Poly Cystic Ovarian Syndome (PCOS) is a fertility condition that affects between 10 and 15 percent of women in the Western world.
All of these women suffer from at least some of the symptoms of PCOS: irregular menstrual cycles, weight gain, difficulty with weight loss, low libido, facial hair growth, balding, and, perhaps most popular of all, acne.
PCOS and acne are inextricably linked. Why? Because PCOS is caused by an underlying hormone imbalance. The very same underlying hormone imbalance causes acne. It is possible to have PCOS without acne, and possible to have this kind of acne without PCOS. But quite frequently they occur together.
Here in this post I explain the hormone imbalance that causes PCOS, and the ways in which it also causes acne.
Also, and importantly: after figuring out how to overcome my own PCOS and acne, I wrote a manual on overcoming PCOS. It’s PCOS Unlocked: The Manual, and you can read all about it here.
PCOS and acne: the underlying hormone imbalance
Most medical professionals understand the hormone problem that underlies PCOS to be quite simple: elevated insulin levels cause the ovaries to produce excess testosterone, which throws a wrench in the menstrual cycle and causes irregularity, cysts on the ovaries, and infertility.
This does indeed happen to be the case for many women with PCOS. Testosterone is their biggest problem. In my PCOS manual, I call this “type I PCOS”.
Yet there are other types of PCOS.
Low female sex hormone levels are another cause of PCOS.
Why? Because–even though most medical professionals don’t understand this–PCOS is not just about high testosterone, but is rather about a fundamental imbalance between testosterone and the female sex hormones.
When estrogen and progesterone levels fall, they get out of fundamental balance with testosterone, which also throws a wrench in the menstrual cycle.
Estrogen and progesterone levels fall for any number of reasons, though by far the most popular reasons have to do with stress and with starvation.
The thing about the female body is that it is highly sensitive to any conditions that may impair it’s ability to healthfully bear children. If you imagine life millions of years ago back on the savannah, it would be quite common for natural disasters or tribal conflict to create stressful times that could hinder a healthy pregnancy. It would also be quite common to come into a period of famine, in which case pregnant women would not be able to get enough food to sustain their pregnancies.
In periods of stress and starvation, pregnant women die more easily.
In order to prevent this from happening, the female body shuts down hormone production when it detects the slightest bit of stress or starvation. Shutting down hormone production prevents the body from becoming pregnant, which would have saved an ancestral woman’s life in the long run.
Our bodies do the same thing.
If we count calories, resrict food intake, limit carbohydrates or fat too much, yo-yo diet, or excercise excessively, our sex hormone levels fall, and our estrogen and progesterone levels become too low both for a healthy menstrual cycle and for clear skin.
You can read more about the female body and psychological stress in this post: psychological stress and hypothalamaic amenorrhea, and more about the female body and starvation-type stress in this post: metabolic distress and hypothalamic amenorrhea.
There is yet one more popular hormone problem that causes PCOS. It’s what happens when DHEA-S levels rise.
Elevated levels of DHEA-S contribute to PCOS because DHEA-S is also an androgen, or male sex hormone.
DHEA-S and testosterone act very similarly in the female body. The primary difference is that testosterone is produced by the ovaries, and DHEA-S is produced by the adrenal glands.
DHEA-S levels rise in response to stress. Whenever you feel stressed out, your body has a choice to make: it can continue to direct it’s hormonal resources toward sex hormone production, or it can divert those resources toward stress hormone production.
This process is often called “pregnenolone steal.” The reason we call it a “steal” is that hormonal resources are literally stolen by the adrenal glands and used for sex hormone production.
Thus you end up with lower hormone levels (like estrogen, progesterone, and the pituitary signalling hormones LH and FSH), as well as elevated DHEA-S levels, which can cause testosterone-like symptoms in the body: PCOS, infertility, facial hair growth, and acne.
So in sum, there are several hormonal factors that may be at play in PCOS:
Testosterone levels may be too high largely due to insulinemia
Estrogen and/or progesterone levels may be too low due to psychological and physical stress
DHEA-S levels may be too high due to psychological stress
Causes of PCOS and causes of acne
So in a very brief, very simplified nutshell: PCOS is caused by and large by an imbalance between male sex hormones and female sex hormones. If testosterone or DHEA-S is elevated, PCOS may result. If estrogen or progesterone is low, PCOS may result. Any of these things can happen at the same time, and often do.
(For more on the details of how all this happens, check out the PCOS manual here.)
This hormone imbalance is also one of the primary causes of acne.
How hormones and acne work
There are three separate layers to the skin, and pores traverse these layers. In order to adequately protect your body and keep toxins on the outside, the outer layer of the skin has to be hydrated and strong.
Pores deliver oil to the out layers from the bottom up. In healthy skin, oil comes up through the pores and oozes onto the surface, lubricating the skin and making it look soft and glowy. Think of it like a well, or a hot spring, or an oil rig.
In acne-prone skin, debris from the surface clogs pores, bacteria clog pores, and oil coming up from the bottom clogs pores. Then all this oil oxidizes and bacteria go on a feeding frenzy – which makes the pores become infected and inflamed.
The problem for women with PCOS is that male sex hormones increase oil production.
Estrogen performs an opposite function, and helps sooth the skin.
When estrogen levels are low, and when oil production increases from elevated testosterone or DHEA-S, acne is often the result.
The kind of acne that usually accompanies PCOS is around the chin, the mouth, and the jaw. It can spread to other areas of the face and the body, particularly the shoulders, buttocks, and back of the thighs, because these are the areas where the skin has the most testosterone receptors. If you have acne in these places there is quite a decent chance that your hormones are at least a bit out of balance, PCOS or no.
For more on hormones and acne, check out this post: cystic acne and hormones: everything you need to know.
PCOS and acne: what to do about it
So what do you do about your acne and PCOS?
For one, tackling PCOS should be a priority.
You can also read some other posts I have on PCOS:
You may also wish to consider tackling your acne from more than one angle. PCOS and underlying hormone problems are in all likelihood a significant factor in your acne, yet there are probably other factors at play. To that end you may wish to check out the posts:
And, most of all, I highly recommend the remarkable acne program by my favorite thinker on the topic of acne, Seppo Puusa. I have learned so much of what I know about acne from Seppo. You can read all about his work, his program, and what he has to offer HERE.
And that’s it! Please let me know your thoughts, your problems, your experiences in the comments! I and everyone else in our community would be honored to learn through your life and wisdom 🙂