PMOS Acne: Why It Happens and What Actually Helps

Persistent acne can be exhausting, especially when you have followed skincare advice, bought the products and still end up dealing with another painful outbreak. If you have polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), it could be your hormones contributing to your symptoms.

PMOS-related acne can improve with treatment. Depending on your symptoms, that might mean prescription creams, hormonal medications or a combination of both. Understanding what is driving your breakouts helps you and your clinician choose a plan that makes sense for you. 

Why Does PMOS Cause Acne?

PMOS can cause acne because the increased androgen activity stimulates the skin’s oil glands. Androgens are male hormones, including testosterone, that everyone produces, although women usually produce a smaller amount. In some women with PMOS, increased androgen levels cause oily skin and breakouts. However, acne can also develop when hormone levels fall within a normal range.

Your skin's oil glands produce sebum, an oily substance that helps protect your skin. When excess sebum mixes with dead skin cells, it can block your pores. When pores become blocked, a bacterium naturally found on your skin, Cutibacterium acnes, can multiply and break down sebum into fatty acids. Bacterial debris, excess oil, reduced skin cell turnover and the body’s natural immune response can trigger inflammation, resulting in inflamed papules, pustules or deep cysts.*

Insulin resistance can also add to the hormonal processes driving PMOS-related acne. When your cells respond less effectively to insulin, your body produces more to compensate. This can, through the action of the ovaries, also increase sebum production and lead to painful outbreaks.**

What Does PMOS Acne Look Like?

PMOS acne usually affects the lower face, chin and jaw, often presenting as deeper nodules or cyst-like lumps, while some women may have a mix of smaller spots and clogged pores. Acne can also affect your neck, chest and upper back. 

Some of the key characteristics of PMOS acne are: 

• Deep cysts and nodules – unlike puberty-related spots, which are often surface whiteheads or blackheads, PMOS acne usually forms deep, tender or painful cysts under the skin’s surface

• Hormonal distribution – PMOS acne usually presents as a distinct pattern across your lower face, chin, jawline, upper neck and around the mouth

• Flare-ups may occur at certain times – you may notice that breakouts are worse around your period, but if you have irregular cycles, this may be more difficult to track, and they can linger for longer

• Less responsive to over-the-counter treatments – because of the hormonal imbalances driving PMOS acne, it often does not respond to standard over-the-counter treatments

On darker skin, inflamed spots can appear brown or purple rather than bright red. Even after inflammation settles, dark marks can remain on the skin. These are pigmentation changes, but acne can also leave permanent scars, which is one reason to start treatment early. 

How doctors diagnose PMOS acne

A doctor can diagnose PMOS acne by examining your skin and discussing any other symptoms you may have with you. To help them understand whether PMOS is contributing to your breakouts, they may ask you about your periods, hair growth, hair thinning and any medications you are taking. You may also need blood tests to check your hormone levels and how your body manages glucose. 

No single test can confirm PMOS. Instead, it is usually diagnosed when at least 2 of the following apply: 

1. Irregular or absent periods – usually characterised by your ovaries not releasing an egg each month (ovulation)

2. Evidence of high androgen levels – signs may include excess facial or body hair (hirsutism) or thinning hair

3. Polycystic ovaries – an ultrasound scan may show small sacs called follicles developing on the ovaries, or a specific blood test to check your anti-Müllerian hormone (AMH) level, which can also tell you if there are an increased number of follicles on your ovaries

Your doctor may also check for other conditions, such as thyroid problems, that can also cause similar symptoms. 

Key differences between PMOS acne and hormonal acne

PMOS acne differs from typical hormonal acne in several ways. PMOS acne is driven by ongoing androgen activity, which insulin resistance can add to, while typical hormonal acne results from cyclical monthly hormone fluctuations. 

Here are some of the key differences between PMOS acne and hormonal acne:

Other skin signs linked to PMOS

Other skin and hair changes that can help your clinician decide whether PMOS may be causing acne include:

• Hirsutism – coarse, darker hair on areas such as the chin, chest or abdomen

• Hair loss – reduced hair density on your scalp, sometimes with a widening parting

• Acanthosis nigricans – darker, thickened, velvety patches that often occur around the neck or armpits, which can be associated with insulin resistance

• Skin tags – small, soft growths that are common in PMOS, but cannot be used to diagnose the condition on their own

How Is PMOS Acne Treated?

