Why Your Skin Might Freak Out During an Endometriosis Flare-Up

It’s been seven years since I was diagnosed with endometriosis, and I’m still learning something new about the condition on what feels like a daily basis. I’ve had multiple surgeries, taken countless sick days, and spent what feels like an eternity organizing and attending doctor’s appointments. Endometriosis has wreaked havoc on my social life, career, and in recent years, my skin — well, so I think. 

Although endometriosis is often referred to as a menstrual disease, it’s actually not — we’ll get into the misinformation later — and it impacts far more than just our pelvis. With more clinical research slowly but surely making its way into publication, providers and patients are realizing that it can affect nearly every part of the body, and that includes the skin, too. (There’s even a type of rare subtype referred to as skin endometriosis, which manifests itself in the skin rather than the uterus.) 

Three years ago, I was also diagnosed with rosacea; papulopustular rosacea to be exact. This subtype of rosacea is characterized by papules and bumps mostly across the cheeks, chin, and nose, paired with the classic inflamed redness across those areas. As a pretty dedicated symptom tracker — which, when you have a chronic illness, becomes second nature — there was one thing I consistently noticed: When I was having an endometriosis flare-up, my skin would flare up too. It turns out, the medical community has been noticing this correlation too. 

After my diagnosis, for the first time, I was able to control the stubborn pimples I’d assumed were acne-related and could calm down the excessive redness and flushing I found so uncomfortable. That’s why, with the help of a set of skilled endometriosis experts and dermatologists, I set out to investigate: Can endometriosis impact our skin? 

• Jessica Opoku-Anane, MD, MS, a board-certified OB/GYN at Columbia University Irving Medical Center and director of Endometriosis Treatment Center in New York City. 
• Ken Sinervo, MD, MSC, FRCSC, ACGE, medical director at Center For Endometriosis Care in Atlanta
• Ranella Hirsch, MD, a board-certified dermatologist based in Boston
• Ife Rodney, MD, a board-certified dermatologist and founding director of Eternal Dermatology in Fulton, Maryland. 

What Is Endometriosis? 

Endometriosis is a disease that affects the uterus and other parts of the body. “The accurate, clinical definition of endometriosis is: a systemic, inflammatory disease characterized by the presence of endometrial-like tissue found outside the uterus, in other areas of the body,” explains Ken Sinervo, MD, the medical director at the Center For Endometriosis Care in Atlanta. In layman’s terms: Normal endometrial tissue lines the uterus and thickens each month. If pregnancy doesn’t occur then this tissue sheds and bleeds, which is your period. Endometriosis, however, means endometrial-like tissue grows outside of the uterus. 

How endometriosis impacts each person varies dramatically, but common symptoms (and there are many) include painful periods, pelvic pain, pain during sex, bowel pain, bladder pain, infertility, leg pain, irregular bleeding, bloating, fatigue, brain fog, nausea, and back pain. The condition is common, “affecting approximately 190 million women, girls, and gender-diverse individuals globally,” Dr. Sinervo says. Despite this, it’s extremely underfunded and under-researched — so much so that we still don’t know how to cure the disease, what causes it, and how it can fully manifest itself, including in the skin. 

How Can Endometriosis Affect the Skin? 

As endometriosis is a full-body disease that can manifest itself in many ways, it’s not surprising that the disease might be affecting our skin. Ranella Hirsch, MD, a board-certified dermatologist in Boston, explains that it’s believed that endometriosis can impact the skin in a number of ways, and with a few conditions. Jessica Opoku-Anane, MD, MS, a board-certified OB/GYN at Columbia University Irving Medical Center and director of Endometriosis Treatment Center in New York City, notes that the skin is a topic that comes up a lot with her patients, which is a connection that she only dug into more after her training and during practice. 

“I learned a lot more after I started practicing. If 20-30 percent of your patients are reporting the same symptom, you realize that it is actually a very common manifestation,” explains Dr. Opoku-Anane. “From our western education, as far as we know, there’s not a lot of evidence to suggest that there is an association, but I think that’s because it’s not been studied.”

Although very few skin conditions have been definitively proven to be linked to endometriosis, the doctors I spoke to said these four seem to have the most potential for a connection to the disease. 

Hormonal acne is caused by (you guessed it) hormonal changes and fluctuations. When you have endometriosis, your hormones are likely to be, well, all over the place. This study from 2014 explored the links between hormonal acne and endometriosis, finding that teenagers with hormonal acne had a 20 percent increased chance of endometriosis. 

Ife Rodney, MD, a board-certified dermatologist and founding director of Eternal Dermatology in Fulton, Maryland, believes that hormonal fluctuation is where the connection between endometriosis and acne lies. That said, she doesn’t believe that endometriosis would be the sole cause of a patient’s acne: “Instead, I think that the timing coincides because both of these conditions can flare with these hormonal changes,” she says. Meaning, that both acne and endometriosis flare-ups independently occur during the time of menstruation due to hormone changes, rather than the endometriosis being the cause of the breakouts.

