Recently we have been getting so many questions regarding skin concerns and how they relate to hormones. For an expert opinion, we called on Melissa's own Naturopathic Doctor, Dr. Kayla Eckart to dive deeper into these topics. We explore the effects of hormones on our skin, as well as some inspired plans of action to help you detect whether yours may be out of balance and tips for how to bring everything back into harmony.

Before answering questions, let’s do a little cycle 101 so that we are all on the same page. Day one of your cycle is the first day of bleeding. Bleeding can last anywhere from a few days to a week. The time between cycles can range between 26 – 32 days (28 days between periods being most common.) Generally speaking, during the first half of your cycle (day 1 – day 14), estrogen is the main player. Estrogen’s main goal is to mature a healthy egg for ovulation. For the sake of simplicity, let’s say ovulation always happens on day 14 (not always the case, I see that it typically varies between day 7 – day 18). This is when the egg is released from the ovary. Ovulation causes progesterone to rise and ideally it will stay elevated for about two weeks or the remainder of the cycle (day 15 – day 28).

This predictable and cyclical nature of the menses is certainly desirable, but many things can interfere with the period and throw everything off track. Cycle abnormalities are one of the first signs of a hormonal imbalance. Symptoms such as abnormal cycles give you valuable clues into your health & the harmony of your hormones. While being often unwelcome and inconvenient, symptoms are actually a way for your body to communicate any imbalances & issues. Your body is in constant communication with you and it’s important to tune in & listen to these cues that she sends you. You can then use the information to ultimately find your way back into balance. Naturopathic Doctors and Functional Medicine Practitioners are often well versed in helping you get back on track using diet, lifestyle, natural therapies, and medications where indicated.

We have all heard the term “hormonal acne,” especially as women. Are there any practices or tips you recommend to help those of us who struggle with hormonal acne around our cycles?

The biggest players when it comes to hormonal acne are estrogen and testosterone. First, let’s talk estrogen. To have a balanced system, we need an optimal amount of estrogen & a proper ratio in comparison with other hormones. Estrogen only becomes an issue when it is either too high or too low.

When it comes to hormonal acne, it is often related to high estrogen or estrogen dominance, meaning the ratio between estrogen and progesterone is off. Typically, estrogen is higher in the first half of the cycle and progesterone in the second half. Well, what happens if after ovulation we don’t have enough progesterone? What if we don’t ovulate at all? The balance of our hormones is thrown off and estrogen dominates all month long. We not only miss out on the benefits of progesterone but also can have symptoms such as acne, heavy bleeding, cramping, premenstrual headaches, and PMS. These are probably most common in the few days or week before the period. If this sounds like you, consider asking your doctor to order lab work. A basic hormone evaluation includes estrogen, progesterone, free testosterone, and total testosterone. It is important to time the blood draw with your cycle. For a 28-day cycle, testing on days 19 - 21 of the cycle (or about 5 days after ovulation) will catch the best snapshot of progesterone and allow for more accurate interpretation. It is not helpful to check progesterone before it is ever put into circulation.

Now for testosterone. Although at lower amounts compared to men, women also make (and benefit) from testosterone. The same theme continues, it is all about balance. Too little testosterone can leave you feeling tired with low libido. Too much testosterone often results in acne, atypical hair growth, and/or irritability. Some women who struggle with acne, hair growth, and/or irregular cycles may have PCOS (polycystic ovarian syndrome.) Despite the name, women do not have to have cysts on their ovaries to be diagnosed with PCOS. Discussing these symptoms with your doctor can help guide treatment to diminish symptoms and optimize hormone balance.

Acne aside, how else do hormone imbalances show up?

Think again of the cyclical nature of a normal 28-day cycle. Day 1 being the first day of bleeding, ovulation at day 14, with estrogen higher the first two weeks and progesterone the second two weeks. Your hormones are doing a coordinated dance all month long. If estrogen leads all the time, and progesterone never has a chance to shine, the second half of your cycle can be quite uncomfortable. When someone doesn’t have enough progesterone to balance their estrogen, symptoms often arise 1 -2 weeks before the period. Common complaints include headaches, insomnia, anxiousness as well as PMS leading up to their cycle. Periods may be heavier, with lots of clotting and/or pain.

