Everything You Need to Know About Hormonal Acne—and How to Clear It for Good

Right before a date or on the eve of a beach trip, you sigh into the mirror and wonder “why now?” For many women, pimples continue to sprout up way past puberty, thanks to fluctuating hormones. The good news: Hormonal acne can be treated.

Hormonal acne is unique

You might be thinking “isn’t all acne caused by hormones?” And you’d be correct. “All types of acne originate from hormones,” explains medical director and dermatologist, Jill Waibel, MD. “Testosterone, a hormone that is present in males and females, increases during adolescence. Testosterone stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug pores. For women, puberty ends at the age of 18 and ends for men at 21.” That doesn’t mean you’ll never get another pimple, unfortunately. “The term hormonal acne typically refers to breakouts that occur in adult women,” says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. “These pimples tend to be red, angry bombs that typically occur along the lower one third of the face, jawline, and neck.”

Know the causes

While you might not feel as moody as you did at age 14, there could be more drama happening under the surface of your skin than you realize. It’s only when the chemicals within come to a literal head, that you start to take note of your hormonal imbalance. “Flares are caused by overstimulating the oil glands and altering the development of the skin cells that line the hair follicles, which causes clogged pores where the acne bacteria grows, leading to inflammation, redness and acne,” explains Debra Jaliman, MD, dermatologist and assistant professor of dermatology at Mount Sinai. “It can present as blackheads, whiteheads, pustules, and cysts. It usually occurs before a period, during perimenopause, after starting or discontinuing birth control pills.” It can also happen in times of great stress.

How to ID hormonal spots

Even if you’ve had clear, smooth skin for a decade, you might wake up in your late 20s with a big red honker and wonder what’s going on. Look for where the pimples are forming. “Common symptoms of hormonal acne are plugged pores and inflammatory pimples in the T-zone area,” Waibel says. This means noticing bulging, and sometimes painful spots underneath your skin that are more common on the most shine-prone parts of your face, including your forehead and jawline. The build-up of oil (that causes that camera-flash resistant blur) is what’s forcing zits to come to the party. As Dr. Zeichner explains: “Androgens, such as testosterone, stimulate oil glands to rev up oil production. This both clogs pores and helps feed acne-causing bacteria on the skin, which promotes inflammation.”

Can you blame your period?

In short, you sure can. In fact, most women who suffer from hormonal acne report more frequent breakouts when they’re expecting their monthly visitor. “Women tend to break out around their period because of cyclical fluctuations in hormones along with the menstrual cycle,” Dr. Zeichner says. While some birth control might help regulate traditional acne, other types of birth control can actually worsen your conditions if they’re hormonal-based. Dr. Zeichner notes that all of the big life moments that most women go through—from trying an IUD to getting pregnant and having children to undergoing menopause—can trigger some unwelcome breakouts. Did you know that certain foods that improve your acne (and some make it worse)?

Hormonal acne is super common

You might envy the friend who proudly proclaims that she’s never had a pimple (and we don’t blame you)—but you should also know that if you suffer from pesky, unpredictable skin, you’re definitely not alone. According to the American Academy of Dermatology, about half of women in the U.S. experience hormonal acne between the ages of 20 and 29. That number goes down to 26 percent between ages 31 and 40, and then down slightly to 25 percent between ages 40 and 49. But even the lowest of those numbers is 1 in 4 women! Still, as you age, your chance of developing that jawline breakout dips, and that’s a good thing.

Myths about hormonal acne

Dr. Waibel says the biggest misconception about hormonal acne is that birth control will help solve the issue, and you should pop a pill and forget about it. “About 10 percent of women’s acne improve with birth control pills, but many worsen with the adding of any external hormones, like birth control pills or IUDs,” she explains. Another falsehood is the belief that you must not be taking good care of your skin. Since genetics play such a big role in our tendency toward breakouts, you could be religious about cleansing and treating your skin and still suffer from hormonal acne. “While some cleansers can help treat acne, breakouts are actually determined by genetics and hormones not because your face is necessarily dirty,” Dr. Zeichner says. “There are some people who do not wash their face much, yet do not break out. There are others who wash their faces much more frequently but do suffer from acne.”

The best ways to treat hormonal acne

Luckily, with the right cocktail of topical treatments and in more severe cases, oral medication, you can help manage, prevent, and treat your breakouts. The first place to start is with over-the-counter formulas that focus on specific ingredients, known to lessen your symptoms and inflammation. “Options include benzoyl peroxide, salicylic acid, and topical retinoids,” Dr. Zeichner says. One powerful retinoid, Differin, recently got FDA approval for sale over the counter, after decades of being available by prescription only. “Leave-on treatments are effective because they have time to exert their effect,” Dr. Zeichner adds. Cleansers are not as effective at combatting acne because they don’t stay on very long, though Dr. Zeichner suggests leaving them on for the length of time it takes you to sing the alphabet; then rinse off. “They can be used alongside leave-on products or in place of them if you have sensitive skin,” he adds.

In addition to what you put on your skin, you can also consider light therapies, often used in derm offices, and now available at drugstores. Dr. Zeichner says blue light helps kill acne-causing bacteria (try Tria Beauty Acne Clearing Blue Light), while red light can reduce the puffiness or redness of your skin (try RejuvaliteMD by Trophy Skin).

If you’re able to visit your dermatologist, there are also oral prescriptions that over time, can help clear hormonal acne almost completely. “We have effective medications to help treat acne, so please visit a dermatologist if you are suffering. Early, effective treatment can help prevent permanent scarring,” Dr. Zeichner says. Prescription medications include oral and topical retinoids and antibiotics, topical prescription dapsone (Aczone gel), prescription strength benzoyl peroxide (in some brand-name drugs such as Epiduo Forte), and hormonal treatments such as spironolactone and even some birth control pills which are FDA-approved to treat acne.”