Acne and Menses

Acne and Menses

There are many things in life we are not sure of. Even my menstruation is not regular. One thing I am sure of though is that once my face breaks out with pimples or acne, my menstruation will follow in about a week. It was OK while I was young as pimples are considered a part of growing up. But now, I am almost menopausal, my menses are as irregular as ever, yet the pimples still come to tell me my menstrual flow is about to start. What gives? Am I unique in this case?

For many years, it has always been known that acne is influenced by hormones. This kind is called hormonal acne. A recent study by Dr. Alan Shalita, a dermatologist, confirmed that nearly half of women experience acne flare-ups during the week preceeding their menstrual period. So, if it¹s any consolation, there are many more like me out there.

Traditional therapies, such as exfoliants and antibiotics, may initially control the acne but have diminishing effects in the long run. This is because the problem is not only skin deep. It involves other organs such as the brain, the adrenals and the ovaries.

Control of the production of hormones starts from the brain. It knows that as a child, we have no use of the hormones for sexual maturation. At about age 9 or 10 however, it recognizes the signs of impending adolescence and stimulates the adrenal gland to produce androgens—the “male” hormone. This is true even in females but through chemical processes, these are further broken down to become “female² hormones.” Androgens stimulate the sebaceous glands to produce an oily substance, the sebum, which then lead to acne formation. They are most active during the teenage years and also explain why acne is more common in male teenagers then females.

Some females do not develop acne until after their teenage years. This is because as their ovaries mature, the cyclic hormonal changes become more pronounced. In the latter half of the menstrual cycle, there is increased production of progesterone, another hormone which stimulates the sebaceous glands to produce more oil. Some conditions also lead to acne breakouts. The most common is the polycystic ovarian syndrome (PCOS) because there is an elevated production of androgens. Pregnancy is another such condition because of the increased activity of the sebaceous glands especially in the last trimester.

What has sebum got to do with acne? Our skin is in a constant process of regeneration. The old cells die and dry out. This is replaced by new skin. Meanwhile, the sebaceous glands produce oil which come out of the pores to keep your skin moist and soft. When there is too much production of sebum, the dead skin become sticky and plug the pores. This traps the oil produced by the sebaceous glands as well as bacteria causing the follicle to swell—this telltale sign is called a pimple or acne. When bacteria (Propionibacterium acnes or P. acnes) is trapped within the follicle, white blood cells attack it leading to a more pronounced swelling and redness, the inflammatory acne.

Hormonal acne is not something you can outgrow. In fact, it can worsen during menopause because the cessation of production of the female hormone estrogen can lead to a predominance of the male hormone testosterone and this being an androgen, lead to acne.

A diagnosis of hormonal acne is given for the following: when acne appears for the first time in adults, when acne flare-ups precede the menstrual cycle, when acne appears in conjunction with other signs of increased androgen production (hirsutism, irregular monthly flow, increased oiliness) or a laboratory result of elevated androgens in the blood.

Acne is one of the most common medical conditions all over the world. As of the moment, there is still no cure. At most, we can only control its outbreak and prevent visible signs or permanent damage. It is important to properly diagnose the cause of your acne. Once known, we have to address the root cause to control the effect.

Fortunately for acne sufferers, there are a lot of options around. Many of these are topical, i.e. applied to the skin, with the primary purpose of speeding up the renewal of the skin. Some are systemic, i.e. taken orally, such as antibiotics to prevent infection coming from the P. acnes bacteria. Others are injected directly into the acne. While these may be effective in the usual acne sufferers, those with hormonal acne may prove to be resilient.

Once a diagnosis of hormonal acne is given, the usual treatment is to give oral contraceptives (OCP). OCPs help regulate the body¹s hormone levels. There are many brands of OCPs in the market. Some OCPs may be more effective than others in preventing acne. Sometimes, OCPs are combined with the usual topical or systemic treatments. Other medicines for hormonal acne include anti-androgens (for obvious reasons) and corticosteroids. The latter however can either prevent or aggravate acne. Therefore, although acne is a common disease, there is no one sure fire way to treat it. Each treatment regimen is tailor fitted to the patient.

The views expressed herein are solely those of the author. For more information, consult a gynecologist.

DR. MALU TORRALBA-MANGUBAT is a fellow of the Philippine Obstetrical and Gynecological Society and the Philippine College of Surgeons.

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April 27, 2004