How Hormones Affect HS and What You Can Do About It

Hidradenitis Suppurativa (HS) is a complex and chronic skin condition that causes painful lumps, abscesses, and scarring, often in areas where skin rubs together—like the armpits, groin, and under the breasts. While the exact cause of HS isn’t fully understood, one thing is clear: hormones play a significant role in how and when HS symptoms appear, worsen, or improve.

Many people living with HS first notice symptoms around puberty, a time of major hormonal shifts. Others find their flare-ups worsen during menstruation, pregnancy, or menopause—again, all periods of hormonal fluctuation. Even stress, which can impact hormone levels like cortisol, may trigger flare-ups or make them more intense. These patterns point to a strong link between hormonal health and HS symptoms.

For women and people assigned female at birth, the condition often follows a cycle that seems to coincide with their monthly periods. Some may experience more painful or numerous lesions just before menstruation, likely due to increased levels of androgens (a group of hormones including testosterone). During pregnancy, HS may improve for some individuals while worsening for others, depending on how their hormones shift. And for those reaching menopause, some find long-awaited relief, while others continue to struggle.

Understanding the connection between hormones and HS can help you gain more control over your symptoms and work with your doctor to find treatments that work best for your body. Whether you’re dealing with monthly flares or considering hormonal therapy, knowing what’s happening behind the scenes empowers you to make informed choices.

In this article, we’ll explore:

The hormonal factors that may influence HS
How hormonal changes at different life stages affect the condition
Treatment options that target hormonal imbalances
Practical tips for managing hormone-related flares

Hormones may not be something you can control completely—but with the right knowledge and care plan, you can learn to manage their impact on your HS more effectively.

The Hormonal Factors That May Influence HS

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with deep roots in the body’s immune and hormonal systems. While the exact cause of HS remains unknown, researchers and medical professionals agree that hormones—particularly androgens—play a key role in triggering and worsening the disease. Understanding these hormonal influences can give patients valuable insight into when and why their flare-ups happen, and how treatment might be tailored to help.

Androgens are a group of hormones that include testosterone and other male sex hormones (though they are present in all genders). These hormones influence the function of hair follicles and oil glands, both of which are central to the development of HS. When androgen levels are elevated or fluctuate significantly, it can lead to increased oil production, follicular blockages, and inflammation—key features in HS flare-ups.

Additionally, hormonal imbalances such as polycystic ovary syndrome (PCOS)—which involves elevated levels of androgens—are often linked with more severe HS symptoms. People with HS and PCOS may experience more frequent or intense breakouts, particularly around the menstrual cycle, due to hormonal instability. This link is further supported by the observation that anti-androgen therapies, like spironolactone, can be helpful for managing HS symptoms in some patients, especially those assigned female at birth.

Another hormonal influence is insulin resistance, which is often tied to metabolic syndromes and obesity. Insulin resistance can contribute to higher androgen levels and inflammation throughout the body. Since HS is also an inflammatory condition, the presence of both insulin resistance and hormonal imbalance can lead to a “perfect storm” of symptom severity.

In short, hormones don’t act alone—but when combined with genetic predisposition, immune system irregularities, and other environmental triggers, they can significantly contribute to the onset and course of HS.

How Hormonal Changes at Different Life Stages Affect HS

Hormonal fluctuations happen naturally across a person’s life, especially for women and people assigned female at birth. These changes often align with the timing and severity of HS symptoms. From puberty to menopause, understanding how hormones affect HS at each stage can help patients and providers take more proactive and personalized approaches to care.

Puberty and HS Onset

For many people, HS first appears during puberty, when the body experiences a sharp increase in androgen production. These hormones are responsible for triggering the development of secondary sexual characteristics—like body hair and oilier skin—but they also increase the activity of sebaceous (oil) glands and can lead to clogged hair follicles.

During this time, teens may notice:

Painful lumps under the arms or around the groin
Small blackheads or boils that recur
Unexplained cysts that eventually drain or scar

Because these symptoms often mimic acne or ingrown hairs, HS may go undiagnosed for years. However, the link between hormonal changes and the appearance of HS is strong, and early intervention during puberty can help reduce long-term damage to the skin.

