It can be easy to assume acne is a surface level issue, but acne and breakouts can often be a symptom of underlying imbalances in the body. With this considered, the treatment of acne should focus on both the outside and the inside – each just as important as the other.
Issues that may influence acne, or excess sebum production, include: stress, hormonal balance, liver function, kidney function, gut health and topical care (including skin care products). For many young women, the oral contraceptive pill (OCP) is recommended to reduce acne symptoms and ‘regulate’ their menstrual cycle. However, the pill can mask the real issue as to why acne is occurring.
Acne is very common for most teenagers, both girls and boys. Those teen years are a time of great change, physically and chemically, and it can take a while for hormones to find their balance. During this time, the body can produce an excess of free androgens (reproductive hormones, including testosterone, that float freely instead of binding to receptors), which is often associated with the development of acne. This excess usually reduces through people’s twenties, as reproductive hormones settle and the acne will likely subside.
So why am I STILL getting acne as an adult? Why have I developed acne now?
Your body is unique, finding balance takes a different amount of time for everyone. However, if you’re female, it might be time to look at how your cycle was before you went on any hormonal contraception (if you haven’t been on hormonal contraception, think back to your cycle as a teenager). Was it longer or shorter than 28 days? Was it the same length each month? Was the bleeding heavy, painful, or maybe very light? These are just a few clues.
It is also valuable to ask yourself these questions: Do you find it easy to gain weight, even when exercising and eating well? Do you get any dark hair growth on your chin, cheeks, tummy, or areola? (A little hair growth in these places is normal, depending on your genetics. It may become a symptom if the hairs are darker, longer or coarser than usual).
If you’ve answered yes to these questions, have very irregular periods (or none at all) and currently experience acne, you may want to ask your practitioner about PCOS. If you are on hormonal contraception, such as ‘the pill,’ PCOS can be difficult diagnose – your symptoms may be masked by your contraception, or in some cases caused by it.
What is PCOS?
Polycystic Ovarian Syndrome relates to irregular periods and a high level of androgens, affecting up to 10% of women. It can be a difficult condition to diagnose as you may experience a range of symptoms, but not all.
Lara Briden, a renowned naturopath who specialises in women’s health, highlights these three criteria for PCOS conditions:
irregular periods or polycystic ovaries (tested by ultrasound)
high androgens (by blood test) or symptoms of high androgens (such as acne and hirsuitism – excess hair growth)
other reasons for high androgens have been ruled out*
*You may experience symptoms associated with high androgens and not have PCOS. This might be associated with hormonal birth control, certain medications, thyroid issues or stress on your adrenals.
Other symptoms of PCOS may include hair loss or thinning, and insulin resistance. It is important you don’t try to diagnose yourself, but rather seek advice from a qualified practitioner such as a naturopath or doctor if you suspect this might be you.
How can I manage PCOS?
There are 4 main types of PCOS, so the management of each can vary. They include: insulin resistant PCOS, post-pill PCOS, inflammatory PCOS and adrenal PCOS.
As a naturopath and medical herbalist, my general recommendations for managing PCOS symptoms would include:
Reducing Sugar Intake
High amounts of sugar can be inflammatory to the gut, which is home to most of our immune cells and microbiota. When the gut is inflamed it is often reflected through the skin – think of it like your body’s alarm system, something is going on inside. Insulin helps the body uptake sugar and send it to the right places for cellular energy. When insulin resistance is occurring, sugar floats freely around the blood and can cause fatigue, cravings and weight gain.
Eliminating Dairy Products
While I know dairy products (including milk, cheese, yoghurt, butter and cream) are a true ‘joy of life’ for most people, they contain high amounts of IGF-1 hormone which exacerbates acne. Cheese in particular, is full of histamines that trigger an immune response which can worsen acne. There is much evidence to support the link between dairy and acne, but the good news is there are many great dairy-free options out there - try Angel Food dairy-free cheese, coconut yoghurt, almond or oat milk, and coconut or soy ice-cream.
Support hormones with a Herbal Formula
Peony and Liquorice are two very powerful herbs that have research to back their synergistic effect in managing PCOS conditions. They help to modulate hormone production, encouraging estrogen, progesterone and testosterone to balance out, reducing excess androgens and so, reducing related symptoms like acne. They may also provide support for insulin resistant PCOS. Other great herbs include Vitex, for hormone modulation, Rhodiola, for stress support and Globe Artichoke for liver support. Speak to a naturopath or medical herbalist to learn more about liquid herbal extracts.
Supplement with Zinc
Zinc is an essential mineral that is an important co-factor for many processes around the body, including suppressing androgens, and supporting ovarian function. Without sufficient zinc, our bodies would not function optimally. This mineral has a strong anti-inflammatory effect, reducing inflammation throughout the body, and especially the skin. Zinc deficiency is very common after coming off the oral contraceptive pill.
Reduce inflammation and Support Adrenals
As I mentioned above, zinc works to reduce the inflammation which drives PCOS. Inflammation in the body disrupts hormone receptors and suppresses ovulation. It also stimulates both adrenal glands and ovaries to produce more androgens. There are other ways to reduce inflammation to support PCOS management including: avoiding inflammatory foods such as wheat and dairy, avoiding inflammatory activities such as smoking or vaping, reducing physical stress by choosing low-intensity exercise like walking or yoga, and reducing deeper layers of stress by balancing work-home lifestyle.
So, what should I do if I think I’ve got PCOS?
Talk to your naturopath or doctor about your symptoms. You can begin with the diet and lifestyle changes, then speak to your health practitioner about taking herbs or minerals to support your body. If you’re into a bit of science, I recommend having a look at The Period Repair Manual by Lara Briden.
While it might be challenging to discover you have PCOS, there are plenty of things you can do to manage symptoms and support your physical and emotional wellbeing. Your body knows how to return to balance, sometimes it just needs a helping hand, and we are here to support you along the way.