The development of hormonal irregularities in the menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts. In addition, many have a history of menstrual irregularities, premenstrual acne flare-up, and facial oiliness. Most acne treatments require prolonged care, from months to years. Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause.
Many oral contraceptives are effective.
It is common to start with oral contraceptives for one to two months. Sometimes just regulating the menstrual cycle is enough to stop the acne. Often women are already on birth control pills, so we add antiandrogens. The hormonal approach is becoming more mainstream, and it is not uncommon to use the two hormones together. Spironolactone is a medication used primarily for the treatment of high blood pressure.