Are persistent acne before periods related to PCOS?

Question

Hi doctor,

I am 31 years old and struggle with persistent acne around my chin and jawline, especially before my period. My skin is also sensitive, so most products burn or make me break out more. My testosterone is slightly elevated.

Could this be hormonal acne or PCOS?
What skin treatments are safe for women trying to conceive?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Acne that clusters around the chin and jawline, flares before your period, and is associated with slightly elevated testosterone does indicate a hormonal pattern.

This can sometimes be related to polycystic ovary syndrome (PCOS), although not always, as some women without PCOS still experience hormonally driven acne.

Since you are trying to conceive, treatments that affect hormones (like oral contraceptives or spironolactone) are not safe options.

Instead, you can focus on skin-directed therapies that are generally safe in this situation: gentle, fragrance-free cleansers and moisturizers, azelaic acid (which helps with acne and pigmentation and is safe during pregnancy), and, in some cases, topical Clindamycin.

Strong retinoids, salicylic acid in high concentrations, and oral anti-androgen medications should be avoided if you are planning a pregnancy.

It may also be worth checking ovarian function, cycle patterns, and conducting an ultrasound if PCOS is suspected, as managing the underlying hormonal balance can improve both fertility and skin health. For now, a gentle routine plus safe prescription topicals should be used.

Could you please share your weight and menstrual history?
Do you have regular menstruation?
Also, do you have any facial hair or hair above your lips?

If PCOS is diagnosed, you may not need a specific acne treatment; treating PCOS can often resolve the acne as well.

I hope this answers your query. Feel free to reach out anytime.

Thank you.