This post was updated on December 20th, 2021
I’ll never forget the day back in my late twenties when I realized my PCOS acne had finally disappeared for good.
That day, my beliefs about acne were completely transformed.
My prior battle with acne was fairly typical for a woman with PCOS. It started when I was young and plagued me for 15 long, pimply years. By the time I was 12, it was so bad my mom took me to a dermatologist who put me on Retin-A and antibiotics. I then took these drugs along with birth control pills and used peroxide-based cleansers in a flailing effort to keep my acne in check. I avoided tank tops and shoulder-less dresses because I was so self-conscious about my PCOS back acne. Like many young women in my situation, I also spent a small fortune on concealers.
But the miraculous change I experienced had nothing to do with skincare products, drugs, or any of the treatments I’d tried before. The secret instead was diet change.
Only a few months before I had started following the type of diet I share during my free 30-Day PCOS Diet Challenge. While it wasn’t easy at the time, it’s now been over 10 years since I’ve had an acne breakout and there’s zero chance I’ll ever go back to my old way of eating.
Having now run hundreds of thousands of women through my 30-Day Challenge, I’ve come to realize that not only is acne completely resolvable, but for many women, it can actually be one of the easiest and quickest PCOS symptoms to treat. Melisa is a great example of this.
While PCOS acne was something I resolved for myself, it’s now something I enjoy helping other women fix almost every single day. In the hope of helping you avoid a 15-year long struggle like mine, here are the three most important lessons I’ve learned about PCOS and acne.
1. PCOS Acne Is Caused By Insulin Resistance & Inflammation
To understand what an ovarian cyst and acne have in common, it helps to know that acne is caused by elevated androgens like testosterone (Uysal, Sahin et al. 2017, Franik, Bizoń et al. 2018). Known as hyperandrogenism, this hormonal disturbance is one of the three defining criteria of a formal polycystic ovary syndrome diagnosis. You don’t necessarily have to have hyperandrogenism to have PCOS, but if acne is an issue, then this is almost certainly an issue for you.
So, what causes hyperandrogenism in women with PCOS? The answer is insulin resistance and/or chronic inflammation.
Not all women with PCOS suffer from insulin resistance but those who do are more likely to have elevated androgens. This then means they’re also more likely to suffer from acne and other related PCOS skin issues.
Chronic inflammation, on the other hand, is a universal issue for women with PCOS. This is a state where your immune system is constantly being lightly triggered in a way that isn’t healthy.
Put simply, if you want to control polycystic ovary syndrome acne then you need to improve how your body regulates insulin and tamp down the flames of chronic inflammation.
2. Conventional PCOS Acne Treatments Don’t Treat The Root Cause
Almost every conventional PCOS acne treatment works either by trying to wipe it out with harsh ingredients or to prevent it from forming by altering our hormone levels.
The downside is that these solutions fail to address inflammation and insulin resistance, so the underlying problem persists. They might mask the symptoms for a time, but the acne will be back as soon as you stop treatment.
The other major downside is that the most effective conventional treatments for PCOS acne also cause side effects. This can adversely affect your health in the long run, as I’ve personally learned the hard way.
As a naïve teenager, I went on antibiotics for many years just to treat my acne. I sorely regret this decision now that I know how detrimental it has likely been to my health. It’s well established that long-term antibiotic use not only harbors the danger of antimicrobial resistance, but it also destroys your healthy gut flora (Jernberg, Löfmark et al. 2010, Lange, Buerger et al. 2016). Given that our gut is the first and most important defense for managing inflammation, long-term antibiotic use is completely counterproductive to managing PCOS.
Going on birth control is another mistake I wished I hadn’t made.
Unfortunately, oral contraceptives are the most common PCOS acne treatment, but that doesn’t mean it’s a good idea. In fact, in my opinion, oral contraceptives should be a last resort rather than a first-line therapy—especially where acne is a primary concern.
While birth control is effective at treating the hyperandrogenism that directly causes acne, it can actually make your PCOS worse. This happens through a number of mechanisms, but some of the key concerns include nutrient depletions (Palmery, Saraceno et al. 2013) and an increase in insulin resistance (Petersen 2002, Mastorakos, Koliopoulos et al. 2006, Piltonen, Puurunen et al. 2012). It’s even been observed that some birth control pills increase biomarkers of inflammation (Hoeger, Davidson et al. 2008, de Medeiros, de Medeiros et al. 2018).
