Polycystic Ovarian Syndrome (PCOS) affects approximately 5 million women in the U.S., and worldwide it is estimated that 1 in 15 women are affected. Some of the symptoms of PCOS include infrequent or absent menstrual cycles, increased facial or body hair growth, scalp hair loss/thinning, and unexplained weight gain or impaired weight loss. Hormonal acne is also a common symptom of PCOS.
The good news: you do have choices to help manage your complexion and regain your confidence.
What’s Going On?
Your HPAO axis (Hypothalamus–Pituitary–Adrenal–Ovarian) is command central for hormone production, including estrogen, progesterone, and androgens (testosterone, 5-dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and androstenedione (A4)).
It’s normal for women to produce some androgens—you need them for mood, libido, and bone health. In fact, all your hormones work together like a finely tuned orchestra to keep your body in balance. But when your hormones—especially insulin levels—are out of balance, one of the most obvious and upsetting symptoms can be acne.
The Link Between Insulin Resistance and Acne
Insulin resistance is one of the root physiological imbalances in most, if not all, cases of PCOS.
Here’s how it works:
- When blood sugar levels are high, your pancreas produces more insulin.
- High insulin and Insulin-like Growth Factor (IGF) stimulate excess androgen production.
- At the same time, insulin reduces your liver’s ability to produce sex hormone-binding globulin (SHBG).
SHBG binds tightly to estrogen, DHT, and testosterone and carries them through the blood. The most critical hormone here is testosterone: when SHBG levels drop, more testosterone enters your tissues unchecked.
This rise in testosterone triggers your body to make excess sebum, an oily substance that mixes with dead skin cells and clogs pores. Once bacteria such as Propionibacterium acnes enters the picture, your immune system launches an inflammatory response—creating red, swollen, and often painful pimples.
High insulin levels fuel excess testosterone, which drives oily skin and clogged pores—the perfect recipe for PCOS-related acne.
What Can You Do?
Over-the-Counter Options
Topical treatments like benzoyl peroxide and salicylic acid can sometimes help mild acne, but they don’t address the underlying hormone imbalance and may not work for PCOS-related breakouts.
Pharmacological Options
- Ortho Tri-Cyclen - A birth control pill that uses a synthetic hormone (norgestimate) to help reduce acne by lowering androgen activity. It is the only oral contraceptive FDA-approved for acne treatment.
- Ortho-Cept - Another oral contraceptive that contains a low-androgenic progestin (desogestrel). It is not FDA-approved for acne but may improve breakouts.
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Spironolactone (Aldactone) - An androgen-suppressing prescription sometimes used for PCOS acne. Originally developed as a diuretic for blood pressure and heart failure, it can reduce androgen activity but comes with potential side effects such as dizziness, nausea, headaches, or digestive upset.
Holistic and Natural Approaches
According to naturopathic physician Tori Hudson, N.D., in The Hormone Connection, holistic remedies may help address PCOS-related acne, though results can take time. These include:
- Vitamin A – moderates skin cell turnover and sebum production (use only under medical supervision)
- Zinc – 30–45 mg daily (check with your doctor before exceeding 30 mg)
- Vitamin E – 400 IU
- Selenium – up to 200 mcg from diet and supplements combined
- Vitamin B6 – 100 mg daily
- Saw palmetto – 160 mg twice daily (standardized to 85–95% fatty acids)
- Tea tree oil – a natural antiseptic for topical use
Supporting hormone balance through nutrition and holistic care addresses the root cause of PCOS acne—something topical treatments alone can’t do.
The Root Cause Perspective
Because PCOS acne is hormonally driven, the most effective strategies go beyond the skin’s surface. Addressing insulin resistance, supporting balanced hormone production, and reducing systemic inflammation are all key steps toward long-term skin health.
