So many times, in our Facebook group, in private chats, and across the web, I have seen women looking for an answer to the same question: what is the connection between Hidradenitis Suppurativa and the menstrual cycle? Why does my HS seem to get worse when I have my period?
It is a complex topic, but I will try to explain it as clearly as I can. I am neither a doctor nor a woman, so I apologize in advance if I make any mistakes. This article reflects personal experience and general information, not medical advice. HS has no definitive cure, and any concerns about symptoms or hormones should be discussed with a qualified healthcare professional.
Hidradenitis Suppurativa and Sex Hormones
Identifying trigger foods and addressing leaky gut, also known as increased intestinal permeability, may be important for some people, but they are only part of the broader process that may help manage symptoms or support remission.
Hormones may also play a major role in HS, as many women know from seeing their symptoms worsen around the start of their period. This does not mean that postmenopausal women, girls who have not yet had their first period, or men cannot develop HS. For example, if you notice that your cysts become inflamed after eating sugar, hormonal and metabolic pathways may be part of the picture.
There are around two hundred known hormones in the human body, each with its own role and closely connected to the others. Together, they help maintain balance and stability. When one hormone is out of balance with the others, it can affect our health through a cascade of effects.
I will not explore every hormone in the human body. Instead, I will focus on the main sex hormones associated with Hidradenitis Suppurativa.
Why Does My Hidradenitis Suppurativa Get Worse During My Period?
Women are two to five times more likely than men to develop HS, and the condition often begins in early adulthood.
You may have noticed your Hidradenitis Suppurativa flare just before or during your period. Hormonal changes may help explain this pattern.
HS is an autoinflammatory condition, not an autoimmune disease, but hormone levels can influence inflammatory activity. This may make symptoms sensitive to the major hormonal shifts that occur throughout the menstrual cycle.
Remember that people with HS are not the only ones who report symptoms worsening before their period. People living with arthritis, asthma, Crohn's disease, thyroid conditions, and other illnesses may notice similar patterns.
It is common to think that menstrual hormone changes are the sole cause of a condition. However, your menstrual cycle alone does not cause HS. If it did, men would not develop the condition. Men do not menstruate and do not have the same hormonal patterns as women, yet they can still have Hidradenitis Suppurativa. If HS were caused ONLY by the menstrual cycle, everyone affected would enter remission after menopause. That does not happen. The same applies to prepubescent girls, who can still develop HS, although it is less common.
Let us now look at the hormonal changes that typically occur during the menstrual cycle and how they may influence your symptoms.
Sex Hormones
The sex hormones testosterone, estrogen, and progesterone belong to a group called steroid hormones. The human body produces these hormones from cholesterol. Their production pathways begin with a hormone called pregnenolone. Depending on the body's needs and its current balance, pregnenolone is converted into different hormones each day.
Testosterone
Testosterone is an anabolic hormone, which means that it supports growth and development in the body. Testosterone is a type of androgen. In men, testosterone contributes to a deeper voice, facial hair growth, and other typically male characteristics. In women, testosterone supports sexual desire, and some of it is converted into estrogen. One possible sign of excess androgen activity is acne. Testosterone can affect skin thickness, wound healing, sebaceous glands, and hair growth, all of which may be relevant to Hidradenitis Suppurativa. Research suggests that androgen signaling may influence HS, although testosterone levels are not consistently elevated in everyone with the condition. Acne is also common among people with HS.
Estrogen
Estrogen may have several roles in HS. Although it is commonly described as a "female hormone," estrogen is also important in men. It is an anabolic hormone that contributes to the development of typically female sex characteristics. It also helps build bone mass and supports healthy lung function.
Estrogen has hundreds of functions in the body, some of which affect the skin. Estrogen can make secretions from sebaceous glands more fluid and may counter some of testosterone's effects on acne. In practical terms, it may help keep pores from becoming blocked. Estrogen also supports the availability and uptake of glucose by muscle fibers, helping the body metabolize carbohydrates and sugars.
Birth control pills containing estrogen are sometimes prescribed for acne. For some people with HS, clinicians may also consider hormonal contraceptives or other medications containing estrogen and progesterone. Responses vary, however, and progesterone can affect the skin in ways that may create favorable conditions for HS flares in some people.
Progesterone
Progesterone is also an anabolic steroid hormone and is involved in the production of other hormones, including the stress hormones cortisol and aldosterone, which we will discuss in a future article. Progesterone also has several functions of its own, some of which may influence HS. On the skin, progesterone can have effects that differ from those of estrogen, including changes in sebum production. Sebum is a thick, oily substance that acts as the skin's natural lubricant.
