My Hormonal Acne Journey With Winlevi

My hormonal acne is my longest relationship to date: I’ve been struggling with my skin for more than a decade. To say it’s been a journey would be the understatement of the century. I’ll spare you the details of everything I’ve tried in hopes of curing my skin issues — it’s a long list — but for me, the one-two punch of spironolactone (an oral medication often prescribed to treat women’s hormonal acne) and the birth control pill was the key to having clear, happy skin for years.

However, when I went off both medications while attempting to get pregnant, my acne returned with a vengeance. I cried (a lot), my confidence was at an all-time low, and I piled on layers of ColourPop No Filter Concealer, my go-to for dealing with breakouts.

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Meet the experts:

• Carmen Castilla, MD is a board-certified dermatologist and clinical instructor of dermatology at Mount Sinai in New York City.
• Mohiba Tareen, MD is a board-certified dermatologist in Roseville, Minnesota.
• Kelsey Holmes, MMS, PA-C is a physician’s assistant in Roseville, Minnesota.

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After I got pregnant with my son in 2020, my skin cleared up again; it remained that way until he was about a year old, when it returned to its inflamed, unhappy state with regular cameo appearances from deep, painful cysts on my chin and jawline. Thanks, hormones!

“During pregnancy there is a dramatic increase in estrogen and progesterone levels, [which] for many women helps clear up their skin,” explains Carmen Castilla, MD, a board-certified dermatologist and clinical instructor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. For about the first six months postpartum, women who breastfeed have little fluctuation in hormone levels, but things may shift shortly thereafter as hormones balance out to pre-pregnancy levels. “These fluctuations restart, leading to a recurrence of acne in many cases” — like mine.

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You may be asking, “Kara, why don’t you just go back on the meds?” Because I’m not not trying to get pregnant again. Spironolactone is contraindicated while pregnant because it blocks male hormones, which can interfere with development of genitalia in a male fetus. As for oral contraceptives, well, obviously you can’t be on those if you’re trying to get pregnant. So I went looking for other solutions and discovered a new medication, called Winlevi, which sounded like it might help cure my breakouts in the short term.

In This Story:

• What Is Hormonal Acne? And Why Can It Be So Difficult to Treat?
• What Is Winlevi and How Does It Work?
• My Thoughts on Winlevi

In general, hormonal acne breakouts are cystic pimples that pop up on the lower cheeks, jawline, and upper neck. “Hormonal acne is caused by a sensitivity to fluctuations in hormone levels. Typically this is tied to normal hormonal fluctuations during the menstrual cycle,” explains Dr. Castilla. “However, having this type of acne does not necessarily mean there is a measurable hormone imbalance; it is more often a skin sensitivity to normal hormone level fluctuations.”

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