Menstrual Cycle-Related Flare-Ups

In individuals who menstruate, HS symptoms often flare cyclically, usually just before or during their period. This is due to the natural drop in estrogen and rise in progesterone and androgens during the luteal phase of the menstrual cycle.

Common symptoms include:

Increased inflammation in existing HS areas
Development of new lesions or nodules
More drainage, pain, or fatigue during flares

These cycle-related flares can be particularly frustrating because they are predictable yet hard to prevent. Some patients find relief through hormonal birth control, which helps stabilize hormone levels throughout the month and reduce premenstrual flares. Options like combination oral contraceptives or intrauterine devices (IUDs) may be explored under the guidance of a gynecologist or dermatologist.

Pregnancy and HS

Pregnancy brings about one of the most dramatic hormonal shifts in a person’s life. For those living with HS, the effects of pregnancy on symptoms can be unpredictable. Some individuals report improvement in their HS during pregnancy, especially in the second and third trimesters, likely due to high levels of progesterone and estrogen. Others, however, experience increased flare-ups, often during the first trimester when the body is still adjusting to rapid hormonal changes.

Factors that may influence HS during pregnancy include:

Increased skin friction from weight gain
Higher levels of sweating and body heat
Immune system changes designed to protect the fetus

Managing HS during pregnancy often requires careful coordination between obstetricians and dermatologists, as many medications are contraindicated during pregnancy. However, gentle topical treatments, hygiene routines, and lifestyle adjustments can help control symptoms during this sensitive time.

Postpartum Period

After childbirth, hormone levels shift rapidly again. Estrogen and progesterone levels drop significantly in the days and weeks following delivery, which can lead to a return of HS symptoms—especially if symptoms had improved during pregnancy.

Many individuals experience postpartum flares as their body adjusts to breastfeeding, fatigue, and emotional changes. Wound care becomes more challenging if lesions develop near the breasts or underarms, and sleep deprivation can increase inflammation throughout the body.

Breastfeeding also presents unique challenges. Some medications may pass into breast milk and need to be paused or changed. That’s why it’s essential to work with a provider to adjust treatments safely during this time.

Perimenopause and Menopause

As individuals enter perimenopause—the transition period leading up to menopause—hormone levels fluctuate erratically. Estrogen begins to decline, and the balance between androgens and estrogens may shift, potentially impacting HS symptoms.

Some people find that their HS worsens during perimenopause due to this imbalance. Others may notice symptoms begin to stabilize or improve as hormone levels fall and menstrual cycles end.

During menopause, when menstruation stops completely, some patients report long-term relief from hormone-related flares. However, this isn’t guaranteed, and postmenopausal HS can still be influenced by weight, insulin resistance, and other chronic conditions.

Treatments for managing hormonal imbalances during menopause—such as hormone replacement therapy (HRT)—must be approached cautiously, as they may affect HS differently for each person.

Hormonal Treatments for HS

Given the strong connection between hormones and HS, it’s not surprising that several treatments aim to address hormonal causes directly. These include:

Spironolactone: A medication that blocks androgen receptors and reduces oil production. It’s commonly prescribed to women with hormonally driven HS and acne.
Oral contraceptives: Combination birth control pills can regulate hormonal fluctuations and reduce flare frequency.
Metformin: While originally developed for diabetes, this medication improves insulin sensitivity and may help reduce androgen levels, especially in patients with PCOS.
Finasteride: Sometimes used off-label for HS in men, finasteride reduces the conversion of testosterone into a more potent form, potentially lowering HS activity.

Each of these treatments carries its own risks and benefits, and not every option is suitable for all individuals. A provider who understands both HS and hormonal health can help guide treatment selection.

In Summary

Hormones play a critical role in the onset, progression, and management of Hidradenitis Suppurativa. From puberty through menopause, fluctuations in androgens, estrogen, and progesterone can significantly affect the frequency and intensity of HS flares. Whether you’re experiencing cycle-related symptoms, managing pregnancy with HS, or noticing changes during menopause, understanding these hormonal influences is key to effective care.