For some people, this produces a healthy, natural glow. For others, as progesterone levels rise, the skin may swell and pores may become blocked. This can cause sebum to build up beneath the skin's surface and may contribute to conditions in which cysts or nodules develop.
At the same time, progesterone may interact with epidermal growth factor signaling, which helps regulate the growth of skin cells. That is not all. Progesterone is also involved in the body's response to insulin. Hormonal and metabolic changes can affect insulin sensitivity, but this relationship is complex and does not mean that progesterone alone causes insulin resistance or diabetes.
Have you ever wondered why pregnant women are screened for gestational diabetes, a condition that develops during pregnancy? Progesterone rises substantially during pregnancy and is necessary to help sustain it. Pregnancy hormones can reduce the body's sensitivity to insulin, increasing the risk of gestational diabetes in some women. Blood sugar levels often return to the usual range after birth, but follow-up remains important because gestational diabetes can increase the risk of developing type 2 diabetes later in life.
Hormonal Cycles
Now that you have a general understanding of what sex hormones do, let us look at how the menstrual cycle may contribute to HS flares. We will use a regular twenty-eight-day cycle as an example. Even if your cycle is different, you may still find useful ideas here for understanding your own patterns.
The Follicular Phase (Days 1-14)
On the first day of menstruation, luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone, and estrogen are at their lowest levels. Testosterone remains relatively stable throughout the cycle, so its effects may be more noticeable on the first day. Soon after bleeding begins, the ovaries start producing more estrogen. Rising estrogen levels trigger the growth of the uterine lining. During the latter part of the follicular phase, estrogen becomes the dominant hormone. Because estrogen supports glucose metabolism, your response to sugar or personal trigger foods may feel different during this phase, although this does not make those foods harmless or guarantee that your HS will remain unchanged
Mid-Cycle Phase: Ovulation
As ovulation approaches, estrogen levels continue to rise, as do LH and FSH, the hormones involved in ovulation. As follicles in the ovaries mature, the ovaries release progesterone as well as estrogen. At this point, you may notice a Hidradenitis Suppurativa flare. Pay attention to how oily your skin feels and whether the appearance of the pores on your nose changes. As progesterone rises, pores may appear smaller, while your face and hair may become oilier. During this phase, progesterone can influence glucose metabolism and insulin signaling. If you eat sugar or one of your personal trigger foods during this phase, you may notice inflammation or a flare, although responses vary from person to person.
The Luteal Phase (Days 15-28)
The luteal phase lasts about fourteen days and makes up the second half of the cycle. Progesterone levels continue to rise, and it becomes the dominant hormone. If you eat sugar or a personal trigger food during this period, you may notice inflammation, but it may be less intense than it would be a few days later. A few days before the end of the cycle, estrogen and progesterone levels fall sharply if pregnancy has not occurred.
This triggers the start of a new menstrual cycle and may also contribute to fluid retention through other hormones, including aldosterone. As bleeding approaches, testosterone's relative influence becomes more noticeable again. For many women, this is the time when flares are most likely. This "high-risk window" may begin in the week before a new period and continue for several days after it starts. You may find it helpful to limit sugar and foods you have personally identified as triggers during this time even though cravings can be intense. Tracking symptoms and food choices can help you identify your own patterns without assuming that every flare has the same cause.
"I Am a Man, I Do Not Have a Period"
Believe it or not, men also experience hormonal rhythms. LH, FSH, testosterone, and estrogen can vary over the course of a day and across seasons. Some studies have reported seasonal variation in testosterone and estrogen levels, while testosterone also follows a daily rhythm and is often highest in the morning. Men also produce progesterone, which contributes to several processes, including electrolyte balance and the regulation of stress hormones. Testosterone levels in men change throughout the day and commonly peak in the morning.
Men may also go through age-related hormonal changes sometimes called andropause, although this is not a direct equivalent of menopause. Unlike the menstrual cycle, there is no established universal male cycle lasting a specific number of weeks, and hormonal patterns vary greatly between individuals. When hormone levels fall outside a healthy range, they may affect inflammation and symptoms. If you suspect a hormonal imbalance, consider discussing androgen testing with a qualified healthcare professional. It may also be useful to ask about insulin sensitivity and other metabolic factors that can interact with hormone health.
Conclusion
I think this is enough for a first overview of how hormones work, at least when it comes to sex hormones.
Hidradenitis Suppurativa may also be influenced by other hormones that we will explore in more detail later, including cortisol and insulin.
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