Vicious Cycle: Your Period & Your Skin

Illustrated by Anna Sudit.
When your period comes to visit, it brings gifts: bloating, fatigue, and even the occasional freak-out. As if all that wasn't bad enough, though, many of us also contend with the seldom recognized, but very real, skin problems that pop up around that time of the month. The cause of the oily complexion and magnified pores that suddenly surface? It's actually our hormones.
As our hormone levels shift from the more female oriented (like estrogen and progesterone) to the more male oriented (like testosterone) during our cycle, our oil glands go into overdrive, pores blow up, and cystic zits emerge. But, in the same way we’ve learned to prep for our periods by traveling with a stash of tampons and extra Motrin, we can also do a thing or two to quell our out-of-whack complexions.
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So, to get the scoop on just how to do this, we enlisted a few experts: Bethanee J. Schlosser, MD, PhD, an assistant professor in dermatology and obstetrics and gynecology at Northwestern University Feinberg School of Medicine; Dr. Sara Gottfried, a San Francisco-based Ob/Gyn and author of The Hormone Cure; and Dr. Jessica Wu, a Los Angeles-based dermatologist and author of Feed Your Face. Ahead, get a week-by-week playbook of what’s happening in our bodies, how it affects the appearance of our skin, and how to get it all under control.
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Illustrated by Anna Sudit.
As far as our skin is concerned, this is the week that should be considered the dreaded time of the month. Between seven to 14 days before the start of our period, our levels of the sex hormone estradiol fall. Meanwhile, our testosterone remains at higher levels than those of the estradiol. This move to more male-prevalent hormones can lead to a more acne-prone complexion, particularly for those with skin that's more acneic in the first place.

“It’s that shift of balance that can lead to increased activity of sebaceous glands and can manifest as oily skin, with an increase in developing acne lesions and oily hair and scalp as well,” says Dr. Schlosser. This is the time when inflammation and zits can rear their ugly heads.

Furthermore, higher testosterone relative to estrogen and progesterone can spur the clogging of pores during this week and create even more congestion on the skin. Why? Acne-prone pores shed about five times as many dead skin cells as healthy pores do. And, our skin just can’t keep up: All of these extra dead cells are more likely to accumulate inside the pore and follicle, becoming sticky and congesting the pores.

“Hormonal fluctuations due to a woman’s menstrual cycle can increase production of sebum closer to a woman’s period, and this excess oil, together with the excess dead skin cells, provides the perfect breeding ground for acne-causing bacteria,” Dr. Gottfried explains. And, even though some oral-contraceptive pills can help clear the complexion by delivering synthetic hormones to the body, simply pumping our systems with estrogen likely won't override the unfortunate beauty effects caused by hormone levels that are more androgen (male hormones, like testosterone, in both men and women).

While the research on the impact of estrogen on the skin isn’t totally clear, Dr. Schlosser says filling your body with an oral estrogen replacement probably won’t lead to happy, glowing skin. The exceptions for this are very specific cases, like being post-menstrual, producing no estrogen for 10 years, and having signs of skin thinning and aging. “It looks as though you need to have some kind of estrogen deficit as a baseline in order to reap the benefits of oral estrogen replacement,” she explains.

Dr. Wu offers another option: “Some scientists suggest getting extractions around the time you ovulate (mid-cycle) to counteract the increased oil you get when you’re PMS-ing and prevent clogged pores. In the office, I often inject hormonal cysts with a drop of dilute cortisone. This shrinks it in a day or two,” she says. This isn’t to say a derm appointment is needed to help alleviate any premenstrual flare-ups — Wu also suggests using a glycolic or salicylic-acid cleanser or scrub to keep pores clean during the second half of your cycle, or two weeks before your period.

Finally, taking a cinnamon supplement or myo-inositol can help, notes Dr. Gottfried of the B complex vitamin, which has been associated with decreased serum testosterone.
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Illustrated by Anna Sudit.
This week, the drama goes on: Excess oil production, in all its pore-clogging glory, can continue, especially if you’re more prone to acne at other times of the month. Dr. Wu notes that the week before our period, while our bodies are producing more androgens than at any other time in this cycle, we can also expect larger pores along with that increase in oil production. “Your skin will look shinier, and you’ll be more likely to get breakouts, including cystic acne, which is made of painful, ‘underground' lumps that are common on the chin and jawline,” she explains.

If this is the case, Wu suggests countering the effect with a two-pronged, internal and external approach. First, modify your diet by cutting dairy, sugar, and refined carbs the week before your period, since these can all up oil production. “Dairy (even organic milk products) contains cow hormones that can affect your oil glands. Instead of milk in your coffee or cereal, try almond, soy, or hemp milk,” she says, adding, “Make sure each meal has protein, not just carbs. This will keep your blood sugar stable and reduce inflammation (which causes redness and pimples).”

Wu also suggests cleansing with an exfoliator two to three times during this week. If your skin is sensitive or red, exfoliate less frequently, and use an enzyme scrub, which, Wu points out, is less irritating.
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Illustrated by Anna Sudit.
Thought the bigger pores and added congestion were bad enough? Well, in this week, the skin on our body becomes more tender, thanks to the release of prostaglandin hormones, which help the uterine lining shed. “Prostaglandins also make you more pain sensitive, so waxing, laser hair removal, and acne extractions may be more painful,” Wu says. So, don't do those this week — unless you're a glutton for punishment, that is.
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Illustrated by Anna Sudit.
Now's the time to go nuts with selfies and Instagram pics: This week is likely to produce your best complexion days. Why? This is the part of your cycle that's controlled by estrogen. “Estrogen works in tandem with progesterone to maintain a delicate equilibrium,” says Dr. Gottfried. “When your estrogen and progesterone are synchronized, your skin is hydrated, smooth, and well girded by collagen.”

Estrogen and progesterone are not only balanced during this time, but our bodies are secreting more of the former now than in other weeks in our monthly cycle. And, miraculously, that can show on our faces: Dr. Schlosser explains that estrogen receptors are located in the skin, both in the dermis and blood vessels. Since the dermis also contains the cells that create collagen, elastin (a protein that gives skin elasticity), and a matrix composed of mega-moisturizing hyaluronic acid, our skin is more likely to look clear, healthy, and brighter when our estrogen secretion is at its cyclical peak.

However, when our complexion is at its best, we're also less likely to be diligent with preventative skin care. But, according to Dr. Schlosser, the best bet for regulating that bumpy road ahead is to continue with a steady skin-care regimen. That means keeping on top of sun protection, refraining from smoking, and using a topical retinoid. As she explains, “That’s something that can be utilized across the board regardless of estrogen status." Remember: Your skin may look great right now, but you've got three other weeks coming up that will put you back at square one with your complexion. Vicious cycle, indeed.
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