Hormonal Acne Treatments That Actually Work (Backed by a Derm)

What Is Hormonal Acne?

Hormonal acne is one of the most stubborn and emotionally frustrating types of breakouts—especially because it often lingers long after the teen years are over. As a board-certified dermatologist, I’ve treated hundreds of women with hormonal acne, and while everyone’s journey is different, the pattern is strikingly similar.

Hormonal acne typically shows up along the lower face, jawline, chin, and neck, and often flares in a cyclical pattern—especially around menstruation. It’s often deeper, cystic, and tender, and is usually linked to fluctuations in androgens (male hormones like testosterone), which increase oil production and inflammation in the skin .

Why Do Women Get Hormonal Acne?

Hormonal acne can occur due to a variety of triggers:

• Menstrual cycles

• Polycystic ovarian syndrome (PCOS)

• Perimenopause or menopause

• Stopping or starting hormonal birth control

• Stress (which increases cortisol and indirectly, androgens)

Genetics and environmental stressors like comedogenic skincare products or poor sleep can worsen things, but hormonal shifts are usually the root cause.

The Best Treatments for Hormonal Acne in Women

FDA-Approved Oral Contraceptive Pills (OCPs)

There are currently four OCPs FDA-approved to treat acne:

• Ortho Tri-Cyclen

• Estrostep

• Yaz

• Beyaz

Each combines estrogen and a specific progestin that helps lower circulating androgens.

These can be game-changers for many women, but they're not for everyone. I always recommend discussing the risks and benefits with a PCP or gynecologist, especially for patients with a personal or family history of blood clots, migraines with aura, or other estrogen-sensitive conditions.

Common side effects: mood changes, nausea, breast tenderness, breakthrough bleeding.

That said, I’m reaching for these more and more—especially when combined with a strong topical routine. They tend to offer better long-term consistency than spironolactone (more on that below).

Spironolactone (The Once Go-To)

Spironolactone used to be my favorite hormonal acne treatment—and for good reason. It’s an androgen receptor blocker, reducing the effect of male hormones on oil glands.

It’s not FDA-approved for acne (yet), but has been used off-label for decades and supported by literature. Typical dosing ranges from 50–150 mg daily.

Side effects can include irregular periods, breast tenderness, fatigue, and low blood pressure. And it’s contraindicated in pregnancy, which makes it tricky for many of my patients.

These days, I rarely reach for it first. Between newer topicals and better OCP options, I find spironolactone works best in very select cases.

Winlevi (Clascoterone 1% Cream)

Meet Winlevi, a topical androgen blocker that finally gives us a way to reduce hormonal activity in the skin without systemic side effects. It’s the first topical of its kind, FDA-approved for acne in 2020.

Clascoterone works by inhibiting the androgen receptors in the sebaceous glands, reducing sebum production and inflammation . It’s safe to use with other topical products, such as tretinoin, benzoyl peroxide, or azelaic acid.

It’s well tolerated, though some users report mild dryness or irritation. For patients with hormonal acne who don’t want systemic medications, Winlevi is a game-changer.

Other Honorable Mentions

Topical Retinoids:
Still foundational. Tretinoin, adapalene, and Altreno (my go-to) help normalize keratinization and reduce clogged pores.

Azelaic Acid:
Has mild anti-androgenic properties and is safe in pregnancy. A gentle option for those with sensitive or rosacea-prone skin.

Isotretinoin (Accutane):
Sometimes necessary for severe, scarring hormonal acne—but I consider it a last resort due to its side effect profile.

Diet & Lifestyle:
Emerging data supports the idea that low glycemic diets and stress-reduction may improve hormonal acne severity, though results are modest.

My Hormonal Acne Treatment Approach in 2025

Today, my preferred approach is to start with an FDA-approved OCP, after receiving appropriate counseling from a PCP or OB-GYN, paired with a gentle but effective topical routine. I’m more cautious with spironolactone and now reserve it for cases where other therapies fall short.

For patients who are not candidates for oral medications—or who simply don’t want them—Winlevi (if it’s covered!) + retinoid + azelaic acid is a winning combo.

Final Thoughts

Hormonal acne is complex, but it’s treatable. The key is a thoughtful, evidence-based approach that balances internal and topical therapy. If you’re struggling, know that you don’t have to do it alone—and you’re definitely not the only one dealing with breakouts in your 30s (or beyond).