The REAL Meaning Behind Adult Acne (And How To Get Rid of It For Good)- Part Two
In Part One of this post, I explained the link between PCOS and adult acne. I also explained why PCOS is misunderstood and underdiagnosed. If you haven’t read it yet, make sure you go back and read Part One here. In Part Two, I’ll explain how I help women address adult acne and PCOS in my clinic.
How I Help Women With Adult Acne
Whether or not you have a clinical diagnosis of PCOS, adult acne is almost always related to hormone imbalance. In my clinic, I use a multi-faceted approach to treating hormone imbalances.
Step 1 is always proper testing to determine exactly what type of hormone imbalance you’re dealing with - there is no “one size fits all” treatment, so proper testing is critical to healing. Every woman I work with recieves a customized plan for healing based on her test results, symptoms, and lifestyle - but there are some general recommendations I start with for many women:
- Optimize Your Diet For Hormone Health
- Nurture Your Microbiome
- Lower Stress
- Promote Ovulation
- The Right Skin Care Routine
Optimize Your Diet For Hormone Health
You don’t need to go on a no-carb diet or severely restrict to optimize your diet for healthy hormones (in fact, that is probably the worst thing you can do!). Start with balancing your blood sugar and insulin. Almost all women with PCOS (regardless of weight) show some signs of insulin resistance.
You can counteract this and get back to healthy blood sugar by:
- Optimizing the amounts and types of carbs you eat. (It’s not about cutting carbs completely. Instead, eat more whole-food carbs, fewer processed carbs.)
- Moving more! It doesn’t have to be in the gym - walk more, hike, dance, swim, just stay active throughout the day.
- Using key supplements. The exact supplements and doses matter, so work with a pro to add in things like inositols, d-pinitol, curcumin, chromium, and berberine - if they are right for you.
Key nutrients for healing acne are:
- Vitamin A - natural sources are cod liver oil, liver, pastured egg yolks.
- Zinc - zinc has been shown to clear acne as effectively as antibiotics! It also interacts positively with Vitamin A. Dietary sources are organ meats, beef and lamb, oysters and scallops.
- Omega-3 fats - These fats are anti-inflammatory and reduce your skin’s reactivity to UV light, too. EPA and DHA are the best sources - find them in fatty fish or a high-quality supplement.
You should also consider cutting dairy from your diet. I don’t like to make blanket dietary suggestions, but for women with acne and PCOS, cutting dairy is almost always helpful.
Here’s why: there is a hormone in milk (from cows, goats, sheep, and camels) called insulin-like growth factor-1 (IGF-1) which mimics insulin in our body. IGF-1 is a growth hormone (which makes sense, as milk is for baby animals!).
In most people, a little dairy here and there can be well-tolerated - humans have a binding protein for IGF-1 that inactivates it. But for women with PCOS or hormonal imbalance who already are likely to be insulin-resistant or have high insulin, the added burden of IGF-1 can be a problem. This is amplified because women with PCOS have LESS of the binding protein for IGF-1 and higher IGF-a levels than other people do, too. And the ovaries of women with PCOS are more sensitive to IGF-1 (and other growth hormones), too.
IGF-1 can also cause your ovaries to overproduce testosterone (an androgen) - which is something we’re trying to minimize.
Not only all of that - but IGF-1 also increases sebum production and inflammation in the skin - sebum is oil on your skin - and encourages new cell growth. As new cells grow, old ones die and are shed.This means more oil and old skin cells potentially clogging pores and causing acne.
For all of these reasons I do recommend you try cutting out dairy if you’re dealing with PCOS or acne. Grass-fed butter and ghee are OK to keep in, as they are almost entirely fat and don’t contain much, if any, IGF-1.
Nurture Your Microbiome
A healthy microbiome is critical for both hormone health and lowering overall inflammation to help calm your skin.
The right gut flora is a main player in regulating your hormones, especially your estrogen levels. If you have too much of the wrong bacteria, the result can be increased estrogens in circulation.
Eating a whole-foods-based diet and taking probiotics are obvious ways to care for your microbiome - but if you’re already doing that and still having gut issues, I highly recommend advanced stool testing. Common gut infections like Blastocystis hominis, H. pylori, candida, and staph or strep overgrowth in the gut correlate to acne in patients. There is also a huge connection between Small Intestine Bacterial Overgrowth (SIBO), candida, and acne - especially rosacea.
Endotoxins released into the bloodstream by a leaky gut (aka increased intestinal permeability) are also a major cause of inflammation in the body and can impact the skin, too.
Lower Stress
This is the advice everyone hates - but it is the MOST important step toward achieving long-term health.
The reason people hate the advice to lower their stress is because they feel like most of their stressors are outside their control (bills, deadlines, work, family drama!) - but the truth is that there are many small steps you CAN control that can help reduce the burden of stress on your body.
