Acne and Severe PMS reversed with Functional Medicine


Acne is most prevalent in teenage years, and when it continues into adulthood it can cause can cause much ongoing distress. In addition to permanent scarring and disfigurement, acne has long-lasting psychosocial effects that affect quality of life.

Acne often presents in rhythm with menstrual cycles, particularly before the onset of menstruation in combination premenstrual syndrome (PMS), indicating hormonal involvement.

There are many natural approaches to consider that have been shown to be effective for helping women resolve their acne and PMS, but are not always understood by primary healthcare practitioners where topical drugs, antibiotics or the pill are the current medical treatments.


BA was 33 years old and working as a solicitor when she came to see me saying:

She said:

“Since the age of 13 I have been suffering from what I think is cystic acne. At that age, once every 6 months or so, I would get one massive spot on my face. As the years have progressed, this has become much more frequent and appear to be more prevalent on my cheeks and jawline. Now, about 10 days before my period, massive cysts develop under my skin. Sometimes they are solid and other times they pop. It causes me severe anxiety and has had had an affect on my mood, social life and confidence.

I’ve been taking antibiotics every other month for the last 4-5 years but they’re not helping.

I also find that 7-10 days before my period I go completely bonkers – my mood, tolerance and anger levels are beyond my control. I feel out of control and unable to deal with my emotions rationally. As soon as my period starts, I have a sense of relief. This is having a negative impact on my husband and my children. I am struggling with my relationships.”

Health history

  • Cystic acne started a 13
  • She was prescribed Lymacyline (a tetracyline antibiotic), Clamidamice (an antibiotic which is given to treat serious bacterial infections), Roaccutane (a vitamin A derivative with multiple side effects), and Yazmin (a contraceptive pill). None of these were effective and her acne was getting progressively worse.
  • 20: began a stressful career and started feeling anxiety, low patience, irritability, feeling angry, emotional and tearful. She had bouts of severe mood swings and uncontrollable anger.
  • Her periods were very heavy in the first 2 days and then flow was normal.
  • Painful periods
  • Ovulation was painful
  • She experience bloating after carbohydrates.

Nutrition history

  • BA’s diet was high in sugar and carbohydrates, and she frequently had sugar cravings, especially on her period.
  • Her nutrition was was low on protein and water
  • She ate dairy 2-3 times a month.

Significant test results

Vitamin DSevere deficiencyLow immune function
Oestrogen too high
CreatinineLowImpaired methylation and liver detoxification of oestrogen
BilirubinHighImpaired liver function
HaemoglobinLowIron deficiency
HbA1cHighInsulin resistance / pre-diabetes

Root cause analysis


  • Acne is mediated by high testosterone levels, stimulated by insulin resistance/spikes mediated by high sugar/starch intake, and dairy via Insulin Growth factor.


  • BA’s oestrogen was too high as evidenced by heavy bleeding and ovulation pain.
  • Excess oestrogen symptoms additionally include premenstrual anxiety, acne and mood swings.
  • Vitamin D is vital modulator of immune and hormonal function, and black women are particularly susceptible to deficiency. Low levels of vitamin D increase susceptibility to PMS.



  • I recommended a low carbohydrate, moderate protein, high fat nutrition plan which was rich in fish and eggs, with a high level of vegetables and beneficial fats, and personalised to BA’s requirements.
  • Avoidance of all cow’s dairy foods.
  • BA was asked to follow my 7 food rules as closely as possible.


  • BA was recommended to use pumpkin seed oil as a cleanser twice a day, applying a teaspoon of the oil to her face and removing with a damp microfibre cloth. After cleansing I recommended she apply vitamin B3 serum.


  • Vitamin D: calibrated dose of emulsified vitamin D drops
  • Drink 1.5 litres of water a day with additional vitamin C, sulphur and potassium.
  • NAC as a liver booster
  • Iron supplementation
  • Niacinamide to calm acne lesion inflammation
  • Minerals and vitamins: including high dose B vitamins, and zinc, selenium, molybdenum, copper, manganese, chromium and boron
  • Active DIM to increase oestrogen detoxification
  • Saw palmetto complex to reduce testosterone levels


SymptomScore out of 6
Initial score
There are massive cysts on her face for 10 days before her period and she can still feel them after period. They are painful when sleeps and wears glasses. She won’t go out if has cysts on her face.
Number of cysts6
Mood disturbance
Premenstrual anger, explosive irritability and crying.

Results – follow-up 1 (+4 weeks)

  • No acne – for the first time since she was 13 (and now is 33 years old)
  • Irritability drastically reduced, only had a few moments of feeling annoyed
  • No period pain
  • No flooding, normal menstrual flow.
  • No pain with ovulation
  • She struggled a bit with the required nutritional changes, especially with adding vegetables to every meal, but has now made it part of her usual diet.


SymptomScore out of 6
Initial scoreScore after 4 weeks
Number of cysts60
Mood disturbance62

I’m really happy with what Sandra has done for me. My skin and mood have completely transformed, to the point where I am so happy.


My review

I was delighted with the quick response that BA had to the protocol, and particularly with how happy and confident she became in her life.

Acne and PMS are so incredibly responsive to focused nutritional interventions, and BA ‘s experience is a perfect example of how having the know-how to balance hormones leads to such a positive results.

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