Is my elevated androgen due to PCOS/PMOS causing acne at 34?

Question

Hello doctor,

I am a 34-year-old woman dealing with hormonal acne and dark pigmentation on my cheeks. My recent hormonal panel showed slightly elevated androgens and normal thyroid levels. I have tried adapalene gel and oral Doxycycline, but keep getting breakouts before my periods. Please tell me;

Could this be PCOS (polycystic ovary syndrome)/PMOS (polyendocrine metabolic ovarian syndrome) related?
Are there any safe prescription creams or oral options that target both acne and pigmentation together?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Disturbance in hormonal levels, exacerbation of acne during the menstrual period, point towards the possibility of polycystic ovary syndrome (PCOS)/ polyendocrine metabolic ovarian syndrome (PMOS). Polycystic ovary syndrome or polyendocrine metabolic ovarian syndrome management can be challenging. Its management includes a multidisciplinary approach.

You need to undergo an ultrasound of the pelvis and ovaries during the seventh to tenth days of your menstrual cycle to confirm PCOS/PMOS. In PCOS/PMOS, hormonal disturbance causes acne, and insulin level disturbance can cause pigmentation known as acanthosis nigricans. If possible, you must undergo a blood test for serum insulin levels as well.

Going forward, Azeleic acid (anti-acne medication), Retinoids (natural derivatives of vitamin A) like Adapalene, and Tretinoin are strong agents that target acne and pigmentation together; however, avoid if you are pregnant or lactating.

I would suggest opting for water-based or gel-based sunscreen as well to prevent darkening of acne marks post-healing. Some lifestyle changes can modify PCOS/PMOS status:

Weight loss.
Brisk walking.
Engaging in sports.
Eating fruits and veggies.
Following a balanced diet.
Maintain hydration.
Drink coconut water and natural fruit juices.
Avoid stressful activities.
Sleep for eight to nine hours.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Is my elevated androgen due to PCOS/PMOS causing acne at 34?

Hormonal acne and pigmentation?