Polycystic Ovarian Syndrome (PCOS) is a type of hormone imbalance characterized by high insulin, high testosterone, and high estrogen. These hormones are what contribute to its symptoms of cystic acne, irregular periods, male pattern hair growth, and weight loss resistance. You can read about PCOS in detail here. In this article we are going to be focusing on PCOS- related acne.

PCOS is truly a metabolic disease creating several hormone irregularities. When these metabolic discrepancies are addressed through natural medicine, hormones re-regulate, and clear skin typically follows. This process can take some time, but its effects are long-lasting. Too often I find women reaching for a quick fix instead of taking the time to listen to their bodies and get to the root cause. Within the mainstream health care system, treatments for PCOS may include a combination of birth control, IUD, Accutane, spironolactone, and/or metformin. These medications can take away the symptoms of PCOS, but they act as band-aid and mute your body’s natural communication with yourself. Furthermore, this symptom-based approach often leads to further imbalances down the road. Notably, oral contraceptives can lead to several nutritional deficiencies and can exacerbate estrogen dominant symptoms, such as weight gain, swelling, and breast tenderness. Also, your mild to moderate acne may come back with a vengeance after discontinuing the pill. Sound familiar? Read more about the best contraception options for PCOS here.

PCOS-related acne is often due to excess androgens or “male hormones” such as testosterone, DHT, and DHEA-S. In the skin the enzyme 5-alpha-reductase converts testosterone into an acne prone form called DHT. DHT levels increase sebum production, allowing acne and inflammation to thrive. You typically see this cystic acne along the jaw line or chin. You might wonder, “where are these high levels of androgens or ‘male hormones’ coming from?” While our ovaries mainly produce estrogen and progesterone, they also secrete testosterone in small amounts. But with PCOS, this testosterone secretion is much higher than normal. Blood sugar irregularities and insulin resistance are common in PCOS and are what lead to the high levels of testosterone. I describe in detail how PCOS is insulin resistance of the ovaries here.

Insulin resistance creates high levels of insulin in your blood stream which interact with your ovaries. Your ovaries can become aggravated and respond by secreting high levels of androgens. This is where you may see the use of spironolactone, a diuretic medication with effects to block this enzyme (5-alpha-reductase), lowering DHT to reduce acne. Metformin, a diabetic drug used to treat insulin resistance, is also commonly used. While both medications can be effective, normally these medications aren’t typically prescribed for young and healthy women. They are mostly reserved for moderate to severe metabolic conditions such as diabetes mellitus, heart disease, and so on.

Furthermore, we must focus on what is causing these high androgens in the first place. When caught early, insulin resistance can be treated with lifestyle and nutritional approaches. A diet rich in colorful plants and clean protein and low in sugar and refined carbs is key!

PCOS-related acne is truly tied back to our nutrition and eating patterns.

Quick check in:

• Have you ever noticed increased fatigue post meals? Or sugar cravings? This is your body communicating it needs more protein or fat in your diet for long, sustained energy.
• Do you notice yourself skipping meals and/or overeating at the next meal?Or do you ever feel hangry or irritable with missing a meal? This is typically a sign that your body needs regular intervals of energy to balance your blood sugar. Eating too often can also contribute to blood sugar swings. Three meals a day with protein at every meal is ideal.
• Do you notice yourself using caffeine (tea, coffee, or energy drinks) to get through the day? This can literally stress your body out by raising your cortisol levels and send your blood sugar sky high. For PCOS-related acne we want to minimize caffeine and stick to 1 cup after a meal to keep your blood sugar steady.

Balancing your blood sugar is the key to repairing the root cause of your PCOS related acne and hormonal imbalance. Follow the few simple tips below achieve body balance:

• Eat 3 meals a day with fat, fiber, and protein.
• Ensure each meal has 20-30g of protein to stabilize your blood sugar.
• Eat fruits and vegetables in every meal. This fiber is going to help support your liver and detox excess hormones.
• Seed cycling
• Sleep 8-9 hrs a night. Not getting enough sleep can set off your blood sugar and cortisol levels.
• Engage in physical activity daily. People who exercise are better detoxifiers!
• Spearmint tea which can help to lower hirsutism or male pattern hair growth.

Minimize

• Snacking: If you do need a snack, think fats and proteins (nuts, seeds, apple with nut butter, etc)
• Caffeine: Aim for no more than 1 cup, after a meal. Stick to green tea over coffee which has antioxidants (epigallocatechins) that naturally inhibit the enzyme 5-alpha-reductase, reducing the acne prone form of testosterone, DHT.
• Refined carbohydrates: Toss the baked goods, white bread, pasta, cereals, etc
• Stress: While it may be challenging to remove stress entirely, we can change how we respond to stress by utilizing stress-reducing techniques (massage, breath work, herbal teas, time with friends/family/loved ones etc).

Read past posts on PCOS here:

PCOS: Insulin Resistance of The Ovaries

Natural Solutions for PCOS: Options Beyond the Pill

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.