Dr. Opoku-Anane echoes Dr. Rodney when it comes to these hormonal changes, but does think endometriosis could be a large culprit — along with certain medications used to help suppress endometriosis symptoms. “It also depends what [medication] you’re on,” she adds.  

Hormonal medications are used for a variety of reasons in endometriosis patients, including for typical birth control or for blocking or suppressing the production of estrogen in an effort to relieve symptoms. It can also help control skin concerns like acne by balancing estrogen, progesterone, and androgen hormones for patients in general.  “We use hormonal contraception with estrogen and progesterone to help treat things like acne, but progesterone alone can cause different skin manifestations as well,” Dr. Opoku-Anane explains. Some of these contraceptives containing progestin (the synthetic version of progesterone) can also impact oil production, which, in turn, can lead to more acne-prone skin.

Habitual changes that often occur during periods of endometriosis flare-ups could encourage breakouts, too. When you’re struggling to complete daily activities, you might be skipping your skin-care routine at night, not slapping on that SPF 50, or settling for less nutritious foods. All of these small changes can stack up, potentially leading to skin that isn’t as happy as it was pre-flare up.  

The general consensus amongst our experts is that if you have both endometriosis and hormonal acne, there’s a chance they’re connected. That said, it might take a while for these links to become definitive. “Unfortunately, like most areas of endometriosis research, we still have a long way to go,” says Dr. Sinervo. 

There’s one common factor with undeniable links to both endometriosis and many skin conditions: inflammation. Rosacea is one of those skin conditions, and it’s the one I personally feel is related closely to my own endometriosis flare-ups. During the month-long flare-ups when my endometriosis and painful bladder syndrome — a secondary health issue thanks to my friend endo — are both acting up, my skin shows all the signature signs of rosacea like blotchiness, papules, and feeling dry, tight, and hot to the touch. That connection, while pretty clear for me, still hasn't been proven at large by clinical studies.

“Endometriosis by its very nature is a chronic inflammatory disease,” states Dr. Sinervo. “While we are not aware of any direct links between rosacea and endometriosis specifically, the disease has indeed demonstrated association with a number of other health concerns, including but not limited to conditions like lupus, inflammatory bowel disease, painful bladder syndrome, thyroid disease, comorbid pain conditions, and several others,” he adds. “Whether they share underlying causes, occur as a consequence of the disease itself, are the result of shared environmental or genetic factors, or something else, remains to be definitively illustrated.” 

This said, I am a beauty editor, and I make sure I keep on top of my regimen even when I’m feeling my worst physically. To treat my symptoms, I aim to keep things simple by keeping micellar water, reusable cotton rounds, and prescription rosacea treatments I know I can count on by my bedside.

Although I do not, many people with endometriosis experience eczema and urticaria (hives) flare-ups that cause dry, scaly, cracked, rashy, sensitive, and even bleeding skin. And unlike the other conditions we’ve mentioned, there are substantial links between those with endometriosis and eczema, dermatitis, hives, and allergies. This particular 2016 study (although not incredibly detailed) draws the conclusion that this link stems from the immune system and inflammatory response. And this 2021 study looking into the co-occurrence of immune-related conditions and endometriosis in younger women — including eczema and psoriasis — found that overall, participants with allergies were 76 percent more likely to be diagnosed with endometriosis compared to participants without allergies. 

“The general thought is that [this link] lies with other inflammatory conditions and that you see them as comorbidities with endometriosis with some regularity,” says Dr. Hirsch. Basically, if you’re dealing with elevated levels of inflammation, it could be causing a whole range of issues, though those issues aren’t necessarily related in any way other than being caused by that inflammation. This is echoed in a 2015 study review concluding that people with endometriosis are at higher risk of several chronic diseases, being more prone to “allergic manifestations and to allergy-related conditions.” Unfortunately, the reasons behind this aren’t concrete: offering up four possibilities, this study in particular pointed towards possible inflammation and deficient immunologic responses. 

Endometriosis and Your Skin: The TL;DR 

When it comes to endometriosis, especially as it relates to the skin, there are still so many unknowns that it would be impossible (and irresponsible) to draw solid conclusions. But if you are experiencing skin symptoms, it’s worth checking in with the professional providing your endometriosis treatment. If you’re in the position to, seek care from a multidisciplinary team at a specialized endometriosis center. This means an endometriosis surgeon will work closely with a team of experts in other fields that closely link to the disease, including urologists, gastroenterologists, pain management doctors, and dermatologists. This kind of integrative medicine has proven to be an asset in endometriosis treatment and can lead to happier, healthier long-term outcomes. 

More info about skin conditions and treatments:

• Your Complete Guide to Phytophotodermatitis
• The Impact Stress Has on Your Skin
• Does Skin Cancer Itch?