For some women, these days tend to coincide with a particular time of the month.
If you have a skin condition like psoriasis or chronic spontaneous urticaria (CSU), you may have noticed that your mood isn’t the only thing that’s affected on a monthly basis – your skin symptoms may be too. That’s because two of the hormones, estrogen and progesterone, that govern your menstrual cycle may possibly affect your skin.1
Before we dig into why your monthly cycle may affect your skin condition, let’s take a step back. Imagine you are a pre-teen again, learning about why you are going through this hell once a month. Here’s how your menstrual cycle breaks down on a biological level…
Levels of estrogen and progesterone fluctuate throughout the month. For example, in a typical cycle, estrogen levels are at their lowest just before your period, then gradually rise, reaching a peak mid cycle before dropping off again in the second half of the month. Progesterone, on the other hand, is at its lowest in the first half of the cycle, then peaks about a week before your period, with a sudden drop just before.2 So, imagine two waves of hormones, one peaking when the other is down, like two hormonal roller coasters side-by-side.
These monthly fluctuations can have a dramatic effect on the skin, thanks to the presence of estrogen receptors throughout the epidermis and dermis, and to a lesser extent progesterone receptors.3 In fact, cyclical changes in estrogen and progesterone affect everything from the skin’s moisture levels to elasticity.3
But sex hormones don’t just affect your complexion – studies suggest they may cause a number of immunological changes deep within the skin, too. They could even possibly influence the course of (you guessed it) psoriasis and CSU.
It may be likely that sex hormones play a role in psoriasis. We know, for instance, that the incidence of the disease peaks around puberty, after pregnancy, and during menopause, while many women find their symptoms improve during pregnancy.4,5 The fact that estrogen appears to encourage the proliferation of keratinocytes (the same skin cells that go into overdrive in psoriasis) also suggests a link.5,6
Sure enough, studies show high levels of estrogen appear to have a calming effect on the immune system. In other words, if you have psoriasis, you may find that your skin improves around the middle of your cycle when estrogen levels are at their highest.5 Conversely, flare-ups are likely to occur when estrogen levels drop just before your period.7 So, be sure to add itchy skin to your PMS symptoms – yay.
Sex hormones also appear to influence CSU. We know, for instance, that the condition is approximately twice as frequent in women as in men,8 while some women notice flare ups coincide with menstrual changes.9
High estrogen levels may even aggravate CSU’s symptoms. Estrogen appears to trigger mast cells to produce more histamine,10 so you may find your hives are at their worst around the middle of your cycle when levels of the hormone peak.11 Indeed, one study found women’s skin was most sensitive around these days.12 Another study revealed that some women with CSU are actually ‘allergic’ to estrogen, and it’s that which triggers hives and swelling.13
Sex hormones are by no means the only factors that affect your skin, but if you do have a hunch that your skin is particularly bad at certain times of the month, it’s a good idea to keep record of the changes. Start jotting down in a journal or keep track on your phone: there are even apps on your phone that will help log your symptoms, allowing you to identify any cyclical patterns. Arming yourself with the data in this way is a really helpful starting point for discussing the issue with your doctor. A clear picture of when your symptoms are at their worst will give him or her a better idea of what might be the trigger so your treatment can be tailored accordingly.
At the very least, being aware of monthly changes in your skin means you’ll be more prepared for pesky flare-ups when they do strike. After all, if you know your skin is likely to act up at certain times in the month, you can plan for it. It might not cure those monthly woes, but it may make your skin a little less angry.
1 Stacked Skincare, What You Need To Know About Hormones And How They Affect Your Skin. Accessed 17 July 2019 https://stackedskincare.com/blogs/news/54756099-what-you-need-to-know-about-hormones-and-how-they-affect-your-skin/
2 Website “BBC” – Oestrogen and progesterone – higher. Last accessed: 29.02.16. http://www.bbc.co.uk/schools/gcsebitesize/science/edexcel_pre_2011/electrical/hormonesrev6.shtml
3 Farage, M et al, Physiological Changes Associated with the Menstrual Cycle. Obstetrical And Gynaelogical Survey, 2009; 64(1) 58-72 https://www.researchgate.net/publication/23681150_Physiological_Changes_Associated_with_the_Menstrual_Cycle
4 Psoriasis of early and late onset: Characterization of two types of psoriasis vulgaris. Henseler, Tilo et al. Journal of the American Academy of Dermatology , Volume 13 , Issue 3 , 450 – 456. http://www.ncbi.nlm.nih.gov/pubmed/?term=4056119
5 Psoriasis: female skin changes in various hormonal stages throughout life--puberty, pregnancy, and menopause. Ceovic R, Mance M, Bukvic Mokos Z, Svetec M, Kostovic K, Stulhofer Buzina D. Biomed Res Int. 2013;2013:571912. http://www.hindawi.com/journals/bmri/2013/571912/
6 Effect of estrogens on skin aging and the potential role of SERMs. Susan Stevenson and Julie Thornton. Clin Interv Aging. 2007 Sep; 2(3): 283–297. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685269/
7The possible relevance of sex hormones on irritant and allergic responses: their importance for skin testing. Miranda A. Farage1, Enzo Berardesca and Howard Maibach. Contact Dermatitis. Volume 62, Issue 2, pages 67–74, February 2010. http://www.ncbi.nlm.nih.gov/pubmed/?term=19807749
8Sex hormones and urticaria. Kasperska-Zajac A1, Brzoza Z, Rogala B. J Dermatol Sci. 2008 Nov;52(2):79-86. J Dermatol Sci. 2008 Nov;52(2):79-86. doi: 10.1016/j.jdermsci.2008.04.002. Epub 2008 May 16. http://www.ncbi.nlm.nih.gov/pubmed/18485675
9 Chronic Urticaria Related to Menses. Shah, A. et al. Journal of Allergy and Clinical Immunology , Volume 127 , Issue 2. http://www.jacionline.org/article/S0091-6749%2810%29023511/fulltext
10 Curr Opin Allergy Clin Immunol. 2013 Feb; 13(1): 92–99. Estrogen effects in allergy and asthma Rana S. Bondsa and Terumi Midoro-Horiutib http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537328/
11 Role of female sex hormones, estradiol and progesterone, in mast cell behavior. Oliver Zierau, Ana C. Zenclussen, and Federico Jensen. Front Immunol. 2012; 3: 169. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377947/
12 Hormonal Link to Autoimmune Allergies. Shilpa Shah. ISRN Allergy Volume 2012 (2012), Article ID 910437, 5 pages. http://www.hindawi.com/journals/isrn/2012/910437/
13 Exogenous oestrogen as an alternative to food allergy in the aetiology of angioneurotic oedema. André F1, Veysseyre-Balter C, Rousset H, Descos L, André C. Toxicology. 2003 Mar 14;185(1-2):155-60. http://www.ncbi.nlm.nih.gov/pubmed/12505453