Your Skin and That Time of the Month

Debbi Gardiner, 30, of San Francisco, Calif., gets an unpleasant reminder each month that her period is coming. Two or three days beforehand, the psoriasis on her scalp gets worse, and she breaks out in eczema.

“It’s always in the same place; it’s always on my neck and my knuckles,” she says.

Catherine Schlueter, 32, of Fort Worth, Texas, finds that the chronic hives she has suffered from for the last 10 years get worse in the days before her period.

“Right around the time of my period, I break out really badly, starting with my feet,” she says.

Both women say their skin problems stop as soon as their periods start.

With the emotional depression and weight gain common in the days before a woman’s period, an exacerbation of a skin problem is the last thing most women need at that time of the month.

But it’s exactly what some women will get.

Acne is the most common skin condition to get worse in the week before a woman’s period, according to Dr. Diane Berson, a dermatologist in private practice and an assistant professor of dermatology at New York University’s School of Medicine.

Unfortunately, “any skin condition can hypothetically flare with a hormonal change,” like menstruation or pregnancy, she says. “So (women) shouldn’t be surprised if that happens.”

Eczema, psoriasis and rosacea, a facial skin condition characterized by flushing and acne, can all get worse around the start of a woman’s period, Berson says.

What’s Going On?
Doctors aren’t entirely certain what causes skin conditions to change with the menstrual cycle, but they think it’s related to fluctuating hormones, including estrogen and progesterone.

The link between menstruation and acne is most clear perhaps partly because acne is so prevalent.

Nearly all teenagers have an occasional bout of acne, and by their mid-teens, more than 40 percent of them have acne so severe that it could use a physician’s help, according to AcneNet, a Web site operated by Roche Laboratories, Inc. and the American Academy of Dermatology. Acne affects both boys and girls fairly equally, according to the site.

But acne isn’t just for teens. In a British study published in the October 1999 edition of The Journal of the American Academy of Dermatology, 12 percent of women over the age of 25 had visible facial acne. The percent of women affected didn’t start to drop dramatically until after age 44, according to the study.

In a normal menstrual cycle when a woman isn’t on any kind of hormonal birth control, levels of estrogen drop and levels of progesterone increase as a woman nears her period, explains Dr. Suzanne Trupin, clinical professor in the department of obstetrics and gynecology at the University of Illinois College of Medicine.

In the case of acne, progesterone may be part of the problem, Trupin says. But she added that the bigger problem is testosterone and the other androgens, or male-like hormones, which cause more sebum, or oil, to be released from the skin.

The ovaries produce a slightly higher grade of androgens in the second half of a woman’s cycle, but they taper off as the period starts, she says.

Testosterone is less effective early in the cycle because of a substance called sex hormone binding globulin, or SHBG, which is produced by the liver and binds with testosterone, keeping it from reaching the skin level, Trupin says.

Estrogen stimulates the liver to make SHBG, but the drop of estrogen in the week before a period may be another reason why acne can be cyclic.

“More of (the testosterone) is free to be active,” she says.

Other Causes
A percentage of women who suffer from a premenstrual worsening of their skin conditions have become sensitized, or allergic, to their own hormones. In a Turkish study published in the March 1997 European Journal of Obstetrics, Gynecology and Reproductive Biology, 23 women who experienced a flare-up or worsening of skin conditions, including hives and eczema, around their menstrual cycle, were tested. Fourteen were found to be sensitive to estrogen, and their conditions improved when they were given an anti-estrogen drug, according to the study.

For some women who suffer from acne, one option may be a low-dose birth control pill. The pills may help regulate a woman’s hormones and reduce acne by up to 84 percent, according to a University of Illinois at Chicago study published in the April 2001 Obstetrics Gynecology.

There are possible downsides to taking the pill, however. According to Trupin, some women may find their skin is more sun-sensitive. They may also experience skin splotches, called melasma, more commonly seen in pregnant women.

Women also shouldn’t overlook that acne can be a sign of other problems. Women who have acne combined with excess facial hair, thinning of scalp hair and/or an irregular menstrual cycle could have an underlying hormonal abnormality, and they should see a physician, Berson says.

Berson recommends women with non-acne skin conditions that flare up before their periods use their normal treatment for the condition.

Although doctors don’t routinely treat these conditions with birth control pills, they may be one possible option.

In theory, if you find that there is a relation (between your cycle and skin flare-ups), you might try to regulate the cycle with birth control pills, because it does help in other hormonally-induced skin conditions, Berson says.