Ah, the unforgettably awkward teenage years when many of us first encountered stubborn hormonal acne—those deep, inflamed, painful cysts that were supposed to vanish for good once you reached adulthood. As you may know all too well (you’re reading this article, after all), these persistent breakouts can also rear their ugly, uh, heads well into your 20s, 30s, 40s, and beyond. Yep, hormone-fueled zits aren’t just a high school rite of passage; they can stick around (or show up) later in life, too.
Hormonal acne, as the name suggests, is influenced by changes in your hormones. It can affect anyone—regardless of their gender, age, or skin care routine.1 However, it’s particularly prevalent in people assigned female at birth from puberty until age 40, and it can also show up in folks going through menopause, Cherise Mizrahi-Levi, DO, New York City-based dermatologist, cofounder of Ayana Dermatology, and clinical instructor at Columbia University, tells SELF.2
That said, just because you’re a full-grown adult wrestling a strong-willed chin zit, that doesn’t necessarily mean hormonal acne is to blame. These are a few of the specific things dermatologists look for when trying to determine what’s really behind those bothersome bumps and spots.
What is hormonal acne, exactly?
First, it’s helpful to understand the difference between hormonal acne and good old-fashioned pimples. The former is linked to (you guessed it) fluctuations in hormones, which can lead to “cyclical breakouts” that usually coincide with a person’s menstrual cycle, Joshua Zeichner, MD, board-certified dermatologist and director of cosmetic and clinical research at the Icahn School of Medicine at Mount Sinai hospital in New York City, tells SELF.1 However, these physiological shifts can also align with other significant life events, which can explain menopausal or postpartum pimples, too.
One important thing to note: Hormonal acne is technically not an official medical diagnosis, Ife J. Rodney, MD, board-certified dermatologist and founding director of Eternal Dermatology and Aesthetics in Fulton, Maryland, tells SELF. However, when a person tends to get very specific types of breakouts around the time of their period or when their body is experiencing vast hormonal changes for other reasons (such as in the case of a condition like polycystic ovary syndrome, or PCOS), dermatologists generally describe it as hormonal acne.
What causes hormonal acne?
Okay, let’s get into the nitty-gritty of those hormones we keep talking about. To get specific, we’re referring to sex hormones that influence how much (or how little) sebum (oil) the sebaceous glands in your skin produce, S. Manjula Jegasothy, MD, board-certified dermatologist and founder of Miami Skin Institute, tells SELF.3
Estrogen, for example, helps to regulate and lower the production of sebum, which can clog pores and cause acne. But there are some life phases when estrogen levels inevitably decrease, like during menstruation or in the years leading up to menopause (known as perimenopause).4 Progesterone, on the other hand—which ramps up during pregnancy and ovulation—can have the opposite effect by triggering the release of sebum, which can, yep, also be a recipe for skin troubles.5