That’s pretty much an ideal cocktail for making your PCOS worse!
Some doctors are now also prescribing metformin for the treatment of PCOS cystic acne. As evidenced by several studies, there’s no doubt that metformin helps with PCOS acne (Lee and Smith 2017, Sharma, Mathur et al. 2019). But just because something works doesn’t necessarily mean it’s a good idea. This is especially true when you consider there are much more effective solutions that have ZERO negative side effects (see lesson #3 below).
The use of metformin for PCOS generally, and acne even more so, is a poor reflection of our modern, 15-minute-consult medical system. Drugs like metformin can be prescribed quickly and easily and they’ll “solve” the problem you came in for, but they’re a good example of Maslow’s hammer (if you only have a hammer, then everything looks like a nail).
There’s some good scientific reasoning supporting this view.
Despite its widespread, persistent use within our PCOS community, leading physicians have reversed their prior positions on metformin. There are now calls within the medical establishment stating that metformin for PCOS should not be used as a first-line therapy (Barbieri 2018). This includes PCOS acne. Given the adverse effects this outdated drug has had on the women within my PCOS community, this statement is certainly long overdue.
When asked about their experiences with metformin, of the 1300+ women I polled, 78% experienced side effects such as diarrhea, heartburn, nausea, abdominal pain, bloating, and vomiting. Given that long-term metformin use can also cause the depletion of vitamin B12 (Aroda, Edelstein et al. 2016), this really doesn’t seem like a sensible solution to acne.
Just like birth control, metformin is clearly a band-aid solution. Sure, it reduces our cells’ resistance to insulin, but it does nothing to address the factors that cause our insulin sensitivity to be low in the first place.
In light of this, my suggestion is to put any metformin prescription in the “only if you’re desperate” pile.
3. The Best Treatment For Polycystic Ovary Syndrome Acne Is Diet Change
So far, I’ve explained that polycystic acne is caused by elevated androgen levels and that this is a consequence of insulin resistance and chronic inflammation. While there are drugs that can alter your hormone levels to suppress androgen production, diet is by far a safer and more effective long-term solution.
That’s because when we eat well, we’re actually treating the underlying causes of our PCOS.
As I explain during my free 30-Day PCOS Diet Challenge, there are many foods women with PCOS should avoid because they cause inflammation in the body. While some foods like industrial seed oils are by their very nature inflammatory, others like gluten and dairy can weaken our intestinal barrier, causing toxins to leak out of our gut and into our bloodstream. It’s only through the success of the inflammatory response our immune systems produce that we don’t get extremely sick from this onslaught. In many cases, your inflammatory response might be so effective that you’re not even aware that these foods are a problem.
Inflammation is doing its job in this instance, it’s just that we don’t want to be mobilizing this response in the first place. Doing so for long periods of time drives all of our PCOS symptoms.
Metabolic health issues like weight gain, insulin resistance, high blood pressure, or non-alcoholic fatty liver disease, are all caused by chronic inflammation (Furman, Campisi et al. 2019). For women with irregular periods or infertility, inflammation is the mechanism behind the hormone imbalances occurring in your ovaries. For women with unwanted hair, male-pattern baldness, weird skin issues, and (of course) acne, chronic inflammation is enemy number one.
This is why diet really matters.
A series of studies in rhesus monkeys have shown the multiple ways that PCOS-like symptoms caused by elevated androgen levels are made worse by a typical western diet. For example, a western-style diet in the presence of chronic hyperandrogenemia has been shown to adversely alter ovarian and uterine structure (Bishop, Mishler et al. 2018), reduce fertility and increase metabolic dysfunction during pregnancy (Bishop, Stouffer et al. 2018), contribute to the development of insulin resistance (True, Takahashi et al. 2017), and cause the kinds of fat metabolism issues that lead to obesity (Varlamov, Bishop et al. 2017).
When we change our diet, we can reverse these mechanisms, as so many past participants of my free 30-Day PCOS Diet Challenge have proven throughout the years.
For example, after years of struggling with other diets, Steffi was skeptical that she’d be able to make a PCOS diet sustainable. Fortunately, she gave it a go, and within a month her acne began to clear. Not only that, but she also lost weight, her mood stabilized, and her acid reflux resolved. A year on, she has continued to maintain this new way of life and has discovered a newfound appreciation for her body.
