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Between the moodiness, cramps, and bloating, the last thing a woman with PMS needs is to look in the mirror and see a big red pimple. But unfortunately, many women do.

Menstrual acne, a flare-up of blemishes every month that coincides with menstruation, is fairly common. According to a study published in the Archives of Dermatology, 63% of acne-prone women experience these premenstrual flares. They usually strike about seven to 10 days before the onset of a woman’s period and then subside as soon as bleeding begins.  

The Science Behind Acne and Periods

The average menstrual cycle is 28 days, and each of these days is different hormonally. “In the first half of a woman’s menstrual cycle, the predominant hormone is estrogen; in the second half, the main hormone is progesterone,” explains ob-gyn Elizabeth Gutrecht Lyster, MD. Lyster is part of Holtorf Medical Group in Orange County, Calif. “Then levels of both hormones fall to their lowest levels of the month as bleeding approaches,” she says.  

Meanwhile, the male hormone testosterone (made in smaller amounts by women) stays at a constant level all month. “This means that before and during menstruation, testosterone is relatively higher than the female hormones,” Lyster says.  

These behind-the-scenes hormonal shifts do all sorts of things to a woman’s skin. For one, the mid-cycle progesterone rise stimulates the production of sebum. Sebum is a thick, oily substance that acts as a natural skin lubricant.   

“And as levels of progesterone increase, skin swells and pores are compressed shut,” explains dermatologist Audrey Kunin, MD, of DERMAdoctor.com. As a result, pores never looked so minimized. “But this tourniquet effect also causes sebum to build up beneath the skin’s surface.”  

In addition, higher testosterone levels around menstruation further activate the sebaceous glands to make even more sebum.  

Sebum yields different effects in different women. “For some, it produces a healthy glow; for others, it creates a chronic oil slick,” Kunin says. The oil provides food for the bacterium P. acnes. This bacterium causes increased breakouts and inflammation around the time of women's periods.  

Unfortunately, you can’t change the relationship between acne and hormones. But there are some things you can do to make those breakouts less severe.

“Menstrual-related acne is not a matter of hygiene; it is an internal effect. However, women still need to take special care of their skin around their periods in order not to make things worse,” Lyster says.

Treating Menstrual Acne

For acne closely related to your period, you may need to do something hormonally to intervene. An ob-gyn or endocrinologist can help. Treatment options include the following:

Birth control pills

Birth control pills may help women who see a clear link between their acne and periods. “Anything that raises estrogen levels will lessen the effects of testosterone in women,” Lyster says. Birth control pills work by increasing a protein called sex-hormone binding globulin (SHBG) in the blood. “SHBG acts like a sponge, soaking up the free testosterone in the bloodstream,” she says. “This means there is less testosterone available to cause acne.”

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