By working with healthcare professionals who specialize in dermatology, gynecology, or endocrinology, patients can explore targeted treatment options that address the hormonal roots of their condition. With knowledge, support, and personalized care, it’s possible to reduce flare-ups and improve quality of life—no matter what hormonal stage of life you’re in.

Treatment Options That Target Hormonal Imbalances

Because hormones—particularly androgens—play a significant role in triggering and aggravating Hidradenitis Suppurativa (HS), many treatment strategies aim to reduce hormonal activity or stabilize fluctuations. While these approaches may not work for everyone, they can be highly effective for those whose flares are clearly tied to their menstrual cycle, PCOS, pregnancy, or other hormonal shifts.

It’s important to remember that hormonal treatment is just one piece of the HS puzzle. A complete care plan often includes wound management, lifestyle changes, and emotional support. Still, targeting the root hormonal contributors can reduce the severity and frequency of flares and improve long-term outcomes.

1. Spironolactone

Spironolactone is one of the most commonly prescribed medications for hormonally influenced HS, particularly in women and people assigned female at birth. It is a potassium-sparing diuretic that also functions as an androgen blocker. By reducing the effects of male hormones like testosterone, spironolactone can help decrease the oil production and follicular blockages that lead to HS lesions.

How it works: Spironolactone binds to androgen receptors, preventing testosterone from acting on oil glands and hair follicles. This can lead to fewer and less severe HS lesions over time.

Who it’s for: Typically prescribed for women of reproductive age who have hormone-related HS, acne, or PCOS. It is not commonly prescribed to men due to the risk of feminizing side effects, such as breast tenderness or reduced libido.

Considerations: Spironolactone is generally well-tolerated but may cause side effects like frequent urination, fatigue, or changes in potassium levels. It should not be used during pregnancy.

2. Hormonal Birth Control

Oral contraceptives (birth control pills) are frequently used to regulate hormonal fluctuations that worsen HS in menstruating individuals. The most effective types are combination pills containing both estrogen and progestin, which help stabilize monthly hormone levels and reduce androgen activity.

How it works: By providing steady hormone levels throughout the cycle, birth control pills prevent the hormone surges that trigger flare-ups before menstruation.

Who it’s for: Menstruating individuals who experience cycle-related HS flares or have coexisting PCOS.

Considerations: Some birth control pills can worsen HS if they contain certain types of progestin. A dermatologist or gynecologist may need to try different formulations to find one that works best for your body.

Other forms of hormonal contraception, like the hormonal IUD or birth control shot (Depo-Provera), may also help but affect individuals differently. Always discuss options and potential side effects with a healthcare provider.

3. Metformin

Originally developed for type 2 diabetes, metformin improves insulin sensitivity and has shown benefits for people with PCOS and hormonally driven HS. Because insulin resistance can contribute to high androgen levels, metformin indirectly helps reduce hormonal acne and HS flares.

How it works: Metformin lowers blood sugar and insulin levels, which can reduce androgen production by the ovaries. In turn, this may reduce HS severity in patients with PCOS or metabolic syndrome.

Who it’s for: Often prescribed to women with HS who also have PCOS or insulin resistance.

Considerations: Metformin is generally safe and inexpensive but may cause gastrointestinal side effects such as nausea or diarrhea. It requires a prescription and medical supervision.

4. Finasteride (and Dutasteride)

Finasteride is a medication that inhibits the conversion of testosterone into dihydrotestosterone (DHT), a more potent androgen that can worsen HS. While less commonly prescribed for HS, it may benefit individuals with severe hormone-driven symptoms, particularly men.

How it works: Blocks the enzyme 5-alpha reductase, reducing DHT levels in the body.

Who it’s for: Typically used in men with HS, though sometimes prescribed off-label for women in specific cases.

Considerations: Finasteride can cause sexual side effects and is not safe for use during pregnancy. It may take several months to see results.

5. Lifestyle and Natural Hormone Management

While not a substitute for medication in moderate to severe HS cases, lifestyle changes can support hormonal balance and improve symptom control.

