Why Does Acne Get Worse Before Period Starts

# Why Does Acne Get Worse Before Your Period Starts?

Introduction

If you’ve noticed that your skin breaks out like clockwork before your period arrives, you’re not alone. Research shows that **65% of adult women experience acne flares linked to their menstrual cycle**, making hormonal breakouts one of the most common skin concerns among women.[1][8] These breakouts are predictable, often painful, and frustratingly consistent—yet many people don’t fully understand what’s happening beneath the surface of their skin.

The connection between your menstrual cycle and acne isn’t coincidental. It’s driven by real hormonal shifts that directly affect how your skin produces oil, responds to bacteria, and manages inflammation. Understanding this relationship is the first step toward managing breakouts more effectively. Rather than treating period acne as a separate problem, recognizing it as a cyclical, hormone-driven condition allows you to anticipate it, prepare your skin, and potentially reduce its severity.

This article breaks down the science behind menstrual acne, explains exactly when and why breakouts occur, and provides practical strategies to keep your skin clear throughout your cycle.

How Hormones Drive Acne Before Your Period

Your menstrual cycle is fundamentally a hormonal event, and your skin is exquisitely sensitive to these fluctuations. Three hormones play the primary roles in triggering premenstrual acne: estrogen, progesterone, and testosterone.

**Estrogen** is responsible for producing elastin, collagen, and hyaluronic acid—compounds that keep your skin hydrated, plump, and resilient.[3] Just before your period, estrogen levels drop significantly. This decline removes one of your skin’s natural protective barriers.

**Progesterone** tells your sebaceous glands to produce more sebum, the oily substance that lubricates your skin.[2][3] In the luteal phase of your cycle (the second half, after ovulation), progesterone levels rise and remain elevated until your period begins. Higher progesterone means more oil production, which creates an ideal environment for acne-causing bacteria to thrive.

**Testosterone**, often thought of as a male hormone, is present in all bodies regardless of sex. While testosterone levels remain relatively stable throughout your cycle, they become *relatively higher* compared to your plummeting estrogen and progesterone levels just before menstruation.[6][7] This shift in hormone ratios triggers your sebaceous glands to produce even more sebum and can increase a process called follicular hyperkeratinization—essentially, dead skin cells clogging your pores.[7]

The combination of these three hormonal shifts creates a perfect storm for breakouts: more oil production, more pore congestion, and more inflammation.

When Exactly Do Premenstrual Breakouts Occur?

Timing is one of the most reliable ways to identify hormonal acne. **91% of women who experience perimenstrual acne report that breakouts begin within seven days before their period starts**, with the majority experiencing worsening symptoms in the week preceding menstruation.[1]

The specific timing breaks down like this:

• **56% of women** report worsening acne in the week before their period[1]
• **17% of women** experience worsening symptoms during menstruation itself[1]
• **24% of women** report worsening symptoms throughout their entire cycle[1]
• **77% of women** find that acne disappears within one week after their period ends[1]

For those with regular 28-day cycles, this typically means breakouts peak between days 22 and 28 of your cycle—the late luteal phase.[7] If your cycle is longer or shorter, adjust these timeframes accordingly.

The predictability of this timing is actually useful information. If you can identify your personal pattern, you can prepare your skin in advance rather than reacting to breakouts after they appear.

Why Breakouts Continue During Your Period

Many people expect acne to clear up once bleeding begins, but hormonal acne often persists into the first few days of menstruation. This happens because hormonal fluctuations don’t stop abruptly when your period starts.

During menstruation, testosterone levels remain relatively elevated compared to your still-low estrogen levels.[6] This continued hormonal imbalance keeps sebaceous glands activated and pores compressed. Additionally, progesterone levels don’t drop to their lowest point until a few days into your period, so the oil-stimulating effects linger.[5]

The good news: **77% of women report that their acne disappears within one week of their period ending**, once hormone levels begin to rebalance.[1] This natural clearing is a sign that your hormones are stabilizing and your skin’s oil production is normalizing.

The Role of Inflammation and Bacteria

Hormonal fluctuations don’t just increase oil production—they also amplify inflammation and bacterial activity. Excess sebum provides food for *Cutibacterium acnes* (formerly *Propionibacterium acnes*), the bacterium primarily responsible for acne formation.[6] When bacteria populations increase in oil-rich environments, they trigger inflammatory responses that manifest as red, painful pimples.

Hormones can also directly increase skin inflammation independent of bacterial activity.[2] This is why hormonal acne often appears as deeper, more painful cystic breakouts rather than surface-level comedones. These breakouts tend to concentrate along the chin and jawline—a hallmark of hormonal acne.[3]

The inflammatory component of hormonal acne is important to understand because it means that simply controlling oil production isn’t always enough. You may also need to address inflammation directly through your skincare routine and, in some cases, through medical treatments.

How Stress Compounds the Problem

Premenstrual syndrome (PMS) brings more than just physical symptoms—it’s associated with increased stress levels, which can independently worsen acne.[2][3] Stress triggers your body to produce cortisol, a hormone that can increase inflammation and sebum production, layering additional acne triggers on top of your existing hormonal fluctuations.

This creates a compounding effect: your hormones are already driving breakouts, and the stress response associated with PMS amplifies that effect. Managing stress during the luteal phase of your cycle—through exercise, sleep, meditation, or other stress-reduction techniques—can help mitigate this secondary trigger.

Preparing Your Skin: A Proactive Strategy

Rather than waiting for breakouts to appear, you can prepare your skin in advance by adjusting your skincare routine during the luteal phase of your cycle (roughly days 15-28 for a standard 28-day cycle).

