Written by: Salma Alsibai, RDN, LDN
We’ve all had to deal with the occasional pimple or blemish, but having to deal with constant acne flare ups can leave us feeling frustrated and just a tad bit self conscious. For women struggling with PCOS, having to make due with acne breakout can seem inevitable and hopeless, however, this does not have to be the case. There are a number of solutions to dealing with hormonal PCOS acne in women.
Why are women with PCOS prone to acne breakouts?
I’ll start by mentioning that acne is common amongst women in general, not just those with PCOS. Often times, physicians will refer to women’s’ acne as hormonal acne. This term is a bit misleading as all acne is hormone induced. This is why most of us had our first bout of acne around the time we hit puberty.
It’s more accurate to say that woman’s acne is cyclical in nature as it relates to our menstrual cycles and hormone fluctuations during those cycles. However, it is the case that women with PCOS are more likely to complain of moderate to severe acne. This comes as no surprise seeing as how unmanaged PCOS leads to greater hormone imbalance.
How do I treat my hormonal acne?
Before we can treat the signs and symptoms we need to understand the underlying cause. Below are a few common causes of acne breakouts and solutions for each.
- Estrogen dominance: In the first half of a women\’s cycle, the follicular phase, estrogen levels gradually increase until they reach their peak about 14 days into the cycle. This estrogen peak is typically what triggers ovulation. Once ovulation takes place, estrogen levels drop and progesterone takes over. Having higher levels of estrogen relative to progesterone during this period can lead to higher DHT levels, which triggers excess sebum or oil production in the sebaceous glands, leading to acne flareups. If you find that you consistently deal with acne in the week or days preceding your period, this may be you.
What to do?
To promote your body’s ability to eliminate free circulating estrogen, increase your fiber intake. Fiber binds to estrogen in your intestines, allowing for it to be eliminated rather than reabsorbed into your bloodstream.
- High Insulin levels: One of the underlying causes of many PCOS symptoms is having high insulin levels in the blood. Insulin tells your ovaries to produce more testosterone, leading to more hormone related acne flareups. Insulin also inhibits the actions of SHBG, (sex hormone binding globulin) which bind to estrogen and androgen, and limits the amount of free circulating hormones. If you know or suspect that you may have insulin resistance, this may be the cause of your acne woes.
What to do?
Follow a low glycemic-index diet, that’s a fancy way of saying limit your simple carbs and sugar intake. Opt instead to switch those simple carbs with whole grain carbs. Some examples of whole grains are brown rice, bulgur, oatmeal, whole-wheat pasta and whole-grain bread (especially flat breads). Cows milk seems to be another acne trigger for people with insulin resistance, particularly skim milk. If you suspect that this may be the case for you, try eliminating cows milk from your diet for 2-4 weeks.
- High Cortisol levels: also known as the stress hormone, cortisol is necessary to our bodies in moderate amounts. But when we have too much or too little of this hormone, it can negatively impact our insulin and testosterone levels. This is why you may see an increase in acne flare ups during stressful times in your life.
What to do? Apart from doing what you can to avoid stressful situations, learn new coping mechanisms that help you physically deal with the stressors in your life. Whether its meditative practices, breathing exercises or journaling, find ways to incorporate some down-time into your busy schedule. It\’s also helpful to make note of the more stressful times of your daily routine, such as the morning commute, and find ways to keep your mind calm and relaxed.
Beneficial Supplements
There are a number of supplements that have been thoroughly researched in connections with both PCOS and acne.
- Inositol: A plethora of studies have shown that a combination Myo-inositol and D-chiro-inositol has a clinically significant impact on improving insulin sensitivity and reducing androgen levels in women with PCOS. As a result, studies have found that this change results in reduced acne presentation in women with PCOS after taking 2g of MYO Inositol, twice per day for 3 months.
- Zinc: A deficiency in this micronutrient is very common among women with PCOS and supplementation has been shown to improve both acne and hirsutism. In one study, women supplemented with Zinc over the course of 8 weeks saw significant reduction in severe acne.
- Omega-3: Researchers first began looking into the connection between omega-3 and acne when it was noted that societies with higher omega-3 intake had markedly fewer instances of acne amongst their population. Given that omega-3 also improves insulin sensitivity and lowers androgen levels in women with PCOS, it may also resolve acne flare ups which result from those two causes.
Other considerations
While improving our diet can help us achieve clearer skin, we should also look at other factors that may be exacerbating the situation. Since the primary issue with hormonal imbalance in relation to acne is the overproduction of sebum and oil, it\’s important to maintain proper hygiene and use appropriate facial cleansers in the mornings, and evenings before bed. For those who use makeup regularly, it\’s important to look for non-comedogenic products that won’t clog pores and lead to inflamed cysts. As with most other treatments, it takes time to see visible results after making the necessary changes. With acne, it takes about 3-6 months to see a visible reduction in acne flare ups and clearer skin. This is why it\’s important to make the appropriate changes and remain consistent for long term results.
Resources:
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Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S52-4. doi: 10.1016/j.jaad.2015.07.042. PMID: 26470617.
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Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Gynecol Endocrinol. 2009 Aug;25(8):508-13. doi: 10.1080/09513590903015544. PMID: 19551544.
Khayef, Golandam et al. “Effects of fish oil supplementation on inflammatory acne.” Lipids in health and disease vol. 11 165. 3 Dec. 2012, doi:10.1186/1476-511X-11-165