This is about one author's personal, anecdotal experience and should not substitute medical advice. If you're having health concerns of any kind, we urge you to speak to a healthcare professional.
I've always been extremely lucky with my skin. Throughout my teens and early 20s, no matter how lackadaisical I was with my skincare routine, my skin just ticked away pretty happy. Then, when I got into the beauty industry, I was lucky enough to try out every skincare treatment, buzzy ingredient and new product launch going—which left my skin healthy, happy and supple.
Pretty sickening, right? Well, I'm paying for it now. For the last six months or so (like clockwork), one week before my period is due, enormous crater-like zits will pop up on my face. I'll feel them come on a couple of days prior, and then when they do appear, they're painful and hard to cover. Not only that, but no matter how much I blast them with salicylic acid, LED light treatments or just leave them be, they seem to hang around like an unwanted friend for a good couple of weeks.
I drink lots of water, eat plenty of greens and have a skincare regime that would rival a Korean 12-step routine, yet I'm still breaking out every month. I attribute some of the blame to the fact I came off the pill around 18 months ago, but since I didn't have troublesome skin before taking the pill, my crazy hormones are not my friend right now.
It's frustrating, painful, annoying and generally just a bit shit, and it's a problem that I know so many 20- and 30-somethings out there also struggle with. So I decided to rope in the advice of some of the best dermatologists I know. Here's their advice to me, and now to you too…
Forever trying to fight off zits before they come (above).
What Causes Hormonal Acne?
"Hormonal acne is due to fluctuations with your hormones," says Stuart Kaplan, founder of Kaplan MD Skincare. "Up to 50% of women in their 20s, and 25% of women in their 40s suffer from hormonal acne. Menstruation and other hormonal imbalances can cause increased androgen levels, specifically testosterone. This causes increased oil (sebum) production in the pores, skin inflammation, clogged hair follicles, and increased bacteria in the pores. All of this leads to acne." Kaplan tells me.
So what is it that makes your skin turn problematic only during your time of the month? During days 19–28 of your menstrual cycle (also known as the luteal phase), your oil production naturally increases. "Oily skin has a hard time keeping up with shedding the dead skin cells, therefore, we get clogged pores which can cause spots to form. This spike in oil production can also feed existing bacteria that might be living on your skin, making our breakouts worse," says Megan Felton, founder of Lion/ne, a London-based skincare consultancy firm.
If you're finding that nonprescription, topical spot creams just aren't working, you're not alone. "This is because the deep cysts that form under the skin cannot be reached by most creams and washes," says Kaplan. "Oral medications are more effective since they work from the inside. These include oral contraceptive pills, oral anti-androgen medications (such as spironolactone), and oral antibiotics. If your acne is severe or scarring, oral isotretinoin (Accutane) may be necessary. Whatever you do, do not squeeze or pick your pimples. This always makes it worse."
But what if you don't want to take medication? For me, my spots definitely aren't severe enough to warrant taking medication. Throughout the rest of the month, my skin completely behaves itself. I came off the pill for a reason, so I don't want to go straight back on it! So what's next?
Birth Control and Hormonal Acne
I spoke to consultant dermatologist Justine Kluk, MD, who explained why coming off the pill could be having this effect on my skin, even months after. "The combined contraceptive pill contains both oestrogen and progesterone and can be an effective way of controlling breakouts by stabilizing hormone levels and reducing androgen activity. After discontinuing the pill, some women will find that their spots start to flare within a few weeks, whilst many only start to notice the problem creeping back as long as six or even 12 months after they’ve come off it."
"If your skin is normally well behaved, it's a good idea to up the BHA products in your regimen a week or so before your period is due," says Felton. "This might mean switching your normal cleanser for a cleanser that's formulated with salicylic acid, which is designed to go deeper into the pore and clean out excess oil and bacteria."
It makes total sense to me to introduce spot-prone skincare and ingredients before my breakouts appear rather than trying to target the cystic acne once it's formed. But this doesn't necessarily mean an overly complicated multi-step routine is best. Sam Bunting thinks that a simple, direct approach to skincare is the best way to target these kinds of breakouts.
"The best approach for most women is a product cull," she tells me. "Simplify your regime, removing any irritants (like excessive use of exfoliators and overuse of foaming cleansers) and build a basic routine from non-comedogenic skincare brands instead. I developed Flawless Cleanser and Moisturiser, the first two products in my skincare range, to meet the needs of adult skin without promoting blemishes.
"Then, depending on the severity of the condition, I will add in therapeutic products. Most acne sufferers will benefit from a retinoid (to prevent clogging) and an anti-inflammatory agent like salicylic acid or benzoyl peroxide."
Kluk agrees that these are the key products to bring blemishes under control: "It's important to stick to your skincare routine as much as possible, remembering to cleanse twice daily and only use non-comedogenic beauty products and makeup. Adding topical benzoyl peroxide, retinol, or salicylic acid to your routine can help unblock pores by removing dead skin cells, decrease shine and reduce redness and inflammation."
If like me, you're suffering from breakouts before or around the time of your period, it might be worth starting fresh with your skincare routine and introducing some of these skincare picks.