Treatment for PMOS acne usually targets the underlying hormonal imbalances that drive increased androgen levels, such as combined oral contraceptive pills and spironolactone, and metformin for insulin resistance, if it also affects you. Your doctor will need to consider factors such as the severity of your symptoms, scarring, previous treatments and whether you want to get pregnant. They may also suggest topical treatments alongside hormonal and medical options. The evidence for supplements is limited, but lifestyle changes can also help. 

Hormonal and medical treatments

Several hormonal and medical treatments are available for managing PMOS acne. These target the hormonal causes of your outbreaks, such as increased androgens and insulin resistance. Oral prescription retinoids may be offered if previous treatments haven’t worked or hormonal options are not suitable for you.

Combined contraceptive pill

The combined oral contraceptive pill can help manage PMOS-related acne by regulating your hormone levels. It works by delivering oestrogen and an anti-androgenic progestogen, such as drospirenone, dienogest or norgestimate, to reduce the amount of circulating androgens in your bloodstream and lower sebum production.*

The combined pill is not suitable for everyone, especially if you are also looking to get pregnant, as it is a birth control method. It’s not always suitable for you if you have a family history of blood clots, have ever had a migraine with aura or if you smoke. However, if you are getting PMOS acne alongside irregular periods, are looking for contraception and meet the prescribing criteria, the combined pill may be a suitable treatment option for you. 

Spironolactone

Spironolactone is an oral pill that is prescribed off-label in the UK to treat hormonal and cystic acne. It may be given for PMOS acne if the combined pill has not worked for you or you cannot take it. Spironolactone works by blocking the effects of androgens, which can help manage PMOS acne breakouts. Contraceptive cover is recommended whilst taking spironolactone due to this anti-androgen effect.

A small study found that spironolactone improved PMOS acne in 25% of women with a lower BMI and 75% of women with a higher BMI affected by PMOS acne.* A meta-analysis involving 563 women with acne found that spironolactone improved acne sixfold compared to a placebo.** Spironolactone helps to control PMOS-related acne breakouts, but it does not cure it, which means it can come back once you stop taking it.

Metformin

If insulin resistance is identified as a driver of PMOS acne, then your doctor may prescribe metformin to reduce glucose production in your liver and improve how your muscles and tissues respond to insulin. Although metformin is not prescribed solely for acne, its benefits for improving insulin sensitivity may help to promote clearer skin.

Isotretinoin

Isotretinoin is a powerful prescription-only retinoid, a derivative of vitamin A, used to treat severe cystic acne that has not responded to other treatments. It is prescribed by a specialist consultant for severe, resistant acne. You must use contraception while taking isotretinoin if you could get pregnant because it can cause serious problems with your baby’s development. You must start using contraception at least 1 month before you start taking isotretinoin and continue using it for at least 1 month after you stop taking isotretinoin. 

Research suggests that isotretinoin on its own can be effective for PMOS patients who also have acne and are not able to take the combined pill.* A further study also found that isotretinoin significantly reduced global acne scores in women with PMOS acne.**

Topical and skincare treatments

Topical acne treatments act directly on processes within the skin that may cause breakouts, such as bacteria, reduced skin cell turnover and inflammation. They can improve PMOS-related acne in some people even though they do not change ovarian hormone production.

Some of the topical acne treatments available include:

Some prescription treatments combine two active ingredients, such as adapalene and benzoyl peroxide. These combinations can treat acne more effectively than either ingredient used alone.*  Your pharmacist or clinician can help you choose the best options for you without overloading your skin. Topical retinoids should not be used during pregnancy or when planning pregnancy. Ask for advice before starting treatment if you are pregnant, trying to conceive or breastfeeding.

Alongside topical treatment, a simple skincare routine can help reduce spots by removing dead skin cells and preventing clogged pores, which can cause inflammation. Some of the things you can do include:

• Use a gentle cleanser, non-comedogenic moisturiser and sunscreen daily to cleanse, hydrate and protect your skin 

• Avoid picking or squeezing spots, which can cause them to spread or scarring

• Avoid harsh scrubs and using several strong products at once because irritation is not proof that treatment is working

Supplements

The evidence for the use of supplements for PMOS acne is limited, but some of the potential options include:

• Myo-inositol – some research has shown that myo-inositol is effective for acne in pregnant women with metabolic or high androgen activity* and can improve the metabolic profile in women with PMOS by reducing circulating androgen levels⁺

• Vitamin D – research suggests that vitamin D supplementation in women with PMOS can improve menstrual periods and reduce androgen levels, which could improve acne symptoms⁺⁺⁺

• Omega-3 – may improve PMOS acne by reducing insulin resistanceᵛ

• Zinc – some research shows that zinc may improve insulin sensitivity, which may improve PMOS acne,ˣ but specific research is limited

Before taking any new supplements, you should check with a doctor or pharmacist that they are suitable for you to take, especially if you take any other medications.

