Struggling with Hormonal Acne in my Mid-30s

Hi! I have perpetual & cyclical hormonal acne around my mouth as a 35 year old healthy female. I’ve tried EVERYTHING under the sun to treat my acne. Conventional treatments include long term use of birth control, accurate, spironolactone. I’m off all of these now as of Nov 2021 in effort to find more natural treatments. I also noticed these conventional treatments only work worked temporarily and I’m looking for long term, focusing on root cause treatments. This past year I sought out two functional medicine doctors, spent thousands on lab tests, hormone tests, stool test, food sensitivity tests, supplements (e.g. DIM, myomin, chaste berry, vitex, estrovera) and more & I am still feeling like I have made no progress. My skin continues to be unpredictable— cystic pimples pop up around my mouth at any moments notice. I try to track my breakouts on a menstrual cycle app but data is inconsistent. I’m a huge believer in a healthy diet & exercise, skin care, & meditation, but despite all of the above I’m still struggling with acne in my mid 30s and it’s taken an emotional/mental toll. Does anyone relate? Is there something I have yet to try that could help? Thanks for reading this!