Weight management: Reducing body fat can lower androgen levels and insulin resistance.
Exercise: Regular physical activity helps regulate hormones and reduce inflammation.
Diet: Anti-inflammatory foods (rich in fiber, omega-3s, and antioxidants) support hormonal health.
Sleep: Getting enough rest helps balance cortisol and reproductive hormones.
Stress management: Chronic stress increases cortisol and disrupts hormonal regulation. Mindfulness, deep breathing, and therapy can help.

Practical Tips for Managing Hormone-Related Flares

Whether you’re already on hormonal treatment or looking for ways to improve your day-to-day experience, these practical strategies can help you manage flares linked to your cycle or other hormonal changes.

1. Track Your Symptoms

Start a symptom journal or use an app to monitor flare patterns. Note:

When flares happen in relation to your menstrual cycle
What triggers seem to be involved (stress, heat, diet, etc.)
Severity and location of lesions

Tracking allows you to anticipate flares, identify hormonal patterns, and have more productive conversations with your healthcare provider.

2. Plan Ahead for Your Period

If you notice flares before your period, plan to minimize discomfort during that window. You might:

Use topical treatments preemptively in trouble spots
Wear soft, moisture-wicking clothing
Avoid shaving or waxing during high-risk times
Use anti-chafing products like zinc oxide or barrier creams

Have a “flare kit” ready with bandages, cleansing wipes, pain relievers, and any medications you might need.

3. Adjust Skincare Around Hormonal Shifts

Hormonal changes can affect your skin’s oil production and sensitivity. During flare-prone times:

Use gentle, non-comedogenic cleansers
Avoid harsh scrubs or exfoliants
Keep the area dry and clean with mild antiseptics
Apply warm compresses to early lesions to encourage drainage

Stick with consistent skincare, but don’t be afraid to adjust your routine during specific parts of your cycle.

4. Support Hormonal Health Through Nutrition

While no one diet cures HS, certain foods may help stabilize hormone levels and reduce inflammation.

Helpful foods include:

Leafy greens, berries, and cruciferous vegetables
Whole grains and legumes
Fatty fish (like salmon) for omega-3s
Seeds like flax and chia (support estrogen metabolism)

Foods to limit:

Dairy (in some individuals, it increases IGF-1, which stimulates androgens)
Sugar and processed carbs (they increase insulin and inflammation)
Fried or overly processed foods

Working with a nutritionist or dietitian can help create a supportive plan tailored to your needs.

5. Don’t Underestimate the Power of Rest and Stress Relief

Stress alters hormonal balance, increases cortisol, and can indirectly trigger flares. When dealing with hormone-related HS, it’s essential to manage stress proactively.

Consider:

Yoga or gentle stretching
Guided meditation or breathwork
Journaling
Talking to a therapist or support group

Prioritize sleep as well—your body restores hormonal balance during deep rest, and poor sleep increases inflammation and insulin resistance.

6. Reevaluate Treatments as Hormones Change

Your hormonal needs evolve over time—what works during your 20s may need to be adjusted in your 30s, during pregnancy, or after menopause. If you notice:

New patterns of flares
Increased sensitivity to treatments
Worsening skin despite stable routines

…it may be time to revisit your care plan. Talk to your doctor about changing birth control, exploring hormonal therapies, or trying new lifestyle approaches.

7. Surround Yourself With Support

Hormonal health and HS can both feel isolating—especially when others don’t understand what you’re going through. Join online HS communities, talk with others who experience hormone-related flares, or bring a trusted friend or partner into your care process.

Just knowing you’re not alone can make a major difference in managing the emotional weight of HS.

In Summary

Hormonal imbalances are a key trigger in many cases of Hidradenitis Suppurativa. Whether it’s puberty, menstruation, pregnancy, or menopause, shifts in estrogen, progesterone, testosterone, and insulin can influence the frequency and severity of flares.

Fortunately, a wide range of treatments—including spironolactone, hormonal birth control, and lifestyle changes—are available to target hormonal causes directly. By combining medical therapy with symptom tracking, nutrition, and stress reduction, many people find they can reduce hormone-related flares and improve quality of life.

HS may not be entirely controllable—but understanding the hormonal link gives you a powerful tool to manage it with more clarity, strategy, and confidence.

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