I don't know but my hormones are wayyy out of balance. I haven't had the money to get checked out. I talked to my doctor about it while I was still on Medicaid but she treated it like it wasn't a big deal. I had a hard time a couple of times when I was 12 or 13, then it got really bad after I turned 15 and hasn't calmed down since but instead it's getting progressively worse.