31 days.

· Periods lasting less than 4 days or more than 6 days.

· PMS symptoms: fluid retention, acne, breast tenderness, mood swings, or headaches.

· A history of contraception use (OCP, Implanon, Mirena, etc.).

· Clearer skin only when on the pill (masking your hormonal imbalances without fixing them).

· Regular use of beauty products containing endocrine-disrupting chemicals (EDCs).

· Excess body hair (upper lip, stomach, nipples, thighs).

· Hair loss or thinning on the scalp.

· Post-pill acne or side effect of the pill or other hormonal contraceptives

· Acne at ovulation, before or during your period.

· Acne on the lower face and jawline

· Cystic acne

PCOS & Acne – What You Need to Know

If you have been diagnosed with Polycystic Ovary Syndrome (PCOS) it is always good to double check you have been diagnosed correctly, as this syndrome is often misdiagnosed.

Diagnosis can only be made on meeting the Rotterdam Criteria, many women are misdiagnosed with PCOS, when in fact they have other hormonal imbalances and conditions that display similar signs and symptoms and therefore may receive incorrect hormonal treatment. PCOS can have very similar symptoms to hypothyroidism and hypothalamic amenorrhea.

It is also important to know that it can be quite normal for adolescent and young women to have polycystic ovaries on ultrasound, that do not have PCOS.

Polycystic ovaries can also occur as part of post-pill syndrome when you come off the pill if it was masking your underlying hormonal imbalances, which can naturally go away with time being off the pill, allowing your ovaries to self-regulate or with Naturopathic treatment.

PCOS can be misdiagnosed instead of thyroid conditions. Symptoms of Hypothyroidism may include: weight gain, fatigue, hair loss, acne, irregular periods, loss of period, heavy periods, fertility issues, depression/mood changes.

PCOS can be misdiagnosed instead of hypothalamic amenorrhoea. Symptoms of Hypothalamic amenorrhoea include irregular periods, acne, loss of period, fertility issues, fatigue, hair loss and increased hunger.

Hypothalamic amenorrhea is caused by excessive stress, excessive exercise and or malnutrition. This is often seen in athletes and marathon runners, women with eating disorders, women with undiagnosed coeliac disease, vegan/vegetarians or women with eating disorders lose their period.

You may also display these signs and symptoms and not fit into these diagnoses, but prevention and Naturopathic treatment is key for prevention of progression of your hormonal imbalances.

It is vital that you are correctly diagnosed with PCOS, hypothyroidism, post-pill syndrome or hypothalamic amenorrhoea for correct treatment, as the treatment for each of these conditions will vary massively and impact your health outcomes.

The treatment for PCOS can be almost opposite to the treatment of hypothalamic amenorrhoea!

Healing Hormonal Acne Naturally

Balancing your hormones takes time, but it is absolutely possible. Here are a few steps that can help support your journey:

· Support your liver → help detox excess hormones.

· Balance blood sugar → stabilise insulin and androgen levels.

· Reduce stress → lower cortisol, which disrupts sex hormones such as androgens.

· Prioritise improving your sebum/oil quality → to reduce acne before your period. Do this via treating the root causes of poor sebum quality through Naturopathy.

· Choose low-toxin skincare & personal care products → reduce hormone-disrupting chemicals.

· See a Naturopath - to get 1:1 hormone testing, treatment and professional assessment and advice – trying to figure out your hormones and acne alone is not only stressful, but can be dangerous with self-prescribing treatments and supplements.

Want to learn more about how to heal your hormones and acne without the pill?

Hormonal acne is your body’s way of signalling that something deeper is out of balance. Instead of just covering up the symptoms, healing naturally means restoring your hormones, nurturing your cycle, and giving your skin what it truly needs.

You deserve to feel confident, radiant, and in control of your skin again – and that starts with understanding your hormones and feeling empowered to get 1:1 support with a Naturopath to give you the right advice and do testing with for targeted treatment for your hormones and skin.