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Last Updated:
Sep 10th, 2007 - 18:59:21
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Question
Since I started menstruating at age 13, I have always suffered from some amount of acne. Throughout the last four years, however, my acne has become progressively worse. It has also become progressively predictable, occurring faithfully at ovulation and the week before my menses. This is very frustrating, considering that I am almost 24 years old and beyond the time that adolescent acne is supposed to strike, and particularly because the acne is starting to leave scars on my face. I feel rather down about this and have a hard time making myself go out of the house when the acne flares up.
My mother is a certified NFP teacher and an RN, and has suggested that I seek help here rather than go on the BCP, a treatment that both a gynecologist and a dermatologist have suggested, since I also suffer from severe cramping during my menses. For my acne, I have tried a myriad of topical creams and oral antibiotics with little or no success. I have tried taking zinc, omega-3 pills, multi-vitamins, vitamin-B complex pills, daily exercise, cutting out caffeine, and limiting my consumption of white flour, sugar and other processed foods. I have, nevertheless, seen very little improvement.
Can a physician who knows about NFP help me? I prefer not to take the BCP for many reasons, one of them being that the BCP will only hide, not solve my problem. But since this problem truly does diminish my enjoyment of life, I am ready to try just about anything. In addition to this question, I wanted to know if there are any such physicians in France, since I am supposed to start a graduate program in Paris in October, but would still like to start treatment, if at all possible.
Thank you,
Cate
Answer
Dear Cate,
I understand your situation as I experienced the same things at your age. I am guessing that your mother has taught you how to chart your cycles and that they are probably regular in length, however, I would like to know some other parameters about your cycle such as what the post-peak average length is (length of luteal phase) and what the mucus cycle score is (what the quantity and quality of the mucus is.)
This information would tell me more about the hormone levels of estrogen and specifically progesterone. I would suspect that the progesterone levels are not quite what they should be. Many women suffer from Polycystic Ovarian Syndrome with mild to severe symptoms. Some of the hallmarks are acne, hirsuitism, obesity, infertility, hypertension, irregular cycles, and impaired glucose tolerance. These can be present in many combinations or by themselves with varying degrees of severity. The ovaries have multiple cysts on them and result in abnormally low progesterone levels.
It is possible that your progesterone levels are low and help to flare the acne just at the time that the progesterone levels are the most important…during the post peak or luteal phase (right before your period). If the progesterone levels were to be checked and found to be low, you could easily be supplemented with human equivalent progesterone (Prometrium) during the luteal phase. To properly check the progesterone levels, you would need to get a level on peak day +3, peak day +5, peak day +7, peak day + 9, and peak day +11. This is expensive so it could be modified.
Many physicians will get the progesterone level on Day 22 (after the start of your last period). However, the labs results are not standardized to normals on those particular days. Pope Paul VI Institute in Omaha, NE has a lab with standardized levels.
The use of progesterone would help improve your acne. Unfortunately, this information was not available to me when I was your age and I ended up using Accutane twice. There were no problems and it did help a lot, however it would have been nice to have a more specific treatment for the symptoms and underlying disorder.
I hope that this will help you!
Gretchen V. Marsh, D.O.
Dr. Marsh is a family practioner in Yuba City, CA where she lives with her husband and 5 boys.
She is a Creighton model certified Medical Consultant and a certified Fertility Care Practioner.
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