Lifestyle and diet

Lifestyle changes can support your metabolic health and improve your skin's appearance, but no single diet is proven best for PMOS. 

A Mediterranean-style approach offers a practical starting point and focuses on vegetables, fruit, wholegrains, beans, nuts, fish and unsaturated fats. Choosing higher-fibre, lower-glycaemic-index (GI) carbohydrates can also help moderate blood glucose rises after a meal.

Regular movement, adequate sleep and proper stress management can fit alongside medical care. Start with changes that suit your circumstances and symptoms.

How Long Does PMOS Acne Treatment Take to Work?

Treating PMOS acne is a long-term commitment, and you're unlikely to notice improvements in your skin’s appearance overnight. Topical treatment can take 6 to 8 weeks to work before you notice results. Hormonal options, like the combined pill and spironolactone, can take 3 to 6 months to work.* So, if your skin hasn’t improved within a few weeks, it doesn’t necessarily mean that the treatment isn’t working. You probably just need more time. 

It’s worth staying on a treatment for as long as your clinician recommends it, because switching too soon can delay your response, especially since you’ll need to start over when you switch treatments. If you haven’t noticed any improvements in your symptoms within 3 months of starting treatment, speak to your clinician for advice.

You can help to monitor your skin’s response by:

• Taking photos of your skin in similar lighting every week, looking for things like fewer new spots, less tenderness and faster healing

• Keeping to agreed review appointments with your clinician to discuss your progress and response

Important: Contact a doctor as soon as possible if you get side effects, worsening painful acne or new scarring when taking a PMOS acne treatment. For signs of a serious reaction, call 111 or 999.

PMOS Acne: The Bottom Line

PMOS can cause acne because of increased androgen activity, with insulin resistance sometimes adding to the picture. However, neither jawline spots nor stubborn breakouts can diagnose the condition, so see a clinician to get the right treatment.

Effective care for acne caused by PMOS considers your skin, other symptoms and priorities at once and may involve topical treatments, hormonal medications, lifestyle changes, or specialist referral.

If acne keeps returning, see your GP for a review. You deserve a treatment plan that takes both the physical discomfort and the emotional impact seriously.

FAQs

Does testosterone cause acne?

Yes. Higher testosterone levels can contribute to acne by increasing oil production in your skin. However, acne can also occur within the normal range because skin sensitivity varies. A blood test alone cannot explain every breakout, and acne does not automatically mean your testosterone is high.

Why is PMOS acne so hard to treat compared to regular acne?

PMOS acne is harder to treat than regular acne because it stems from systemic hormone and metabolic imbalances rather than surface oil or bacteria. PMOS-related acne often doesn't respond to topical or over-the-counter treatments, so treating the underlying causes matters too. This often includes hormonal treatments to reduce androgen activity or medications, such as metformin, to improve your blood sugar levels

Can diet alone clear PMOS acne? 

No. Diet alone cannot effectively clear PMOS acne, but changing what you eat can improve or manage your symptoms. For example, a low-glycaemic-index or Mediterranean-style diet that prioritises fruit, vegetables, wholegrains, fish and lean meat can help manage acne alongside medical treatments.  

Does losing weight help PMOS acne?

It depends. Where appropriate, weight management may improve metabolic health and some hormonal features of PMOS, with research showing that even a modest loss of 5% can improve cycle regularity, ovulation and insulin sensitivity.* Whether that translates into clearer skin varies, and weight loss doesn't guarantee acne improvement. PMOS also affects women at lower weights. 

Is PMOS acne the same as teenage acne?

No. Although they can look similar, PMOS acne and teenage acne have different causes, locations and treatment needs. Teenage acne occurs because hormonal surges during puberty temporarily increase oil production, leading to breakouts across the face, chest and back. PMOS acne results from excess androgen production, sometimes with insulin resistance, which cause the skin’s oil glands to overproduce sebum.