If you are a woman with HS and you have noticed that your flares seem to get worse around your period, you are not imagining it. Research consistently shows that the majority of women with HS experience perimenstrual flares, and a 2025 study from Duke University confirmed that the menstrual cycle has a measurable, statistically significant impact on patient-reported HS outcomes.
The Numbers
Studies report that between 50 and 78 percent of adult women with HS report that their symptoms worsen in the days before or during menstruation. The Duke University research published in March 2025 used patient-reported outcome data to document that HS disease activity scores were significantly higher in the perimenstrual phase compared to other phases of the menstrual cycle.
Why Does This Happen?
The exact mechanisms are not fully understood, but several hormonal factors are thought to contribute. Progesterone, which rises in the luteal phase (the two weeks before menstruation), has pro-inflammatory effects and may stimulate sebaceous glands and apocrine sweat glands, both of which are involved in HS pathogenesis. The drop in estrogen that occurs before menstruation may also reduce its anti-inflammatory protective effects.
Additionally, androgen levels fluctuate across the menstrual cycle, and androgens are known to influence sebaceous and apocrine gland activity. HS is more common in women than men, and the condition often improves during pregnancy (when estrogen is high) and worsens after menopause, further supporting a hormonal component.
Hormonal Treatments for HS
Several hormonal therapies are used off-label for HS in women, meaning they are not specifically FDA-approved for HS but have evidence supporting their use.
| Treatment | Mechanism | Evidence Level | Notes |
|---|---|---|---|
| Spironolactone | Anti-androgen | Moderate | Commonly used; may reduce flare frequency |
| Combined OCP | Estrogen + progestin | Moderate | Some formulations better than others for HS |
| Finasteride | 5-alpha reductase inhibitor | Limited | Used in some male patients |
| Metformin | Insulin sensitizer | Limited | May help in patients with metabolic syndrome |
Tracking Your Cycle and HS Activity
One of the most useful things you can do is track your HS flares alongside your menstrual cycle for two to three months. This data can be invaluable when discussing hormonal treatment options with your dermatologist or gynecologist. Apps that track both menstrual cycles and symptom diaries can help identify patterns.
If you notice a clear perimenstrual pattern, this is important clinical information. Some clinicians use this pattern to guide treatment decisions, for example, considering hormonal therapies as an adjunct to biologic treatment, or timing certain interventions around the menstrual cycle.
Environmental Factors and Hormones
A 2025 study published in Nature identified a potential link between plastic-associated endocrine disruptors and HS. The research found that certain chemicals found in plastics may reduce levels of Nicastrin, a protein encoded by a gene (NCSTN) that is mutated in some familial forms of HS. While this research is preliminary and does not establish a direct causal link, it adds to the body of evidence suggesting that environmental endocrine disruptors may play a role in HS for some patients.