Endometriosis occurs when tissuelike endometrium — the tissue that usually grows inside the uterus — grows outside the uterus. Endometriosis can cause many symptoms, including excessive pain during the menstrual cycle, bloating, weight gain, and abnormal menstrual flow.

One of the lesser-known symptoms of endometriosis is hormonal cystic acne. Cystic acne results in inflamed cysts (fluid-filled sacs) deep under the skin. Here’s what you need to know if you have this symptom, including what causes it and how it can be managed.

What Is Hormonal Cystic Acne?

Cystic acne occurs when cysts form deep beneath the skin due to hormonal changes in the body. These inflamed cysts can last for a long time before they erupt onto the skin, making them difficult to treat or manage. They can also lead to scarring if they are handled improperly.

Cystic acne is related to changes in hormone levels — it often gets worse in the two weeks before a woman’s menstrual period. The hormonal changes that take place during this time make the condition worse, causing it to flare up. Because endometriosis is connected to the hormonal cycle, the condition can also be associated with cystic acne breakouts in some individuals.

Approximately 1 percent of women who have endometriosis also experience cystic acne. Conversely, having cystic acne as a teenager is linked to developing endometriosis later in life. It’s not clear whether cystic acne causes endometriosis or vice versa, or if some related factor causes both.

What Is It Like To Have Hormonal Cystic Acne?

Having hormonal cystic acne can be more difficult than it might seem. One of our MyEndometriosisTeam members described her experience, sharing that the skin condition caused her to withdraw from social activities: “Two years ago, I had bad cystic acne. It messed with my confidence. I even started to isolate myself.” Another member explained, “My acne was so bad, I fell into depression and everything.” Yet another shared that cystic acne made her feel “humiliated to look in the mirror.”

As these members describe, hormonal cystic acne can interfere with a person’s self-confidence and overall well-being, sometimes leading to depression, anxiety, and isolation.

What Causes Hormonal Cystic Acne in Endometriosis?

There are several ways that hormonal cystic acne and endometriosis are connected. Cystic acne may be the result of hormones, or it may be a medication side effect.

Hormones

Hormones like estrogen regulate the production of sebum, a waxy, oily substance produced by glands in the face. When the body’s hormone levels are abnormal or uncontrolled (as they often are in people diagnosed with endometriosis), sebum production can drastically increase.

Excess sebum is associated with cystic acne. Thus, the hormonal imbalances associated with endometriosis can cause this acne. When you complicate the situation by taking medications that can also change hormone levels, as discussed below, the acne can become even more severe.

Certain Endometriosis Medications

Danazol (Danocrine) is a synthetic androgen (a sex hormone) that provides relief for many people diagnosed with endometriosis. It can stop endometriosis growths from getting bigger and relieve lower pelvic pain.

However, one of its major side effects is increased oil production. As a result, some people find that their acne is worse when they take the medication. Side effects like oily skin and acne typically resolve after stopping treatment with danazol, although it may take as long as nine months to clear completely.

MyEndometriosisTeam members have reported that other medications they take for endometriosis have caused cystic acne. One member shared, “I’ve tried Visanne [dienogest] for 6+ months and have decided to go back on birth control. My worst side effect was acne. I have cystic pustules all over my face, chest, and back.” Another explained, “Over the summer into September, my old OB-GYN prescribed me progesterone, which made me break out in cystic acne.”

How To Manage Hormonal Cystic Acne With Endometriosis

There are many things that you can do to manage hormonal acne associated with endometriosis:

• Find the right dermatologist.
• Refine your cleansing regimen.
• Watch your makeup.
• Don’t pick your pimples.
• Rethink your medication.

Find the Right Dermatologist

First, it’s important to find a dermatologist who has experience dealing with cystic acne. You may even be able to find one who works with people also diagnosed with endometriosis. A good dermatologist will look at the problem comprehensively, considering your diet, exercise habits, overall lifestyle, and more, as all of these can affect cystic acne.

Refine Your Cleansing Regimen

It’s important to find a cleansing and skin care regimen that is right for you. For some people this comes easily, while others have to try several products before they determine which ones are right for their skin.

Ask your dermatologist for advice. There may be prescription skin care products that work better for you than those found over the counter. Your dermatologist may also be able to tell you what products to try from the drugstore — and what to avoid.

You will likely want to look for noncomedogenic face washes, moisturizers, and sunscreen. These products are formulated to avoid clogging the pores, which may cause or worsen acne breakouts.

Watch Your Makeup

As with skin care products, it is important to consider what is in your makeup. Many cosmetics now available have been designed not to worsen sebum buildup on your skin or increase oiliness. You may want to ask a dermatology specialist for recommendations if you aren’t sure where to start.

Don’t Pick Your Pimples

One of the most important things you can do when caring for hormonal acne is to keep your hands off your face. Touching skin increases oiliness, as the natural oils from your hands can transfer to the skin on your face. On top of that, the residue of other substances or contaminants — even ones you can’t see — on your hands can transfer to your face and make the problem worse.

Trying to pop cystic acne is also not a good idea. However tempting it may be, popping cystic pimples is even worse than squeezing noncystic acne. Because the cysts are so deep under the skin, squeezing or picking at them can do significant damage to the skin around the pimple. This can cause scarring and worsen the appearance of existing lesions.

Rethink Your Medication

If you didn’t experience cystic acne until after you started medication for endometriosis, you might want to consider talking to your doctor about trying a different medication or treating the endometriosis in different ways. This may involve taking birth control pills or other contraceptives (birth control) rather than hormonal treatments like danazol.

You and your gynecologist can discuss the pros and cons of all of your treatment options. They will provide medical advice as to what treatment options will best manage your endometriosis while causing the fewest side effects.

Find Your Team Today

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

If you are looking for support on your journey with endometriosis, consider joining us at MyEndometriosisTeam. Have you experienced cystic acne? What has worked to treat it? Share your thoughts or tips in the comments below or by posting on MyEndometriosisTeam.