Some simple but powerful things you can start doing right now:
- Get quality sleep - that means going to bed with 7-8 hours before you have to wake
- Avoid blue light after sunset - get the glasses, change the settings on your phone, and dim the lights inside
- Start a daily meditation/gratitude practice - just 5-10 minutes can set the tone for your entire day
Promote Ovulation
Supplementation should always be done only after proper testing and consulting with a practitioner. That being said, there are supplements that can support and promote ovulation that I use with my patients:
- Flaxseed and DIM to address excess estrogen
- Saw palmetto, reishi, pygeum, zinc, white peony/licorice, and green tea to slow the conversion of estrogen to testosterone
- Vitex (aka chasteberry) to support Hypothalamic-Pituitary-Ovarian signalling and progesterone production.
- Adrenal and thyroid support, as needed (this is why you need proper testing!)
The Right Skin Care Routine
A pimple here or there - or a bad breakout after you use a new face wash - is potentially a topical issue. That means it has to do with what you’re putting on to your skin from the outside, externally. But most cases of adult acne are more a result of internal imbalances (like we’ve been talking about in this article).
That being said, what you put on your skin still matters. Don’t use harsh products externally on your skin. Instead, try more simple options. I love:
- Mother Dirt spray (promotes a healthy skin bacteria)
- NERD skincare system
- Homemade masks with Manuka honey, tea tree oil, turmeric powder, and apple cider vinegar
This Is A Whole-Body Issue
I hope you take away this key point from this article: acne is a whole-body issue, not just a skin thing!
Whether you have PCOS or not, if you have adult acne, it is a sign that something isn’t working right in your body. From gut issues to hormone imbalances, there are multiple overlapping, underlying causes that could be causing your skin troubles.
But, I also hope you now understand that PCOS is underdiagnosed and misunderstood - and it could be affecting you.
Once I discovered that truth, I was finally on my way to #clearskineveryday (not to mention better moods, healthy monthly cycles, & healthier hair and nails!).
I’m passionate about helping women uncover the root causes of their health problems and address them naturally. If you’re dealing with adult acne, I’d love for you to book a free 20-minute root cause symptom analysis consultation with my team. These appointments are TOTALLY free, and there’s no obligation to book any further appointments. See what time slots we have open here.
The REAL Meaning Behind Adult Acne (And How To Get Rid of It For Good)- Part One
You wake up on the day of your dream-job interview, look in the mirror… and there it is, a big pimple on your chin.
You wish you could blame it on nerves, but the truth is that lately your skin is more broken out than it was when you were a teenager. You don’t know what else to try...
- You’re already spending tons of cash on facials and trips to the dermatologist
- You’ve tried every “miracle” regimen at Sephora
- You even tried cutting back on nights out with your girlfriends!
But here’s what you don’t know… what you think is just “annoying adult acne” might actually be more than that. It could be a sign you have Polycystic Ovarian Syndrome.
I know what you’re thinking - you’ve heard of PCOS and you couldn’t possibly have it! You have normal cycles (well, at least your birth control pill makes them seem normal), you’re not overweight (although you do feel like you carry a bit more weight than you should, given how active you are), and you don’t have any other symptoms (except the acne… and your hair is thinning a bit… and the need to wax your lip every month…).
Listen girl, I get it! When I found out I had PCOS, I was shocked. But it turns out, I actually had a pretty atypical case. And you might too.
Misinformation about what PCOS is and the symptoms it can cause let many women slip through the cracks and never get the diagnosis or treatment they deserve.
Adult acne isn’t normal, and it isn’t something you should have to deal with. Finding the root cause of your acne and addressing it can mean clear skin and better health (because acne is always a sign of a bigger problem). And even if you’re certain you don’t have PCOS, keep reading anyways - you may be surprised by what you learn!
What PCOS Is (And Isn’t)
The #1 misconception about PCOS is that it is simply a condition where cysts develop on the ovaries. So wrong. In fact, some women with PCOS don’t even have cystic ovaries!
PCOS is actually the most common type of hormone and metabolism imbalance. It affects 1 out of 10 women. (Yes, that number is the same as 10% - a huge amount.)
Based on the Rotterdam Criteria from 2003, there are 3 diagnostic criteria for PCOS - and to be formally diagnosed, you have to have at least 2:
- Confirmed androgen excess on labs or androgen excess symptoms
- Ovulatory dysfunction
- Multiple cysts on ovaries (PCOM) diagnosed via imaging ultrasound
If you have at least 2 of the 3 criteria above, your doctor can diagnose you with PCOS.
In 2018 PCOS diagnosis guidelines were updated by a combined counsel of the Australian National Health and Medical Research Council, European Society of Human Reproduction and Embryology, and American Society for Reproductive Medicine.
It was a HUGE step forward in the treatment and diagnosis of PCOS, since the new guidelines (finally!) took into account how different PCOS can be in different women.
Here are their new recommendations:
- Androgen excess can be diagnosed by measuring free testosterone or bioavailable total testosterone. However, elevations in the hormones Androstenedione and DHEAS can also indicate PCOS, even without elevated testosterone.
