Does endometriosis cause acne?

Endometriosis (‘endo’) is often named as a cause of acne in adult women. Here, we look at what the science actually says.

What endometriosis is

Endometriosis is a condition where cells similar to those lining the uterus grow elsewhere in the body, most often in the pelvis. They develop their own blood supply, and their presence causes inflammation. For some women this means chronic pain, heavy periods, scarring and fertility problems. Anyone who has lived with it knows how debilitating it can be.

Around 1 in 10 women of reproductive age has endometriosis. We don’t fully understand why it happens, but genetics play a part: the risk is six times higher if a close relative has it. Management can involve hormonal medicines, anti-inflammatories or surgery, and it can be a long road.

Does it affect skin?

We don’t really know. Studies have found links between endometriosis and some skin conditions, but it seems unlikely that endometriosis causes them.

The best-known link is with acne. Severe teenage acne is more common in people who have endometriosis, either at the time or diagnosed later. This is often summed up as ‘hormonal imbalance in endo drives acne’, but the science says otherwise.

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Why the two are linked

Acne is driven by androgens (often called male hormones). They boost oil production, cause cells to build up in hair follicles, and set the scene for pimples. Endometriosis doesn’t raise androgen levels, so it shouldn’t drive acne this way.

Another theory is that oestrogen or progesterone play a role. But that doesn’t hold up either. Adding these hormones, for example in the combined contraceptive pill, generally improves acne rather than worsening it. And not all endometriosis raises oestrogen levels.

The more likely explanation is genetic. Genes linked to endometriosis and to acne sit extremely close together on the same chromosome (8q24, for fellow science nerds). A small variation in one tends to travel with a variation in the other, something geneticists call ‘linkage disequilibrium’. A landmark 2014 study by Xie and colleagues found this to be the most likely reason acne is more common in people with endometriosis.

Endometriosis probably doesn’t cause acne, or the other way round. The two are more likely to occur together because of shared genetics.

Endometriosis has also been linked with sun sensitivity, more freckles and moles, and possibly a higher risk of melanoma, although the evidence for melanoma is weak. Again, shared genetics is the likely reason.

What this means for you

If you have endometriosis, you’re more likely to have acne too. Unlike some other gynaecological conditions, such as polycystic ovary syndrome, managing endometriosis isn’t expected to improve acne. The good news is that acne can be managed in its own right, with evidence-based care and a doctor who looks at your whole health picture.

References

1. Xie J, Kvaskoff M, Li Y, et al. Severe teenage acne and risk of endometriosis. Hum Reprod. 2014;29(11):2592-9.
2. Farland LV, Lorrain S, Missmer SA, et al. Endometriosis and the risk of skin cancer: a prospective cohort study. Cancer Causes Control. 2017;28(10):1011-19.
3. Kvaskoff M, Han J, Qureshi AA, Missmer SA. Pigmentary traits, family history of melanoma and the risk of endometriosis: a cohort study of US women. Int J Epidemiol. 2014;43(1):255-63.
4. Kvaskoff M, Mesrine S, Fournier A, et al. Personal history of endometriosis and risk of cutaneous melanoma in a large prospective cohort of French women. Arch Intern Med. 2007;167(19):2061-5.
5. Somigliana E, Viganò P, Parazzini F, et al. Association between endometriosis and cancer: a comprehensive review and a critical analysis of clinical and epidemiological evidence. Gynecol Oncol. 2006;101(2):331-41.
6. Somigliana E, Viganò P, Abbiati A, et al. ‘Here comes the sun’: pigmentary traits and sun habits in women with endometriosis. Hum Reprod. 2010;25(3):728-33.
7. Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. JAMA. 2021;326(24):2507-18.
8. Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2012;(3):CD002122.
9. Hu T, Wei Z, Ju Q, Chen X. Sex hormones and acne: state of the art. J Dtsch Dermatol Ges. 2021;19(4):509-15.
10. Clayton RW, Langan EA, Ansell DM, et al. Neuroendocrinology and neurobiology of sebaceous glands. Biol Rev Camb Philos Soc. 2020;95(3):592-624.

This article is general information only. It isn’t a substitute for personal medical advice, so speak with a health professional about your own skin.