Katy is another great example. Six months after changing her diet, she managed to clear up her skin without using medication. She lost weight, and resolved her previous gut-related issues. Katy now has her entire family eating healthier, sharing the gift of good nutrition with her husband and children.
So, what does a low inflammation, insulin conscious, PCOS acne diet look like?
…A plate that’s 100% whole foods with loads of healthy fats.
Increasing fat consumption along with the smart use of carbohydrates is a key factor for improving insulin sensitivity. By eating small amounts of carbs with each meal (in the presence of fat and protein), we reduce the rate at which our blood sugar levels change. This lowers our cellular demand for insulin which over time, results in increased sensitivity.
Following a PCOS acne diet also means moving away from the processed foods and ingredients that drive inflammation. The biggest problem items being sugar, gluten, and dairy.
For a comprehensive overview of what this entails, I have a beginner’s guide to a PCOS diet that can quickly bring you up to speed.
It’s Time To Say Goodbye To PCOS Acne For Good
While I’m incredibly thankful I was finally able to get rid of my acne, I wish I’d been able to take the right steps sooner, rather than wasting so much time on solutions that didn’t work.
I know diet changes aren’t easy to implement. They take time, money and a heck of a lot of dedication. As a former sugarholic, I remember how painful it was to part ways with my addiction. But the thing to keep in mind is that acne is a presenting symptom for a much wider systemic problem.
It’s the cliché tip of the PCOS iceberg.
To flip this ominous imagery around though, the good news is that there’s so much more to be gained than what’s on the surface (of your face). Changing how you eat means addressing the root causes of PCOS which means a healthier body composition, improved fertility, better sleep, more energy, and a resolving of all your other symptoms.
If you’re sick of both your PCOS and acne and are ready to focus on your long-term health, then make sure to sign-up for my next free 30-Day PCOS-Diet Challenge. This fun program brings together tens of thousands of women from around the world to start working towards a PCOS-friendly lifestyle. The Challenge includes recipes, shopping lists, nutritional video lessons and more, but what makes it really special is the kind support of so many like-minded women. Not only do we discuss many of the psychological barriers to success, but we also take the time to cheer one another on as we make these changes together.
In a few months’ time when you wake up to perfectly clear skin, you’ll be so glad you joined us.
P.S. I also have a free 3-day PCOS meal plan which you can download here. This can be a helpful first step prior to joining the 30-Day Challenge and can get you started right away rather than having to wait. With easy, practical recipes and a print-ready shopping list this is a great way to explore a PCOS-friendly diet without having to commit to a 30-Day program.
Since 2010, Kym Campbell has used evidence-based diet and lifestyle interventions to manage her PCOS. After getting her symptoms under control and falling pregnant naturally, Kym now advocates for dietary change as part of any PCOS treatment plan. Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
Aroda, V. R., S. L. Edelstein, R. B. Goldberg, W. C. Knowler, S. M. Marcovina, T. J. Orchard, G. A. Bray, D. S. Schade, M. G. Temprosa, N. H. White and J. P. Crandall (2016). “Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study.” J Clin Endocrinol Metab 101(4): 1754-1761.
Barbieri, R. L. E., D.A. (2018). “Metformin for treatment of the polycystic ovary syndrome.” UpToDate.
Bishop, C. V., E. C. Mishler, D. L. Takahashi, T. E. Reiter, K. R. Bond, C. A. True, O. D. Slayden and R. L. Stouffer (2018). “Chronic hyperandrogenemia in the presence and absence of a western-style diet impairs ovarian and uterine structure/function in young adult rhesus monkeys.” Hum Reprod 33(1): 128-139.
Bishop, C. V., R. L. Stouffer, D. L. Takahashi, E. C. Mishler, M. C. Wilcox, O. D. Slayden and C. A. True (2018). “Chronic hyperandrogenemia and western-style diet beginning at puberty reduces fertility and increases metabolic dysfunction during pregnancy in young adult, female macaques.” Hum Reprod 33(4): 694-705.
de Medeiros, S. F., M. A. S. de Medeiros, N. D. Santos, B. B. Barbosa and M. M. W. Yamamoto (2018). “Combined Oral Contraceptive Effects on Low-Grade Chronic Inflammatory Mediators in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.” International Journal of Inflammation.
