Hormonal acne in women is most commonly driven by androgen excess (testosterone and DHT), oestrogen dominance, poor hormone detoxification through the liver and gut, gut dysbiosis disrupting the oestrobolome, nutrient deficiencies (particularly zinc, vitamin A, and omega-3s), and elevated insulin. These imbalances cause increased sebum production, inflammation, and disrupted skin cell turnover — resulting in the characteristic breakouts on the chin, jawline, and lower face that worsen around ovulation and before menstruation.

Yes. A naturopath specialising in hormonal acne, like Khianna at Tommi Rose Natural Health, uses gut microbiome testing, nutritional medicine, herbal therapy, and dietary changes to investigate and address the root causes. Rather than suppressing symptoms with topical treatments or the pill, the naturopathic approach identifies why the acne is occurring — whether the driver is gut dysbiosis, androgen excess, poor detoxification, or nutrient deficiency — and addresses it directly. Most clients see meaningful improvement within 8–12 weeks of consistent treatment.

Pre-menstrual acne flares are driven by the hormonal shift in the luteal phase — progesterone rises after ovulation and can stimulate sebaceous glands, while oestrogen drops in the days before menstruation, reducing its anti-inflammatory effects. If androgen levels are elevated or oestrogen detoxification is impaired, these fluctuations are amplified. Gut dysbiosis worsens this by interfering with the oestrobolome — the gut bacteria responsible for regulating oestrogen metabolism and preventing oestrogen from being reactivated and recirculated.

The gut and skin are closely connected through what researchers call the gut-skin axis. An imbalanced gut microbiome drives systemic inflammation that manifests in the skin, and disrupts oestrogen metabolism through the oestrobolome. When gut bacteria are imbalanced, oestrogen is poorly detoxified and recirculated, contributing to hormonal acne. Gut microbiome testing at Tommi Rose Natural Health frequently identifies these imbalances — explaining why skin issues haven't responded to topical treatments alone, and providing a clear target for treatment.

Most women notice initial improvements within 4–6 weeks. Meaningful skin clearing typically occurs within 8–12 weeks as dietary changes and targeted protocols take effect. Because the skin cell cycle runs on approximately 28-day intervals, internal changes take at least one to two full cycles to show up visibly on the skin. Complex or long-standing hormonal acne may require 3–6 months for complete resolution, though improvements are usually visible well before that.

Foods most commonly associated with hormonal acne include high-glycaemic foods (which spike insulin and increase androgen production), conventional dairy (which contains IGF-1 and may stimulate sebum production), processed seed oils (which promote inflammatory pathways in the skin), and alcohol (which impairs liver detoxification of oestrogen). However, food triggers are individual — gut microbiome testing helps identify whether specific dietary factors are driving dysbiosis and inflammation in your particular case.