**Two weeks before your period:**

• Introduce or increase the frequency of exfoliation to prevent pore congestion. Use either chemical exfoliants (like salicylic acid or glycolic acid) or gentle physical exfoliation 2-3 times per week.
• Salicylic acid is particularly effective for hormonal acne because it penetrates pores and reduces follicular hyperkeratinization.[7] Look for concentrations between 0.5% and 2%.
• Add a lightweight, non-comedogenic moisturizer to prevent your skin from overcompensating with excess oil production.

**One week before your period:**

• Increase the frequency of your acne-fighting treatments. If you use benzoyl peroxide or retinoids, you can typically increase application frequency during this window.
• Benzoyl peroxide targets the bacteria responsible for acne and is particularly useful during high-breakout periods.
• Reduce or pause any potentially irritating treatments (like vitamin C serums or strong acids) to avoid sensitizing your skin when it’s already inflamed.
• Ensure you’re using a non-comedogenic sunscreen daily, as some acne treatments increase sun sensitivity.

**During your period:**

• Maintain your acne-fighting routine but monitor for irritation. If your skin feels raw or reactive, dial back frequency or strength.
• Continue exfoliation but be gentler—your skin barrier may be more compromised during menstruation.
• Stay hydrated and maintain consistent sleep, as both support skin healing.

**After your period:**

• Gradually return to your baseline routine as breakouts clear and hormones rebalance.
• This is an ideal time to focus on barrier repair and hydration rather than aggressive acne treatment.

Medical Treatment Options for Severe Hormonal Acne

If over-the-counter skincare adjustments don’t adequately control your breakouts, several medical treatments specifically target hormonal acne:

**Oral contraceptives** regulate hormone levels throughout your cycle, preventing the dramatic fluctuations that trigger breakouts. Birth control pills containing both estrogen and progestin can reduce acne severity by 40-60% in many users.

**Spironolactone** is an anti-androgen medication that blocks testosterone’s effects on sebaceous glands. It’s particularly effective for acne concentrated on the lower face and jawline.

**Retinoids** (prescription-strength vitamin A derivatives) normalize skin cell turnover and reduce sebum production. They’re especially useful for preventing the follicular hyperkeratinization that contributes to hormonal acne.

**Antibiotics** combined with benzoyl peroxide can reduce bacterial populations and inflammation during severe flares, though they’re typically used short-term to avoid antibiotic resistance.

Consult a dermatologist to determine which option aligns with your health history and acne severity.

Tracking Your Cycle to Predict Breakouts

One of the most practical tools for managing hormonal acne is simply tracking your menstrual cycle. By noting when breakouts occur relative to your period, you can identify your personal pattern and prepare accordingly.

Use a period-tracking app or a simple calendar to record:

• The first day of your period
• When breakouts typically appear
• Which areas of your face are affected
• The severity of breakouts

After tracking for 2-3 cycles, you’ll have a clear picture of your personal timeline. This allows you to start preventive skincare measures before breakouts actually appear, rather than treating them reactively.

Next Steps

Now that you understand the hormonal mechanisms behind premenstrual acne, take these actions:

**Track your next cycle.** Note when breakouts appear relative to your period to confirm the hormonal connection.

**Adjust your routine strategically.** Implement the proactive skincare adjustments outlined above during your luteal phase.

**Identify your key triggers.** Determine whether oil production, inflammation, or bacterial activity is your primary concern, and choose treatments accordingly.

**Consult a dermatologist if needed.** If over-the-counter measures don’t adequately control breakouts after 2-3 cycles of consistent effort, discuss medical options like oral contraceptives or spironolactone.

**Be patient with your skin.** Hormonal acne is a systemic issue, not a topical one. It typically takes 2-3 months of consistent treatment to see meaningful improvement.

Frequently Asked Questions

**Q: Can I prevent hormonal acne entirely?**

A: Complete prevention isn’t realistic for most people, since hormonal fluctuations are a natural part of your cycle. However, you can significantly reduce severity and frequency through proactive skincare, stress management, and in some cases, medical treatments like oral contraceptives. The goal is management rather than elimination.

**Q: Is hormonal acne different from regular acne?**

A: Yes, in several important ways. Hormonal acne is cyclical and predictable, typically appearing 7-10 days before your period and clearing within a week after it ends.[2] It concentrates on the lower face, jawline, and chin rather than appearing randomly across your face.[3] Hormonal breakouts also tend to be deeper and more painful (cystic) rather than surface-level. Regular acne appears randomly and isn’t tied to your menstrual cycle.

**Q: Will birth control clear my acne?**

A: Birth control can significantly improve hormonal acne by stabilizing hormone levels, but results vary. Some women see 40-60% improvement, while others see minimal change. The specific formulation matters—pills containing both estrogen and progestin are most effective for acne. It typically takes 3-6 months to see full results. Discuss options with your gynecologist or dermatologist.

**Q: What’s the best ingredient for hormonal acne?**

A: Salicylic acid is particularly effective because it addresses the follicular hyperkeratinization (pore clogging) that hormonal fluctuations trigger.[7] Benzoyl peroxide targets the bacteria that thrives in excess oil. Retinoids normalize skin cell turnover and reduce sebum production. For inflammation, niacinamide and azelaic acid are helpful. Most people benefit from combining ingredients—for example, salicylic acid for exfoliation plus benzoyl peroxide for bacteria control.

**Q: Why does my acne get worse during my period if hormones are dropping?**

A: While estrogen and progesterone drop, testosterone remains relatively stable and thus becomes *relatively higher* compared to your falling female hormones.[6][7] This shift in hormone ratios keeps sebaceous glands activated. Additionally, progesterone doesn’t reach its lowest point until a few days into your period, so oil-stimulating effects persist. The hormonal rebalancing that clears acne happens gradually over the first week of menstruation.