Everything You Need to Know About Hormonal Acne, According to Skin Experts—and Someone Who’s Been There

At 32, I randomly started experiencing acne. It worsened over time, and nothing I seemed to throw at it stuck. At last, I visited a couple of trusted experts, at my wits end and almost ready to give up. That was when I discovered my acne was mostly hormonal in nature.

Now, a year on, things are much better. My active acne has mostly healed, and I am practising much healthier skincare and lifestyle habits. But the experience was very difficult. Having acne later in life feels so unexpected, and the emotional impact it has is just as heavy as the physical.

So, if you're experiencing acne right now, chances are it could be hormonal. Read on to discover the symptoms, causes and treatments for hormonal acne, according to two trusted experts, and a girl who's (very recently) been there.

How do you recognise hormonal acne?

Acne comes in so many forms: the odd spot, all-over breakouts, blackheads, pustules... the list goes on and on. So how exactly does the average person (i.e. not a dermatologist) recognise when acne is hormonal in nature? With certain similarities to other types such as fungal and bacterial, it can be difficult.

Interestingly, both skin experts I spoke to agree that most types of acne will have some relation to hormones in some way. "Hormonal acne is a bit of a misnomer, as all acne is technically hormonal," says Dr Alexis Granite, Consultant Dermatologist and Founder of Joonbyrd, while Pamela Marshall, Clinical Aesthetician and founder of Mortar & Milk concurs: "My experience from the treatment room is that most acne has a baseline in hormones. Of course, there are exceptions to this, but generally hormones are consistently an undercurrent." Breakouts may be down to something else, but they often are hormonal as well.

However, there are signs acne is mostly hormonal, take for example, the placement and timing of your spots. "When we talk about hormonal acne we typically are referring to acne in women that flares up around our menstrual cycle and presents as deep, painful cysts and nodules over the lower face rather than superficial blackheads and whiteheads," explains Dr Granite. That said, sometimes that area can also break out just because someone is splashing their cleanser off rather than using a flannel," says Marshall. For this reason, "everything contributes and it takes some detective work to figure out that exact reasoning."

Having your hormones checked with a few blood tests at the GP can be a great place to start, but these results aren't the be all and end all: mine came back as ''normal'' and yet my acne was hormonal. Seeing a skin specialist, therefore, is highly recommended. They will examine your skin closely, and ask you a series of questions, while also looking at your clinical history.

What causes hormonal acne?

We often think of hormonal acne as something teenagers will suffer from. Going through puberty can be a key time period where breakouts flare up, certainly. But as adults, we are often talking about different stages of life: often those when our hormone levels naturally change.

"Women are more prone to hormonal acne, especially around puberty, 20s-30s and again in perimenopause/menopause," says Granite. "PCOS is a very common cause of hormonal acne," she adds.

Similarly, says Marshall, anyone with slightly elevated androgen levels may be more prone to acne. "Androgen, when heightened, will send messages to the sebaceous glands to produce excess oil. When that happens, our pilosebaceous unit gets angry and swells, creating a spot."

Can you prevent hormonal acne?

From my experience, hormonal acne can completely take you by surprise. As someone who's always had a rigorous skincare routine and healthy habits, it did me. For this reason, I'd argue it can be difficult to prevent acne of this kind, because we can't always control what happens naturally to our bodies.

If you are aware that your hormones are slightly out of balance and want to take steps to avoid skin repercussions, there are options, but annoyingly, many of these are birth control-based. "This is obviously not an option for everyone and sometimes birth control can make it worse," notes Marshall. "I can't tell you how many times I've had to take clients off of the Mirena Coil as it often can cause hormonal acne."

How to treat hormonal acne

That said (re. prevention), there are plenty of treatment options, and this fact in itself can feel overwhelming. Before I went to see Granite and Marshall, I threw everything at my acne to see what stuck, but this only exacerbated my symptoms. For this reason, seeing a skin expert (a registered dermatologist or recommended facialist specialising in acne) is so important. They can lay out your treatment plan, making it personalised to you. This can include skincare routine adjustments, lifestyle changes, oral medication and professional treatments.

Dr Granite explains: "I think of treatment for acne as a ladder, with the mildest treatments at the bottom. Over the counter oil-ree moisturisers, ingredients such as salicylic acid, supplements, pimple patches are at the base of the ladder. From there we can build on a treatment plan including topical prescriptions, at-home and in-clinic LED, oral antibiotics and hormonal treatments such as contraceptives and spironolactone, lasers such as AviClear and finally isotretinoin."

Prescription-only items may be required if you reach that step on the 'ladder'. These can include topical products and oral medications. "There are a variety of topical medications available in the UK including benzoyl peroxide, clindamycin and erythromycin, adapalane, tretinoin, azelaic acid and combinations of these," says Granite. "Deep cystic acne typically requires oral treatment as well and options include oral antibiotics, spironolactone, oral contraceptives and isotretinoin."

A skincare specialist can also offer you lifestyle advice, from cleaning your makeup brushes, pillowcase and towels more often, to suggesting supplements or dietary shifts.

Then there's the overall skincare routine: again, this is something you should be personally prescribed by an expert, ideally. This is because all skin types are different, and different symptoms of hormonal acne require different topical treatment. I've included products I have used below, that were recommended to me by Granite and Marshall specifically. I have found these are hormonal-acne safe (as well as my medicated creams, which are also included but not listed).

Final advice for hormonal acne sufferers

Before having acne, I thought I understood the impact this skin condition could have on a person. But experiencing it myself has totally changed my perspective; acne not only changes you physically, it also takes its toll on your mental wellbeing. It can feel overwhelming (particularly in terms of finding a solution) and isolating. I also strangely felt a level of shame, as if I had somehow failed my skin.

But the message here is this: you're not alone, and if you are pro-active about things, they usually will get a whole lot better. Qualified, recommended skin experts are your best friends (you can access them either directly, or through the NHS), and you should trust their advice. This is my best tip.