'My HS is significantly impacted by my cycle'

BACKGROUNDHidradenitis suppurativa (HS) is a chronic skin condition that causes painful abscesses, nodules and tunnelling in the skin folds. HS disproportionately affects women, and androgenic hormones are implicated in its pathophysiology.

OBJECTIVESTo explore the impact of menstruation and pregnancy on HS.

METHODSTwo anonymous online surveys were created on Microsoft Forms and distributed via social media platforms (Facebook, Instagram, X and LinkedIn). The surveys were also shared via the HS Support Network UK and Ireland and HS Ireland's mailing lists. The first survey explored the impact of menstruation on HS (open from 16 December 2024 to 18 January 2025); the second survey explored the impact of pregnancy on HS (open from 6 June to 20 August 2025). Survey data were analysed using descriptive statistics and free-text responses were coded, categorized into themes and analysed manually.

RESULTSOf 255 participants who responded to the first survey, 96.1% (n = 245/255) noticed changes in their HS during their menstrual cycle. Of these, 99.6% (n = 244/245) experienced worsening symptoms. Of 43 respondents to the second survey, 58% (n = 25/43) reported HS worsening during pregnancy. Flare-ups typically occurred during the premenstrual phase and the second trimester of pregnancy. Respondents reported variable disease improvement with the antiandrogenic drugs metformin and spironolactone. Some respondents reported difficulty in caring for their newborn babies during the postpartum period, primarily because of pain caused by their HS.

CONCLUSIONThis study demonstrates a strong association between hormonal fluctuations and HS symptom deterioration. Clinicians should proactively assess menstrual patterns in HS management and provide support during the pregnancy and postpartum periods. Coordinated multidisciplinary care is essential. Further research is needed to evaluate antiandrogenic therapies for hormonally triggered HS exacerbations.

Abstract from PubMed