Why do PCOS and HS occur together so often?

Both PCOS and HS are driven by androgen excess and insulin resistance. Elevated androgens stimulate the apocrine and sebaceous glands that are central to HS pathogenesis, while insulin resistance promotes further androgen production in the ovaries. This creates a reinforcing cycle that worsens both conditions simultaneously.

Can treating PCOS improve HS?

Yes. Treatments that lower androgens or improve insulin sensitivity - such as metformin, spironolactone, or combined oral contraceptives - have been shown to reduce HS flare frequency in some patients. A dermatologist and gynecologist or endocrinologist working together can optimize treatment for both conditions.

Should I tell my dermatologist I have PCOS?

Absolutely. PCOS is directly relevant to HS management because it affects hormone levels, insulin sensitivity, and treatment choices. Some HS treatments (like certain antibiotics or biologics) interact with PCOS medications. Your dermatologist needs the full picture to create the safest, most effective treatment plan.

Does weight loss help both PCOS and HS?

Yes. Even modest weight loss (5-10% of body weight) can reduce androgen levels, improve insulin sensitivity, and decrease HS flare frequency. Weight loss also improves PCOS symptoms including irregular periods and fertility. However, weight loss is not a cure for either condition - both require medical management regardless of body weight.

Can birth control pills help HS in women with PCOS?

Combined oral contraceptives (COCs) containing anti-androgenic progestins (such as drospirenone or cyproterone acetate) can reduce androgen-driven HS flares and also help regulate periods in PCOS. They are not appropriate for all patients - discuss risks and benefits with your doctor, particularly if you smoke or have cardiovascular risk factors.

Hormonal Comorbidity

HS and PCOS: The Hormonal Connection

Polycystic ovary syndrome and hidradenitis suppurativa share deep hormonal and metabolic roots. Understanding this connection can unlock better treatment for both conditions.

Last reviewed: April 2026|10 min read

Medical disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making changes to your treatment plan.

Key Takeaway

Women with PCOS are significantly more likely to develop HS than those without PCOS. Both conditions are driven by androgen excess and insulin resistance, meaning that treatments targeting hormones or metabolic function - such as spironolactone, metformin, or anti-androgenic contraceptives - can benefit both conditions simultaneously.

Why They Co-Occur

Shared Biological Mechanisms

PCOS and HS are not simply two conditions that happen to occur together - they share overlapping biological pathways that cause and reinforce each other.

Androgen Excess

Both PCOS and HS are driven by elevated androgens. In PCOS, the ovaries produce excess testosterone and DHEA-S. These androgens stimulate the apocrine and sebaceous glands in the skin, promoting the follicular plugging and gland rupture that trigger HS lesions. Women with PCOS who have HS often have measurably higher androgen levels than those with HS alone.

Insulin Resistance

Insulin resistance is a hallmark of PCOS and is increasingly recognized as a contributing factor in HS. High insulin levels stimulate ovarian androgen production and promote systemic inflammation. Metformin, which improves insulin sensitivity, has shown benefit in reducing HS flare frequency in several clinical studies.

Chronic Inflammation

Both conditions involve elevated pro-inflammatory cytokines including TNF-alpha, IL-1beta, and IL-6. This shared inflammatory environment means that controlling inflammation in one condition may benefit the other. Biologics that target TNF-alpha (like adalimumab) or IL-17 (like secukinumab) may also reduce systemic inflammation relevant to PCOS.

Microbiome Disruption

Emerging research suggests that gut microbiome dysbiosis - an imbalance in gut bacteria - may link PCOS and HS. Both conditions are associated with altered gut flora that promotes systemic inflammation and hormone dysregulation. Dietary interventions that support gut health may benefit both conditions.

Symptom Overlap

Symptoms: What Overlaps and What Differs

Some symptoms are unique to each condition; others are shared. Understanding the overlap helps you and your doctors identify which condition is driving each symptom.

Symptom	PCOS	HS
Irregular or absent periods	Yes	-
Excess facial or body hair (hirsutism)	Yes	-
Acne (face, chest, back)	Yes	-
Painful nodules in skin folds	-	Yes
Draining tunnels (sinus tracts)	-	Yes
Scarring in affected areas	-	Yes
Fatigue and low energy	Yes	Yes
Weight gain or difficulty losing weight	Yes	Yes
Mood changes, depression, anxiety	Yes	Yes
Elevated androgens on blood tests	Yes	Yes

Treatment

Treatments That Address Both Conditions

Because PCOS and HS share hormonal and metabolic drivers, several treatments can improve both conditions at once. A coordinated approach between your dermatologist and gynecologist or endocrinologist is ideal.

Spironolactone

Anti-Androgen

An anti-androgen medication that blocks androgen receptors. Used in PCOS for hirsutism and acne, and increasingly used off-label for HS in women. Reduces androgen-driven flares in both conditions.

Metformin

Insulin Sensitizer

Improves insulin sensitivity and reduces ovarian androgen production. Several small studies show reduced HS flare frequency. Particularly useful in patients with both PCOS and metabolic syndrome.

Combined Oral Contraceptives

Hormonal

Pills containing anti-androgenic progestins (drospirenone, cyproterone acetate) suppress ovarian androgen production and regulate periods. Can reduce androgen-driven HS flares in women with PCOS.

Biologics (Adalimumab, Secukinumab)

Biologic Therapy

FDA-approved for moderate-to-severe HS. Target specific inflammatory pathways (TNF-alpha, IL-17). Also reduce systemic inflammation relevant to PCOS. Require specialist prescription and monitoring.

Anti-Inflammatory Diet

Lifestyle

A low-glycemic, anti-inflammatory diet reduces insulin spikes, lowers androgen levels, and may reduce HS flare frequency. Particularly beneficial for patients with both PCOS and HS. Dairy and high-glycemic foods are common triggers for both conditions.

FAQ

Frequently Asked Questions

HS and Hormones Women's Health Hub HS and Diabetes HS Comorbidities Overview Nutrition & Lifestyle

References

1.Kromann CB, et al. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Acta Derm Venereol. 2014;94(5):553-557. PubMed
2.Garg A, et al. Prevalence and co-morbidities of hidradenitis suppurativa in the United States. Dermatology. 2014;228(3):261-265. PubMed
3.Verdolini R, et al. Metformin in the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol. 2013;27(9):1101-1108. PubMed
4.Alikhan A, et al. North American clinical management guidelines for hidradenitis suppurativa. J Am Acad Dermatol. 2019;81(1):76-90. PubMed
5.Teede HJ, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-1618. PubMed
6.Bukvic Mokos Z, et al. Understanding the relationship between smoking and hidradenitis suppurativa. Acta Dermatovenerol Croat. 2020;28(1):9-13. PubMed