I’ve spent a lot of time educating and discussing the effects of HRT, hormonal imbalance, and even pregnancy hormones on body piercings. Hormones are our body's chemical messengers, which instruct our bodies to do many different processes. They have a major effect on our skin, our bodies’ immune responses, and many factors that can affect how a body piercing heals. So it should come as no surprise that PCOS, a hormonal condition that affects the ovaries during reproductive years, can also have a major effect on how piercings heal. There is little discussion about the ways having these hormonal conditions can have such broad effects, and as such many clients find themselves struggling to heal piercings and wondering what they are doing wrong. Likewise, many piercers are not informed about this condition and may not be prepared for how to guide clients through healing.
What is PCOS
Polycystic ovary syndrome is a condition where you may have few, abnormal, or very long periods. It is often caused by an overproduction of androgen, and can also include small cysts that form on the ovaries. Folks with PCOS may also struggle with excess facial and body hair, severe acne, and male-pattern baldness. PCOS can also cause infertility, weight gain, liver inflammation, type 2 diabetes, depression, anxiety, eating disorders, and endometrial cancer.
The exact causes of PCOS are unknown. Some factors that play a role in this are insulin resistance, inflammation, hereditary components, and hormonal changes. Research does suggest that PCOS may be linked to certain genetic markers. White blood cells create substances in response to infection or injury, this response is low-grade inflammation. Research has shown that folks with PCOS have a long-term, low-grade inflammation level that can lead to polycystic ovaries producing androgens, which can lead to heart and blood issues.
PCOS is considered a common problem, with more than 200,000 cases in the US per year.
Piercing Clients with PCOS
This next section is for the piercers (but it’s honestly also for the clients). When it comes to clients who have PCOS they can absolutely still get piercings! But how we approach piercing them is very different than how we may approach other clients of ours. To start, it’s important to remember no client is required to provide you with intimate medical details. While it does help us do our job better to know these things, legally we can’t force clients to disclose this.
In an ideal situation, your client will be forthcoming about having PCOS, and you can go from there to figure out the best way to work with them. As I mentioned above PCOS is a hormonal condition that can also come along with persistent, consent low-grade inflammation. This can often mean the initial inflammation response to being pierced can sometimes be stronger in clients with PCOS. I find that you may need to leave excess room for swelling, and piercing at a slightly larger size allows for more stability when dealing with persistent inflammation. For example, I’ll use 16g for earlobes and nostrils and 14g for conches and helixes. Since excess inflammation is a concern, I find these slightly larger sizes are much more stable over time and deal with less overselling and irritation. You can also expect some clients with PCOS to stay swollen longer and may have to adjust timeframes for downsizing. Everyone's experience of PCOS is going to be different, and everyone's impact of it on piercings is going to be different. I usually prefer to air on the side of caution and start simple with one or two easy piercings, using simple jewelry, and monitor how they heal and how much their PCOS may effect initial piercing and swelling before we move on to doing more advanced or complicated piercings.
This also means adjusting aftercare to meet our client's needs as well. Clients with PCOS may need to incorporate tools like cool compresses to help control swelling after piercing. I love sending clients home with saline wipes they can store in the fridge for this exact purpose. I also usually check in more often and do regular virtual follow-ups to monitor swelling and track exactly how the initial healing is going. Because the inflammation response is so much stronger, clients may more easily struggle with irritation bumps and issues after a catch or a snag. I find starting with simple jewelry such as plain beads, discs, and cabs, to minimize catching or snagging, can also be beneficial. I also stress lifestyle changes that may minimize trauma to the piercing, including using travel pillows when sleeping, being mindful of clothing choices, etc. Excess androgens can cause similar skin changes to HRT, including oilier skin, and more acne-prone skin. This can create unique struggles with moisture irritations in certain placements, especially eyebrows, bridges, and high nostrils. Try to monitor your client's general skin health, and keep in mind the way their skin in general may be affecting this healing process. And since PCOS can affect immune responses, your client's immune system in general may have a harder time with healing piercings. This can present as much longer healing timeframes, being more prone to irritation bumps and issues, and having a harder time recovering from setbacks. This is why taking a slow and careful approach is ideal, and working closely with your client to help with healing is essential.
Documenting the healing process and staying in touch allows us not only to learn how their individual body heals but make changes to aftercare and jewelry as needed to work through the healing process. This information then lets you know how to further with with that client- if they are healing well and easily I may do 2 piercings next time, or be willing to do a more difficult piercing. If they are struggling and having issues we may need to reassess piercing plans or aftercare to determine what we can safely do.
The biggest takeaway is to approach each client individually and with care. Everyone's PCOS may look different, and there is no reason to rush into piercing and doing a lot. A slower, cautious approach to start will allow both you and your client to understand how they heal without overwhelming their body or potentially causing severe scarring or damage to already fragile tissue.
Getting Pierced with PCOS
The previous section discussed things from a piercer's perspective, but I also think it helps inform clients about what getting successful piercings with PCOS can look like. What I hear more often than not is folks being told “You can’t heal piercings with PCOS” or piercers just turning them away and being unwilling to work with them. Your piercer should be asking you good questions about your PCOS and your body, and listening to you. They should take time to thoroughly assess your skin and discuss a plan to approach piercing you with care and compassion. It’s a red flag if a piercer just turns you away simply for having PCOS but it is also a red flag if a piercer says yes but doesn’t seem to really care, and is just going to take your money and pierce you willy nilly.
However, from you as the client I ask for patience. Working with any medical conditions well and ensuring your piercings heal well and without issues does require more work, and often a slower approach. I know you may be excited about all the piercings and all the pretty jewelry you want, but it’s very important to have patience. Plan to start off slowly and understand how your body heals before jumping into doing a lot of work. Be willing to compromise with your piercer on a plan that may mean waiting longer before your goal jewelry or goal piercings. Understand that your body may heal more slowly and your piercer may advise you to wait longer than originally planned to do more. You may also have more work to do with aftercare in order to get your body to heal, and it’s important to be committed to that extra work. From more cleaning to more checkups to more downsizes, be ready to do what you need to to get these piercings to heal.
PCOS is an incredibly common condition that thousands of people deal with daily. Despite this, it doesn’t have to be a barrier to getting the piercings and modifications you desire. With an informed piercer, a cautious and gentle approach, and some patience, we can absolutely make beautiful piercings happen for people with all levels of PCOS. Happy healing!