The relationship between estrogen and acne is somewhat complex because hormone fluctuations in the normal female menstrual cycle can cause acne at different times. Low levels of estrogen and proportionally higher levels of androgen hormones generally cause estrogen-related cystic acne. Hormone imbalances that decrease estrogen levels or raise androgen levels will increase the likelihood of acne formation because they increase the amount of oil produced by the sebaceous glands under the skin’s surface. Birth control pills can alleviate some severe acne, as they carefully maintain the estrogen and androgen levels in the bloodstream.
Androgens are the primary hormone-related cause of acne in many women. These hormones are what stimulate the sebaceous glands to produce an oily substance known as sebum. Too much of this substance can often become stuck in the pores, providing a breeding ground for common skin bacteria that multiply under the skin’s surface. Once the bacteria have multiplied, they can often cause inflammation, which leads to cystic acne. Estrogen is able to cancel out or mask the androgens’ effects on the body.
High levels of estrogen and acne occur at opposite times in a typical menstrual cycle. During the first half of the cycle, before ovulation occurs, estrogen levels gradually rise. Not only does this reduce the effects of the androgens in the body, but it also reduces the occurrence of acne. The body reaches its estrogen peak right before ovulation, after which the estrogen levels gradually taper off. Acne usually increases after ovulation in the time known as the luteal phase, and it becomes the worst just before menstruation.
During the luteal phase of the cycle, progesterone, a hormone that possesses both estrogen-like and androgen-like properties, gradually rises. Progesterone fluctuations can increase bloating and fluid levels, which in turn squeeze the pores on the face. This reduction in pore size often worsens the symptoms of acne because it further limits the body’s ability to clear away the excess oil.
Birth control pills provide carefully controlled estrogen and progesterone levels in the bloodstream. By keeping the estrogen levels consistent throughout the month, the pills are able to reduce the androgen effects during the luteal phase in addition to reducing general hormone fluctuations. This ultimately leads to a reduction in acne for many women, especially those who experienced severe hormone imbalances before beginning treatment.
