Hormones, PMS and skin

From the moment we officially step into adolescence and our body starts being affected by physical and psychological changes, we need to be aware that these changes are caused by changes in the level of hormones which enabled that transition. In women, levels of oestrogen, testosterone and progesterone vary and fluctuate from one month to the next, causing numerous changes in the body and also including manifestations on the skin. This fluctuation is known under the term “monthly” or “menstrual” cycle. In this article we will take a look at exactly what kind of hormonal changes occur in that monthly period and why we get more acne and other unwanted dermatological manifestations in certain parts of the cycle. Assuming that the cycle is regular and that it lasts the standard 28 days, hormonal changes are easily followed throughout those four weeks.

In order to know which hormones are responsible for the condition of our skin and in what way, it must be said that that the skin has hormonal receptors and that it is most heavily influenced by four hormones which fluctuate throughout the month and change their mutual ratio levels. The skin even produces its own hormones, which is a less known fact, since we generally think hormones are produced only by glands such as the adrenal gland or perhaps the ovaries or testicles.

The first hormone that needs to be mentioned is oestrogen. It opposes androgen hormones, reduces sebum production and has a soothing effect on tissue and inflammatory processes. This is the reason why skin looks its best when the body is producing large amounts of oestrogen and why in most cases oestrogen rich birth control pills work wonders for clearing up skin imperfections.

The second and third hormone are androgens – testosterone and dihydrotestosterone (DHT). Through the mechanism of enzyme 5 alpha reductase, testosterone converts in the body into the most potent form of androgen DHT, which then directly affects sebaceous glands and the appearance of acne. This is why acne very often appear accompanying hormonal androgen-dominated disorders.

The last hormone that has an extremely important role when skin is concerned is definitely progesterone. This hormone takes dual action. In case there’s a lot of it in the organism it affects the skin in such a way that the surface tissue slightly swells, which gives it a characteristic plump look. However, at the same time that process has an occlusive effect on the pores, making progesterone potentially problematic for persons who have problems with hormonal acne. On the other hand, progesterone in the second half of the cycle opposes the effects of androgens, which means that its deficiency can also cause the appearance of acne.

Skin needs to be observed on a weekly basis and the skincare routine adjusted according to its needs in order to ensure that it remains as healthy as possible and unburdened by hormonal changes. The reason why some of us have hormonally sensitive skin, while others don’t notice any changes on their skin during their cycle, probably lays in genetics, although there is still much that is unknown about how these mechanisms work. So let’s first explain the exact changes our skin goes through from the first to the fourth week of the cycle.

First week of cycle (day 1-7)

The first week of the cycle begins with the start of menstrual bleeding. In this period levels of progesterone and oestrogen (so-called “female” hormones) are low which may have a negative effect on the skin. Testosterone is also very sparse, but surrounded by low levels of oestrogen and progesterone, it may have relative predominance and prompt the creation of sebum and imperfections. If testosterone is not predominant the skin may, due to lack of oestrogen, appear dry and tired. Also prostaglandin is being produced, rendering the skin sensitive to pain, which might make a visit to the beauty salon at this time more painful than usual. The same hormone also may cause increased redness, making the general appearance of the skin even worse. Fortunately, this phase is followed by a raise in oestrogen levels, which has a calming and balancing effect on the skin.

Second week of cycle (day 7-14)

In the second week of the cycle there’s a raise in levels of oestrogen which prompts collagen synthesis and a uniform skin tone, so skin looks more beautiful, plum and gets less oily. Skin is more robust, less prone to redness and better tolerates more aggressive treatments. This is the phase that precedes ovulation during which we are biologically “programmed” for attracting a partner, which means that at this time skin also looks its best. The mutual ratio between oestrogen and androgen hormones in this phase is optimum and skin is the least inclined towards developing imperfections. This is the ideal period for introducing new cosmetic products since the chance of making a wrong assessment on whether a product is comedogenic or not is lowest.

Third week of cycle (day 14-21)

The first phase of this week is marked by a sudden fall in oestrogen and a small raise in testosterone which may cause ovulation acne. These acne are of a temporary type and are generally not cystic in nature since only a few days later oestrogen goes through a second slight raise along with a raise in progesterone. The peak of progesterone levels happens on the 21stday of the cycle after which progesterone levels fall and prepare the body for menstrual bleeding. In this phase PMS may appear and progressively intensify until the beginning of menstrual bleeding, while all lower levels of oestrogen paired with a relatively stable testosterone and raising progesterone may have a negative effect on the skin.

Fourth week of cycle (day 21-28)

In this phase skin has the tendency to look its worst. Progesterone clogs pores, while stable testosterone has a relative dominance over oestrogen which enables its conversion into the most potent androgen, dihydrotestosterone (DHT). DHT is the main culprit for the appearance of acne but also for androgen alopecia (balding). Apart from skin, hair also looks its worst in this phase, the scalp is excessively oily and a decline in hair quality can be noticed. Skin may look swollen due to water retention. With the fall in progesterone menstrual bleeding will soon begin, marking the first day of the new cycle and restarting the cyclical fluctuation of hormones that goes along with it.

So, you have noticed your skin is affected by hormonal changes…now what?

First, you must know that you’re not alone and that most people have the same problem as you, to a greater or lesser degree. Hormones cannot be directly influenced by cosmetics, but high quality cosmetics most certainly can be used wisely in order to correct as much as possible or even prevent the negative effect of hormones on the skin. Taking into account all the processes we have described, the care we need to provide for our skin can be divided into two distinct segments.

The first fourteen days of the cycle it is important to adequately moisturise and nourish the skin and to take advantage of all the benefits of this period when the skin is relatively resistant and not inclined to react to new products or to hormones. You’re testing out a new cream? That’s great. This the best time for introducing new products into your routine. Are you planning a visit to the beauty salon? Book a spot between the tenth and fourteenth day of your cycle. In this period the skin gets less oily so it’s important not to dry it out with products that are not sufficiently hydrating and nourishing. Otherwise mechanical dehydration might prompt undesired production of sebum as a defence mechanism against external stressors. Products that don’t contain irritants and are rich in antioxidants will ensure that you enter the next phase of your cycle with skin that is prepared for the upcoming hormonal fluctuations.

Once in the middle of your cycle start thinking about the changes that will occur in the next couple of days. If you are not already using chemical exfoliators now is the time to introduce them into your routine so as to prevent clogged pores accompanying the upcoming raise in progesterone levels. If you are noticing more intensive production of sebum in this period don’t continue to insist on using heavy and occlusive creams, but replace them with lighter gel-creams that don’t weigh down the skin. Avoid products based on irritating alcohol and perfumes since in that way you are prompting even more sebum production. Once or twice a week introduce a clay mask into your evening routine to cleanse your skin and prevent the appearance of imperfections. Lastly, the final week in the cycle is not an ideal time for booking more aggressive beauty treatments or for introducing new products.

In conclusion, the role of stress in the development of acne must also be mentioned, especially in the period of PMS when we are touchier than usual. Stress prompts the secretion of hormones from the adrenal gland, such as cortisol, whose high levels in turn increase the levels of androgen hormones responsible for increased sebum production and appearance of acne. Stress regulation, a healthy diet and sufficient sleep, especially in the second half of the cycle are of extreme importance and greatly contribute to the improvement of skin quality.

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