There are many different ways to track your menstrual cycle, some high tech, others … not so much.

And for some of us, all we have to do to know where we are in our cycle is to look in the mirror. Thanks to our hormones, our complexion doubles as a calendar. Zit marks the spot … but why? And is there anything you can do to stop it?

We talked to gynecologist Niccia diTrapano, MD, about period pimples: What they look like, where and when you’ll find them — and what you can do to prevent them.

What do period pimples look like?

According to Dr. diTrapano, “Hormonal acne often forms painful cysts or papules that are deeper — and more painful — than your typical whiteheads or blackheads.”

In many cases, hormonal acne never develops a head at all. It just sits there, mocking you, and leaving your skin tender to the touch.

Where and when are period pimples likely to pop up?

Hormonal breakouts most often make their home on the lower third of your face — think chin and jawline. But Dr. diTrapano says that period acne can also take up residence on your cheeks, neck and around your mouth, as well as on your shoulders and back.

How long does menstrual acne last?

The menstrual cycle is not a fixed thing. It changes from person to person and month to month. For that reason, when exactly period acne starts — and how long it lasts — varies. “It can last for a few days or for a few weeks,” Dr. diTrapano says. “It impacts each person differently.”

What causes period pimples?

“Your hormones fluctuate throughout your menstrual cycle,” Dr. diTrapano explains, “and that can lead to changes such as an increase in sebum production, which is the oil in your skin. That increase in sebum contributes to the formation of acne.”

The when of menstrual breakouts is a bit more complicated than the what. Many people experience breakouts in the lead up to their period — in fact, acne flares are one of the primary symptoms of premenstrual syndrome (PMS). The premenstrual period is when estrogen levels are lowest, and your progesterone levels are going up. Progesterone increases sebum production. But, as Dr. diTrapano explains, hormones fluctuate throughout your entire menstrual cycle.

For example, while we often think of testosterone as a “male hormone,” all people make testosterone. “Your skin may be more prone to react to testosterone,” Dr. diTrapano states, “which can cause hormonal acne at different points in your cycle.”

It’s worth noting that you can also experience breakouts during pregnancy or menopause, too. Yippee.

How to prevent period breakouts

“Although it may not be completely preventable,” Dr. diTrapano says, “there are thing you can do to decrease your risk of breaking out.” Here are a few lifestyle changes that can make a difference:

• Reduce your stress levels. Easier said than done, we know. But it’s true: When we’re under a lot of stress, our hormone balance and immune system are disrupted, creating a pimple playground on our faces. You can’t remove stress from your life entirely, but developing some healthy coping mechanisms could keep your complexion clearer.
• Get plenty of sleep. A 2019 study found that there’s a correlation between the quality of sleep a person gets and the severity of their acne. That makes sense because our cortisol levels go up when we’re running on empty, which throws our other hormones off kilter.
• Eat a balanced diet. It’s a bit of a stretch to say, “you are what you eat,” but it’s definitely true that certain foods are blemish boosters. If you want to improve your acne, eating a healthy, mostly plant-based diet — and limiting sugar, processed foods and alcohol — is a great start. From there, you can also integrate foods into your diet that combat inflammation, dryness and oxidative stress.
• Use noncomedogenic face products. It’s a mouthful, but that six-syllable adjective can make a big difference for your skin. Noncomedogenic makeup, skin care and hair care products are specifically designed not to clog your pores.
• Consider oral contraceptives. “A lot of people still don’t know that there are FDA-approved oral contraceptive options that are approved for the treatment of acne,” Dr. diTrapano shares. Birth control also has fringe benefits: If your period is irregular or you struggle with cramps and other symptoms, going on the pill may help. It will take a few months to see an improvement in your complexion, so don’t despair if you aren’t seeing results immediately. Of course, if you’re trying to get pregnant, oral contraceptives are a non-starter. Luckily, there are other options out there to help you.
• Talk to your healthcare provider. Ob/Gyns and other healthcare providers can talk to you about over-the-counter and prescription treatment options for hormonal acne. They can prescribe a range of medications for acne, like retinoids, spironolactone (an anti-androgen medication) and birth control. If those treatments aren’t working after a few months, they can always refer you to a dermatologist. And if you have other symptoms — like irregular periods or an increase in body hair — they may also do tests to check for underlying medical conditions like polycystic ovary syndrome (PCOS). 

How to get rid of period acne

Prevention’s great, but what should you do if you’re mid-breakout? We recommend the following to ease the pain and banish your blemishes faster:

• Warm and cold compresses. Warm compresses can help ease the pressure by drawing out the pus, while the cold compresses can ease pain and reduce inflammation.
• Use a benzoyl peroxide cleanser or spot treatment. Benzoyl peroxide kills bacteria and dries out the oil and sebum. If you have sensitive skin, use a lower concentration to prevent irritation.
• Use a gentle, noncomedogenic cleanser — and avoid scrubbing. The last thing you want to do is further irritate your already angry skin.
• Use skin care products that contain salicylic acid. This beta-hydroxy acid is a go-to ingredient to unclog pores and exfoliate your skin.
• Soothe your skin with Centella Asiatica. Also known as tiger grass, cica, or gotu kola, Centella Asiatica fights inflammation and bacteria, while promoting wound healing and moisturizing. It’s sort of a skin care Swiss Army™ knife.
• DON’T PICK! We say this with love: Your hands are covered in bacteria. Not only is period acne less pop-able, but touching it can also further inflame your skin. If you’re a serial squeezer, consider covering your zits with hydrocolloid pimple patches to keep them safe.

The bottom line

Hormonal acne happens to everybody from time to time. But it can be especially obnoxious if you menstruate. If lifestyle changes and over-the-counter treatments aren’t keeping your period pimples at bay, consider speaking to a healthcare provider. They can discuss other options for acne management. They may even prescribe medications to prevent future flare ups.