Franik, G., A. Bizoń, S. Włoch, K. Kowalczyk, A. Biernacka-Bartnik and P. Madej (2018). “Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome.” Eur Rev Med Pharmacol Sci 22(14): 4411-4418.
Furman, D., J. Campisi, E. Verdin, P. Carrera-Bastos, S. Targ, C. Franceschi, L. Ferrucci, D. W. Gilroy, A. Fasano, G. W. Miller, A. H. Miller, A. Mantovani, C. M. Weyand, N. Barzilai, J. J. Goronzy, T. A. Rando, R. B. Effros, A. Lucia, N. Kleinstreuer and G. M. Slavich (2019). “Chronic inflammation in the etiology of disease across the life span.” Nature Medicine 25(12): 1822-1832.
Hoeger, K., K. Davidson, L. Kochman, T. Cherry, L. Kopin and D. S. Guzick (2008). “The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials.” J Clin Endocrinol Metab 93(11): 4299-4306.
Jernberg, C., S. Löfmark, C. Edlund and J. K. Jansson (2010). “Long-term impacts of antibiotic exposure on the human intestinal microbiota.” Microbiology (Reading) 156(Pt 11): 3216-3223.
Lange, K., M. Buerger, A. Stallmach and T. Bruns (2016). “Effects of Antibiotics on Gut Microbiota.” Dig Dis 34(3): 260-268.
Lee, J. K. and A. D. Smith (2017). “Metformin as an adjunct therapy for the treatment of moderate to severe acne vulgaris.” Dermatol Online J 23(11).
Mastorakos, G., C. Koliopoulos, E. Deligeoroglou, E. Diamanti-Kandarakis and G. Creatsas (2006). “Effects of two forms of combined oral contraceptives on carbohydrate metabolism in adolescents with polycystic ovary syndrome.” Fertil Steril 85(2): 420-427.
Palmery, M., A. Saraceno, A. Vaiarelli and G. Carlomagno (2013). “Oral contraceptives and changes in nutritional requirements.” Eur Rev Med Pharmacol Sci 17(13): 1804-1813.
Petersen, K. R. (2002). “Pharmacodynamic effects of oral contraceptive steroids on biochemical markers for arterial thrombosis. Studies in non-diabetic women and in women with insulin-dependent diabetes mellitus.” Dan Med Bull 49(1): 43-60.
Piltonen, T., J. Puurunen, P. Hedberg, A. Ruokonen, S. J. Mutt, K. H. Herzig, A. Nissinen, L. Morin-Papunen and J. S. Tapanainen (2012). “Oral, transdermal and vaginal combined contraceptives induce an increase in markers of chronic inflammation and impair insulin sensitivity in young healthy normal-weight women: a randomized study.” Hum Reprod 27(10): 3046-3056.
Sharma, S., D. K. Mathur, V. Paliwal and P. Bhargava (2019). “Efficacy of Metformin in the Treatment of Acne in Women with Polycystic Ovarian Syndrome: A Newer Approach to Acne Therapy.” J Clin Aesthet Dermatol 12(5): 34-38.
True, C. A., D. L. Takahashi, S. E. Burns, E. C. Mishler, K. R. Bond, M. C. Wilcox, A. R. Calhoun, L. A. Bader, T. A. Dean, N. D. Ryan, O. D. Slayden, J. L. Cameron and R. L. Stouffer (2017). “Chronic combined hyperandrogenemia and western-style diet in young female rhesus macaques causes greater metabolic impairments compared to either treatment alone.” Hum Reprod 32(9): 1880-1891.
Uysal, G., Y. Sahin, K. Unluhizarci, A. Ferahbas, S. Z. Uludag, E. Aygen and F. Kelestimur (2017). “Is acne a sign of androgen excess disorder or not?” Eur J Obstet Gynecol Reprod Biol 211: 21-25.
Varlamov, O., C. V. Bishop, M. Handu, D. Takahashi, S. Srinivasan, A. White and C. T. Roberts, Jr. (2017). “Combined androgen excess and Western-style diet accelerates adipose tissue dysfunction in young adult, female nonhuman primates.” Hum Reprod 32(9): 1892-1902.