Hormones can take you on a wild ride—physically and emotionally. From your first PMS breakout to the infamous hot flashes of menopause, it’s a rollercoaster from day one, with your complexion often bearing the brunt of these ups and downs. So, it’s no surprise that people tend to see changes in their skin during fertility treatments—when their body is suddenly managing a huge onslaught of these embryo-friendly chemicals.

“Skin, in general, can be very sensitive to hormonal changes,” says Julie Rhee, MD, FACOG, a reproductive endocrinologist and infertility specialist at Kindbody in St. Louis. So any changes that you might notice from normal hormone fluctuations, like getting acne around your period, can be magnified on your skin during fertility treatments.

If that sounds like you, you’re not alone. In fact, it’s a really common complaint, says Loretta Ciraldo, MD, FAAD, a Miami-based board-certified dermatologist and founder of Dr. Loretta Skincare, who sees a number of people in their thirties, “in various stages of family planning,” all of whom are experiencing changes to their skin.

So, here’s what you can expect from your complexion during this incredibly sensitive time.

It’s important to know how hormone levels affect your skin

“Hormones affect every part of your body. They travel in your bloodstream to your tissue and organs,” says Anna Cabeca, MD, triple-board certified OB-GYN and author of MenuPause: Five Unique Eating Plans to Break Through Your Weight Loss Plateau and Improve Mood, Sleep and Hot Flashes. “Think of them as your body’s chemical messengers. They impact your metabolism and determine how your body absorbs food, which then impacts your energy level, your sex drive, and your digestive system. This then impacts your appearance, from bloating—which really is an issue of water retention—all the way to your skin.”

There are dozens of hormones in the human body—way more than in this brief list—but here are a few key players that impact your skin:

1. Estrogen

Estrogen, the hormone that regulates your menstrual cycle, is best known for its ability to improve acne. According to Dr. Ciraldo, “loss of estrogen will result in more breakouts for some women.” When estrogen levels get low (which tends to happen during menopause), it can also lead to decreased collagen production, increased sensitivity to UV damage, and dull, dry-looking skin.

2. Androgens

Androgens, aka your sex and reproductive hormones, “can increase sebum production,” says Hadley King, MD, a board-certified dermatologist based in New York City, which can lead to acne. Estrogen can typically counterbalance them, which is why hormonal contraceptives can be helpful in preventing breakouts.

3. Progesterone and progestin

Similar to androgens, progesterone, and progestin (the synthetic version of progesterone that’s in certain birth control methods) may also increase sebum production and worsen acne, says Dr. King.  Again, when progestin is combined with estrogen in hormonal contraceptives it can actually improve acne. “Birth control methods that contain estrogen and progestin, like the pill, patch, or ring, are often helpful for decreasing sebum and acne,” she says.

But that’s also not the whole picture. “It’s complicated because hormonal birth control comes in many forms and contains different types and levels of hormones. And even the same formulation may affect different people differently,” says Dr. King. So you might react differently than your friend, even if you take the same hormonal birth control.

As for progesterone, you might see a difference in your skin at certain times of the month when your levels are higher. “In a natural menstrual cycle, women are more likely to have acne or oily skin just prior to ovulation or after ovulation from progesterone effects,” says Dr. Rhee. Those effects can include noticeable skin changes like facial swelling, hyperpigmentation, and oily skin.

4. Cortisol

Cortisol is known as the ‘stress hormone” for a reason, as it can have a dramatic impact on the skin, says Dr. Ciraldo. “Since it activates oil glands to produce more sebum and skin oils, breakouts can increase [when there’s an overproduction],” he says, and it can even cause hair loss.

You might experience skin changes when going off birth control

The first step on any family planning journey is to go off birth control, whether that’s removing an IUD, nixing the pill, taking out the ring, etc. Consider this phase one, and know that it may be the toughest phase for your skin.

“Among my patients, I have found that the group that has the most medication-related changes in their skin is the group who are coming off of birth control,” says Dr. Ciraldo. Of course, some people won’t see any changes at all, it really just depends on how your body reacts to these hormone fluctuations, she says.

If you do notice any changes in your skin when you stop hormonal contraceptives, it likely means that you’ll need to change your routine to address these new (or old) issues. “Going off the pill can unmask sensitive skin issues,” adds Catharine Marshall, MD, an OB/GYN and gynecologic surgeon in La Jolla, CA.

For example, you may have experienced acne suppression while taking an estrogen-based contraceptive, but once you remove those hormones from the equation, your breakouts are ready to come out in full force.

“The bad news is that people with naturally higher androgen levels and oily skin who are prone to acne can get new flares when they stop taking the pill,” she says, but those effects mostly pertain to estrogen pills, and likely won’t happen with oral progestin or progestin IUDs.

Dr. King agrees. “For several months after discontinuing oral contraceptive pills, hormone levels go through an adjustment phase, and acne may particularly flare during this window,” she says, though she mentions it varies based on your own physiological makeup and which form of pills or contraceptives you’ve been using.

You might also see changes to your skin during fertility treatments

Once you’re past the first stage of getting off birth control, you’ll start preparing for fertility treatments, which means you’re about to have a whole lot more hormones in your system. But, how much and which ones really depends on the type of treatment you receive.

There are several options for family planning and fertility treatments these days, including egg retrieval and freezing, intrauterine insemination (IUI), and in vitro fertilization (IVF)—all of which can involve injecting hormonal medications.

