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Acne is infuriating. And severe acne or cystic acne can destroy your confidence.
And endometriosis is even worse. The painful periods, the more painful surgical procedure, and the fertility worries…
They’re both as common as they are frustrating. Endometriosis and acne often appear together, and if you have one, you’re more likely to have the other.
But does endometriosis cause acne?
What we don’t know yet
(I gotta mention at this point that I’m not a doctor, just a former sufferer of severe teenage acne who got interested in hormones.)
We don’t know whether endometriosis causes acne, or whether acne causes endometriosis.
We don’t know for sure that there’s a shared root cause that causes both acne and endo, but it does appear that way. There’s a lot of good evidence that endometriosis is caused by hormones, and it’s virtually proven that acne can be caused by hormones (in addition to other root causes).
Hormonal imbalances, acne, and endometriosis
The relationship between hormones and acne is clear! And the relationship between hormones and endometriosis is clear! So why can’t we say that acne and endometriosis have the same cause?
Because endo is caused by an excess of one specific hormone: estrogen. And that excess estrogen wreaks havoc on your system, causing various side effects: endometrial tissue growth outside the uterus, severe pain during your menstrual period, and even insulin resistance.
Acne, on the other hand, can also be caused by excess estrogen, but it can be caused by excess testosterone or excess androgen as well! And nearly every teen will experience acne simply because of the hormonal changes of puberty, even if they aren’t out of hormonal balance. So acne has lots of possible causes: it could be from hormonal conditions like endo, and it could also just be from typical hormonal fluctuations.
THere’s evidence that severe teen acne makes you more likely to be diagnosed with endo down the road — however, that does NOT mean that if you’re a teenager with bad acne today you’re guaranteed to get endo someday. Your hormonal imbalance may well not be an excess of estrogen! There’s absolutely no reason to start worrying about your future or your fertility just because you have acne.
(I always worry about younger people reading this stuff! I don’t want someone to think that because they are dealing with acne, even severe acne, that they are looking at a lifetime of hormonal problems. I had severe teenaged acne and show the very mildest signs of excess androgen, but my fertility was fine, skin cleared up, all that.)
This is one of the really frustrating things about hormonal imbalance: the same symptoms can be caused by conditions that are “opposite”.
For example, consider endometriosis and PCOS.
Endometriosis vs PCOS for acne
Another hormonal disorder that affects women and the menstrual cycle is PCOS — polycystic ovary syndrome. So, endo is caused by excess androgen, not excess estrogen. (They aren’t really opposites–I’m oversimplifying that a little. It’s actually possible to have both at the same time, though that’s very rare.)
However: both conditions are associated with hormonal acne or severe acne, because acne can be caused by any kind of hormone levels imbalance.
This is also why birth control pills or other forms of hormonal birth control are often effective treatment options for all three conditions! Even though endo and PCOS are “opposites”, they are both often going to improve through hormonal contraceptives because the birth control will kind of override your imbalanced hormone levels.
There are other hormonal treatments that will only work for one issue or the other –spironolactone, for example, will often help PCOS but can make the symptoms of endometriosis worse! This can be helpful info if you’re prescribed spiro for hormonal acne breakouts! If your periods get easier or you see reduced body hair, you may have had PCOS.
For endometriosis, the relationship is murkier, and some people report that spiro makes their endometriosis worse! They might get more severe symptoms, excessive bleeding around their period, and it might lead to endometriosis lesions or more painful cysts. Other endo sufferers report great results from spiro! So it can be worth a try, but endo patients should go into it knowing that if spironolactone makes their first period worse, they should go back to their doctor right away.
About birth control, endometriosis, and social media
I know there’s a lot out there on social media right now trashing hormonal birth control of any type. And on some level, I can understand why people would have reservations about young women who end up taking the pill for 40 years. But hormonal birth control is the simplest hormone treatment available for endometriosis. And each patient may need to try a couple different treatments to get something that works for them, but it is truly worth a try for someone suffering through endo.
If your hormones are out of balance, you are not damaging them with birth control. And the associated risk of endometriosis isn’t just the chronic pelvic pain and skin issues: it’s also one of the most common causes of infertility. Hormonal birth control is not only protecting your quality of life in the short term, it’s protecting your fertility (or your daughter’s) in the future.
My parents were very reluctant to give me hormonal birth control for my acne as a teenager, for all the reasons parents usually give. I struggled with the hormonal acne and periods that were much more painful than they needed to be for a year while they came to terms with it. Eventually, they went with the medical advice and let the pediatrician prescribe the pill. And it helped so much.
It’s valid to worry about your hormones. I don’t want to ridicule that. And it’s great to focus on balancing them with a healthy diet and regular exercise and enough sleep (OH MY GOD start with the sleep!!!). But to spend years in pelvic and abdominal pain, building up scar tissue and risking your fertility, just because an influencer told you the pill is bad? Or to leave your daughter reliant on pain medication and potentially render her infertile for fear that she will start the pill and decide it means she should have sex during her teenage years? In my opinion, neither of those things is ‘protecting your hormones’.
I already have endometriosis — how do I manage my acne?
First, let me acknowledge that it can be super hard to get diagnosed with endometriosis! Because of systemic issues in our system that don’t take women’s medical issues and women’s pain seriously, endo is not always diagnosed promptly. And you may be pretty sure it’s endo and feel like you’re not being taken seriously. In that case, you may not have access to all the items on this list, but you can try the ones that don’t require a doctor or a prescription.
If you’ve been diagnosed with endometriosis and you’re dealing with hormonal acne, here are some things to try:
- First: talk to your doctor. You might benefit from some of the hormonal medications discussed above. If they’re willing to prescribe the pill, or you feel comfortable trying spiro, those can both address hormonal acne and also help with some of the other endometriosis symptoms.
- Next: work on your skincare routine. Hormonal acne doesn’t come from dirty skin, so it’s not a cleanliness problem. However, you can improve your hormonal acne with BHA products that help dissolve the excess oils that cause hormonal acne. (I wrote about my favorite, salicylic acid, here: Is Salicylic Acid Good for Rosacea? Best Peel Options). Salicylic acid will help moderate your sebum production and manage the inflammatory response that makes cysts so big.)
- And slowly, over time: experiment with lifestyle changes to manage your hormones. Some endo patients benefit from limiting caffeine; others thrive without alcohol; still others need a low-FODMAP diet. Trialing these lifestyle changes can help you get an idea of what will improve your acne and manage your other endo symptoms. This takes a long time, but the time will pass anyway! Try the changes one at a time, and decide whether or not you want to make each one permanent.
Living with endometriosis is hard. And though acne is a small part of it overall, the confidence that comes with clear skin can make it easier to face the other parts of endo. I hope that this post has given you some things to try!