- When irregular menstrual cycles are present, a PCOS diagnosis should be considered. Irregular is defined as cycles less than 21 days, greater than 35 days, or less than 8 cycles per year. However, ovulatory dysfunction can still occur with regular cycles - this can be confirmed or ruled out with serum progesterone levels taken in the second half of the cycle.
- Ultrasound should not be used for the diagnosis of PCOS in those less than 8 years out from their first period, because many younger women have multifollicular ovaries, even without having PCOS.
The new diagnostic criteria don’t mention weight - and that’s because your weight is not part of the diagnosis for PCOS. Only 30% of people with PCOS are overweight or obese. And pain is not a symptom of PCOS, either.
What Does PCOS Do To You?
The hormone imbalance in PCOS creates problems with how the ovaries function, so the egg that should develop each month may not, or may not be released during ovulation (aka anovulation).
Some women think that if they aren’t actively trying to get pregnant, anovulation is no big deal - but regular ovulation is a sign your body is humming. Many women with PCOS also experience irregular cycles. Again - this is more than just a fertility problem (though it is that too!) A healthy period is a sign your overall health (physical & mental) is good
(Side note - if your doctor prescribed the pill to regulate your cycle, this is still a problem! More on that later, so keep reading).
But PCOS is about way more than just ovulation.
Excess Androgens Are The Real Cause of Adult Acne
Women with PCOS tend to have an excess of androgens. Androgens are male hormones, and an excess can mean high testosterone, high DHEA, or high metabolites of either.
Excess androgens are responsible for some of the most dreaded PCOS symptoms like:
- Acne (especially on the chin, jaw, and back)
- Male pattern hair loss/thinning
- Hirsutism (male-pattern hair growth, like on the face)
- Anger, irritability, mood swings
- Poor stress response
- Increased anxiety and depression
Not every woman with excess androgens has all of the above symptoms - and sometimes one symptom can be severe (like acne!) while other can be more mild (maybe just a bit more hair on your upper lip).
But pay attention here - hormones levels are complex! Many women with PCOS also have symptoms of high estrogen. It commonly happens like this: DHEA is high, but progesterone is low relative to estrogen levels. On top of that, many women have poor estrogen detox because their liver is overburdened.
How PCOS Presents in Real Women
Remember, every woman is unique - but there’s a common scenario I see in my clinic with women with PCOS. And - full disclosure - I was one of these women too!
Here’s a story I hear from a typical PCOS patient with acne in my clinic about her teenage years/early 20s:
- Her period came in her later teens (or never started naturally)….or started “on time” but then had irregular long windows between
- Acne started to develop and so did hair in places she didn’t want it --(like nipples, lip, chin, stomach)
- She may have been put on oral birth control pills to “regulate” her period and help deal with the acne
- And she might have been put on antibiotics like tetracycline or Accutane to further help control the acne
Sound familiar to you?
Then, as she aged into her 20s and 30s:
- As other women’s acne clears up, hers is getting worse than ever
- She may start to gain weight around her middle (even if she remains thin), or struggle to control her weight despite a healthy lifestyle
- Her hair might lose its luster and start to thin
- She may notice more anxiety and depression, trouble recovering from stress
And if she decides to stop taking the pill, here’s what usually happens:
- Her period takes a long time to return after stopping the pill - or it NEVER comes back
- Can’t conceive easily or without intervention
Not all of these symptoms are drastic (although some women do have very dramatic symptoms as a result of PCOS) - they can be subtle annoyances that hint at a bigger underlying problem.
What Not To Do If You Have PCOS & Acne
Most doctors - be they GPs, gynecologists, or dermatologists - only think of acne as a cosmetic issue. They often don’t make the link between acne and bigger issues like PCOS or hormone imbalance - especially if your other symptoms are mild or masked by the artificial hormones in the pill.
So, if you go see your doctor complaining about acne, you’ll probably be given one of these 3 things:
- Oral contraceptives (birth control pills)
- Antibiotics like tetracycline
- Medications like Accutane
While these meds might help short-term for some women, in the long-run they only make PCOS symptoms worse. Research has shown women with PCOS already have a less diverse microbiome than women without PCOS (and, that increasing microbiome diversity may be an essential part of treatment). The pill, Accutane, and antibiotics all only further damage the microbiome (especially when you’re taking them long term!)
Our microbiome (aka all the bacteria living in our gut) are critical for hormone biotransformation - that means they help produce and then clear out hormones. To have healthy hormones, (and clear skin) you’ve got to have a healthy gut - and taking any of these common acne meds can wreck your gut!
(It always comes back to the gut!)
Don’t Panic!
If you’re reading this and thinking you may have PCOS - or are nodding along because you were prescribed the Pill and antibiotics to treat your acne - please don’t panic!
Our bodies are so resilient, and there is a lot you can do to balance your hormones. In Part Two of this article, I’ll explain exactly what you CAN do and how I help women with acne, hormone imbalances, and PCOS in my clinic. Check out Part Two here.