Hidradenitis suppurativa (HS) in women of reproductive age presents unique challenges due to hormonal influences, comorbidities such as polycystic ovary syndrome (PCOS), and considerations for pregnancy. This chapter explores the clinical presentation, hormonal influences, management strategies, and reproductive health concerns for women with HS, particularly those planning to conceive. The premenstrual exacerbation of HS symptoms, observed in over 60% of women, highlights the role of hormonal fluctuations. Management of HS in this population requires careful consideration of safe treatment options, particularly in the context of pregnancy and breastfeeding. Common treatments include topical therapies, systemic antibiotics, hormonal agents, and biologics, though their use must be tailored to the patient’s reproductive goals. Coexisting obesity and metabolic syndrome further complicate disease management and fertility. The psychosocial burden of HS, including the impact on sexual health and quality of life, emphasizes the importance of early recognition, patient education, and a multidisciplinary approach to optimize care for women of reproductive age with HS.