Hidradenitis suppurtiva (HS), also known as acne inversa, is an inflammatory skin disease that is more common in women than in men. It primarily affects women of childbearing age or people who have menstrual cycles. HS rarely occurs after menopause.

Different health and lifestyle factors can affect HS symptoms. Some people’s HS symptoms worsen around the time of their menstrual periods. Although not everyone will have this experience, menstrual periods are considered a risk factor for the aggravation of HS symptoms, along with other health and lifestyle factors like exercise, obesity, and stress.

Research suggests that somewhere from 43 percent to 77 percent of people experience a worsening in HS symptoms around the time of their menstrual period. Some myHSteam members comment about HS symptoms during their period:

“I find that my HS flares up just before a period,” wrote one myHSteam member. Another member said, “I’m back to flaring in all areas again during and now after my menstrual cycle. It’s a never-ending cycle.”

HS symptoms like painful bumps, cysts, and lesions, and the location of these symptoms — in the armpits, buttocks, genitals, groin, and breasts — can greatly affect one’s quality of life. Because there is no definite cause or cure for the skin condition, doctors and scientists aim to understand how factors like menstrual periods cause or contribute to HS flares. They aren’t completely sure why some individuals experience worse HS symptoms before and/or during menses.

According to the American Academy of Dermatology, one idea is that sex hormones — which vary before menstruation — may affect HS symptoms. Some doctors believe this theory and suggest using hormonal therapies like oral contraceptives. However, more research is needed to understand the association between menstrual periods, HS symptoms, and flares.

Menstrual Periods and HS

Many people with HS have reported that their symptoms are worse during their menstrual period. Some experience a worsening of HS symptoms the week before.

“My HS is always worse one week before my menstrual period, and I get really sore,” wrote a member of myHSteam.

Menstrual periods have been shown to affect HS symptoms in several different ways.

Worsens HS Overall

HS symptoms overall become worse before or during the menstrual period. A research study published in the International Journal of Women’s Dermatology used surveys to ask women with HS about their symptoms during menstruation. The study found that 77 percent of the women surveyed experienced worse HS symptoms during their period.

A different survey found that 63 percent of women with HS reported worse symptoms during menstruation. Many members on myHSteam echo these findings. One member wrote, “My HS symptoms get worse with my period.” “Ovulation is when I’m at my worst!” noted another member.

As HS symptoms and their location on the body can vary from person to person, so can the effect of menstrual periods on HS symptoms. For some, menstrual periods may worsen HS disease severity overall. For others, their period may cause an increase in specific symptoms like pain. “My underarms have been flaring up a lot lately, and I’ve been in a lot of pain. It usually gets worse when my menstrual is here,” wrote a myHSteam member.

Triggers HS Outbreaks

Another experience many have reported is an outbreak or increase in the number of HS lumps and boils right before their menstrual cycle. A member of myHSteam wrote, “I notice the number of boils increases with my cycle.” Another wrote, “I have been having a lot more outbreaks lately. Do any of you women notice more during your period? I break out so badly with mine.”

In a research study, 87 percent of women said that their HS flares occurred always or often with their menstrual period. About 79 percent of women said that the HS flare occurred the week before their menstrual period.

Other Related Factors

There are some other interesting findings that are worth noting from research surveys about factors related to menstrual periods and HS symptoms. One study found that women with menstrual HS flares had higher rates of menstrual acne flares, as compared to women who did not have menstrual HS flares. In general, HS is associated with severe acne. A connection between menstrual HS flares and menstrual acne flares needs to be further researched.

Another interesting finding about menstrual HS flares is that they may be more likely in people with a family history of HS. A research study found that 50 percent of women with a family history of HS had menstrual-related HS flares. Only 28 percent of women without a family history of HS experienced menstrual-related HS flares.

Why Menstrual Periods Affect HS

Women mostly experience HS during their menstrual cycles, and menstrual cycles affect HS symptoms for many. For these reasons, scientists have suggested that sex hormones (estrogen and progesterone) might influence HS. Many doctors and scientists believe that hormones might play a role in the development of HS and also the relationship between menstrual periods and HS.

Although it’s suggested that hormones have something to do with HS, the specifics are not well understood. More research on the topic is needed, and you can read more about hormones and HS flares.

How To Manage Menstrual-related HS Symptoms

There are many medications and procedures used to manage HS symptoms. For HS symptoms that worsen with your menstrual period, a doctor may recommend the same therapies used to treat regular HS. Or, they may have you test out medications that influence the menstrual cycle and sex hormones. For example, your doctor may have you try birth control pills or anti-androgens like spironolactone (Aldactone).

Be sure to tell your doctor about the details of your HS symptoms, including if they get worse with your menstrual period. Disclosing all of the details about your HS symptoms will help your doctor to find the best treatment option for you.

Some members of myHSteam have offered suggestions for managing menstrual-related HS symptoms:

• “My doctor and I decided to try low-dose estrogen, and it has really worked wonders. I start taking it when I’m premenstrual, and it zaps whatever flare-up was about to happen.”
• “I went on the Depo-Provera shot and it helped so much! Not having periods seems to really help.”
• “I am currently using Mama Au Soothing Honey Salve to help. It is very soothing and helps my lesions to drain sooner than they usually would. I also use natural deodorant. While I still have lesions or boils, I am not in pain — which is tolerable for me.”
• “Several months and around my period is when my HS breaks out the worst. I just started using EmuaidMax ointment.”

Not all treatment options will work the same for everyone. Talk to your dermatologist about finding the right treatment for you.

Find Your Team

A great way to deal with the effects of menses on HS is by talking to others — especially those who may understand what you’re going through.

On myHSteam, the social network for people with HS and their loved ones, more than 24,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Do your HS symptoms get worse with your menstrual period? Share your experience in the comments below, or start a conversation by posting on your Activities page.