Besides our cycles, are there other things that can disrupt or throw our hormones out of balance?

It’s important to understand that the primary goal of the menstrual cycle is to keep our hormones in balance. However, both internal and external factors prevent this from happening. It is often an imbalance elsewhere in the body that creates the cycle disruption. Our endocrine (hormone) systems and menstrual cycles are incredibly sensitive to stressors elsewhere in the body. Even inflammation or emotional stress can disrupt our menstrual cycles. Can you recall a time when you've skipped a period due to extreme stress, or perhaps improper diet? That is a clear indication of your body's intuitive nature and knowing that it may not be an optimal time to get pregnant due to either an unsafe or stressful environment or situation.

Another internal factor often overlooked when it comes to hormonal and menstrual health is the thyroid gland. Thyroid hormone is critical for the maturation of a healthy egg for ovulation. Both hypothyroidism (deficient thyroid hormone) and hyperthyroidism (excess thyroid hormone) can impact the menstrual cycle and fertility. Hypothyroidism among women is one of the most common issues I see in my office. This can present with irregular menstrual cycles in combination with other symptoms such as fatigue, hair loss, constipation, depressed mood, heart palpitations, and cold intolerance. If you are wanting to take a closer look at your thyroid health, talk to your doctor about ordering a full thyroid workup. I personally like to see the following: TSH, free T3, free T4, and thyroid antibodies.

It is easy to forget about all of the external factors that impact our menstrual cycle and hormone balance. Oral birth control is a tough one. Oral contraceptives are a great form of birth control but are too often used to manage symptoms of hormonal dysregulation such as irregular or painful periods and acne. Although effective, they do not treat this issue at the root cause. If you are taking birth control for reasons other than birth control, consider talking to a Functional Medicine Practitioner or Naturopathic Doctor.

Another consideration is our exposure to environmental toxins and estrogen-mimicking molecules. These chemicals are commonly found in pesticides, plastics, cleaning, and beauty products. Taking a close look at your skin and beauty care is an essential step to achieve hormone balance. Many chemicals in our body products, makeup, shampoos, and fragrances mimic estrogen and can absolutely contribute to hormone issues and estrogen-dominant symptoms. To make it more confusing, these chemicals that “act” like estrogen will not show up in lab tests. This means that you can be experiencing many symptoms related to estrogen excess and have completely normal labs.

The first step is to be aware of these exposures and make more conscious decisions. If you are just starting the process it can feel overwhelming. Make the transitions slowly, if needed. As you run out of a product, simply replace it with a cleaner option. Citrine Natural Beauty makes this easy. When shopping online or in their store, you can feel confident that you are choosing a clean option. When it comes to non-beauty products and your nutrition, attempt to become familiar with the “Environmental Working Group.” You can use the website to look at your products and evaluate for toxicity.

Lastly, “detoxification” receives a fair amount of attention these days and has become a trendy topic. Sure, there are various nutrients, herbs, and supplements that can aid the body’s detox mechanisms. A little extra support can go a long way. It is important, however, to acknowledge that your body is designed to detox and is doing so with or without extra help. I first recommend starting with supporting your body’s natural means of detoxification. The organs of elimination (or emunctories) can benefit from some extra attention. Your liver, kidneys, digestive system, lymphatics, lungs, and skin all share the responsibility of detoxification. If this topic interests you, check out my virtual group “Detoxing Through Self-Care.”

Do you have any tips, rituals, or routine practices to keep our hormones balanced?

Hormone supportive rituals often come in the form of self-care. To simplify it further, creating balance within the body always circles back to the foundations of health. These key elements to maintain and restore wellness include: nutrition, hydration, sleep, movement, stress management, time in nature, and joyful relationships & play. Tending to these areas will naturally create a level of homeostasis with the ability to heal and thrive.

Keep in mind, we benefit from routine. Our primal instincts like the assurance that there is a predictable nature to our day. Going to bed at the same time, and scheduled meals signal to the body that our basic needs are met. Sleeping in a dark room and opening the curtains at the full moon helps sync our bodies with the natural rhythms of nature. Incorporating nourishing rituals to remind the body that we are safe and cared for can also go a long way. The healthy cascade of hormones and neurotransmitters that result from healthful experiences are reason enough to prioritize joy and stress management.