Estrogen levels increase dramatically with egg freezing and IVF

When it comes to IVF and egg freezing, prepare for estrogen. “IVF treatment simply means we use hormones to stimulate the ovaries to produce more eggs, so to experience a fluctuation in hormones is just part of the treatment and to be expected,” says Dr. Cabeca.

According to Dr. Rhee, during an IVF or egg-freezing cycle, estrogen levels can climb to 10 times higher (or more) than what your body is naturally accustomed to thanks to the injectible medications that stimulate egg and follicle growth. Not surprisingly, this has the potential to show up on your skin.

A 2018 study from The Journal of Cutaneous Medicine and Surgery estimated approximately 27 percent of patients undergoing IVF had skin changes associated with the treatments. The most common concern—which was found in about 13.5 percent of patients—was a red, round, welt-like rash called urticaria, aka hives. Acne was also a concern for about 3 percent of patients. “Many women going through IVF do complain about skin changes and acne,” says Dr. Rhee, adding that these complaints are largely related to the types of hormones being used in the injections. For example, according to that same study, 96 percent of the women dealing with hives were also on progesterone as part of their IVF treatment.

The sky-high estrogen levels that come along with IVF can lead to both sensitization of the skin and “hyperpigmentation of skin color, which is temporary, and often resolves after the IVF cycle,” says Dr. Rhee. That means you could see dark spots develop on your skin, but they will usually go away after you’re done with treatment.

You could see fewer changes during IUI treatments

When it comes to IUI, there’s a chance you won’t see any difference in your skin. “The changes to your skin are often less noticeable with IUI, since estrogen levels usually do not get as high in IUI cycles,” says Dr. Rhee.

Though, Dr. Marshall says there are a couple of approaches to IUI that can impact the skin in different ways. “IUI can be done without hormonal egg stimulation, but has pretty low success rates on its own,” she says. “Its success with injecting gonadotropins (hormone stimulators) is much higher, at 20-percent success per cycle.” So depending on what type of IUI you’re undergoing (hormonal vs non-hormonal), it may impact your skin in a similar way as IVF.

The stress of fertility treatments can also impact your skin

Shots aside, the stress that’s often associated with the family planning process may also affect your skin. “In the IVF/IUI group I have found that there are often more stress-related skin issues, including sensitivity, and skin redness and blotchiness,” says Dr. Ciraldo. Here’s why: If you are super stressed out while getting your body ready for IVF, your skin can become even more sensitive, she says.

You may also see other skin conditions worsen during this time. “We even see conditions like eczema and psoriasis flare in some, but not all, women who are undergoing IVF/IUI treatments,” says Dr. Ciraldo.

5 tips for how to handle skin changes during fertility treatments

1. See a dermatologist

Since fertility treatments can really wreak havoc on your skin, if you’re already prone to breakouts or other issues with your complexion, it’s a good idea to see a dermatologist regularly. They can help you manage the changes to your skin as you navigate an already stressful process, says Dr. Marshall.

2. Adjust your skin-care routine

As you undergo fertility treatments, you may need to re-evaluate your skin care needs and adjust your regimen. “Monitor how your skin is doing, and consider adjusting your at-home regimen if you do see visible change,” says Dr. Ciraldo. “You may need to switch to a cleanser that has more anti-acne benefits, for example, one with salicylic or glycolic [acids],” she says.

It’s also possible that you’ll need to exfoliate more regularly, which you can with alpha-hydroxy acids (AHAs), glycolic acid, or retinol, says Dr. Ciraldo. Though, if your skin is feeling extra sensitive when going through treatment, you may actually want to steer clear of AHAs and retinoids, at least for the time being, she says.

The good news is small changes can make a big difference if you’re seeing more breakouts, acne, or other issues, says Dr. Rhee. “A good skin-care routine during fertility treatment can help ameliorate these symptoms.”

If none of those changes seem to be making a difference, there are always prescription options available, says Dr. King, which, again, is why having a dermatologist is really important during this time.

3. Be ready to adjust it again

Of course, all of this can change if and when you do conceive—pregnancy skin care is a whole other ball game. “Topical skin care products and prescriptions have not been studied well in pregnant women,” says Dr. Marshall. In general, she says to avoid ingredients and preparations that haven’t been studied—it’s always better to err on the side of caution.

“The consensus is to avoid products that might be toxic to a pregnancy, or that can affect hormone levels, like tretinoin, adapalene, and other topical vitamin A, anti-acne, and anti-wrinkle preparations,” says Dr. Marshall. She also says to avoid putting any chemicals on your face that you could ingest, like oleander extract, ceramides, peptides, fluorouracil, and podophyllum. And of course, Accutane, which is known to cause birth defects, is an absolute no-go during pregnancy.

4. Nourish your body

It’s also a good idea to take care of your body, in general, when going through fertility treatments (and throughout life), says Dr. Cabeca, who recommends working with your physician to ensure you’re nourishing your body in a way that promotes your overall health. “I always say ‘healthy digestion for a glowing complexion,’” she adds.

5. Try to be patient and gentle with yourself

This is easier said than done, but going through fertility treatments can be physically and emotionally challenging, so when you also start seeing changes in your skin, it can be really disheartening. But, as Dr. Rhee puts it, “The most important thing to consider is that these changes are reversible and short-lived.”