POST-PILL ACNE - WHAT IS GOING ON & CONSIDERATIONS TO RESTORE BALANCE
A lot of young women are prescribed the pill for their acne, and often it seems to magically heal acne. But what has changed in your body, and why has it come back years later when you stop the pill?
The synthetic hormones in the pill suppress ovarian androgen production and increase SHBG, which reduces the amount of free testosterone circulating in the body. This means less androgen stimulation of the sebaceous glands and less sebum production. Because our skin needs sebum for moisture, your body begins to work overtime to try and fight the sebum-suppressing effect of the pill.
When you come off the pill and your ovaries start to make their own androgens (aka testosterone) again, this adds a stimulatory effect to sebum production. This can cause an exaggerated rebound effect of sebum production before your hormones start to balance out again and sebum production matches the amount your skin needs for moisture.
If your acne started to flare up after coming off the pill, these are strategies to support bringing your body back into balance.
1. Investigate your hormones
→ Firstly, we want to understand whether an underlying hormonal imbalance, such as post-pill PMOS, may be contributing to your acne. Testing your reproductive hormones at least 3 months after stopping the pill can provide valuable insight into your hormonal profile and help us develop a targeted, personalised treatment plan.
→ If you do have a monthly bleed after coming off the pill, I recommend testing your hormones on Day 2 or Day 3 of your period. A good starting place is to investigate your testosterone & free androgen index, LH, FSH, prolactin, oestrogen, and SHBG. From here, naturopathic herbal medicine is a helpful tool to bring your hormones back into a balanced rhythm.
2. Balance your blood sugar with a protein anchor at every meal
→ Insulin resistance is increasingly common, even in those with lean body types. Higher insulin levels stimulate the ovaries to produce more androgens, which increase sebum production and clog pores. Insulin can also be tested in a fasting blood test.
→ To stabilise your blood sugars and reduce this insulin spike, include protein with every meal. This includes meat, fish, nuts, seeds, and legumes.
3. Replenish nutrients essential for skin and hormonal health that the pill depletes
→ The pill depletes various nutrients that are important for our hormones and skin health, including zinc, B12, B6, magnesium, selenium, and vitamin C. We can incorporate these in your diet or use supplementation where necessary.
→ A nourishing, anti-inflammatory Mediterranean-style diet is your skin’s best friend. Focus on including omega-3s through fatty fish, chia seeds, nuts and seeds, a variety of fresh fruit and vegetables, extra virgin olive oil, mushrooms, and bitter foods for detoxification.
4. Support your detoxification pathways
→ Your liver metabolises your hormones (both synthetic versions from the pill and naturally produced by your own body) so that they can be eliminated from the body via your gut. If your liver is sluggish, hormone detoxification is impaired. Since your skin is a detoxification organ, toxins may be pushed towards your skin instead, contributing to visible inflammation and acne. Bitter foods are a simple daily liver-loving addition, including green tea, turmeric, tahini, dark chocolate, grapefruit, rocket, olive oil, and artichokes.
→ Your gut is where the metabolised hormones and toxins are excreted from the body. If you aren’t moving your bowels every day, these metabolised hormones and toxins can be reabsorbed and recycled, worsening acne. We want to make sure you are pooping daily and that your gut lining is strong so that toxins aren’t leaking into your bloodstream and causing inflammation. There are various nutrients like glutamine and zinc essential for a strong gut lining, and prebiotics and probiotics can help to support gut motility.
→ Your lymph system carries wastes to and from lymph nodes, which filter toxins out of your bloodstream, reducing inflammation. The lymph system doesn’t have a pump like the bloodstream has the heart, and so it relies on physical stimulation through things like movement (hello walking, yoga, star jumps), massage, and gentle dry brushing.
5. Protect your peace & reduce cortisol
→ We’ve all heard of cortisol by now, and while we need it for our sleep-wake cycle, if we are in a constant state of stress, your reproductive hormones take the toll and insulin levels can indirectly become elevated, which increases androgen production. In this way, chronically elevated cortisol can increase the volume and the rate of sebum production and worsen acne.
→ You don’t need to quit your job and do nothing all day to reduce your cortisol. Simple strategies like Vagus nerve stimulation multiple times throughout the day, saying no to social situations when you are already exhausted, lighting a candle in the shower, reducing the intensity of exercise, and reducing caffeine intake are small but powerful acts.
→ I also love to use nutritional support like L-theanine and magnesium to support the nervous system and reduce cortisol levels, or herbal medicine to support the adrenal glands and calm an overactive mind for my patients where indicated.
It’s also important to know that post-pill acne doesn’t always come back immediately after the pill; in fact, it tends to peak 6 months post-pill before your ovaries start to properly regulate hormone production again after having been shut down for years.
Naturopathic support can help to reduce the severity of acne and rebound effects from coming off the pill.
