- Acne is a common skin condition that can range from mild to severe
- Dermatologists can prescribe specific hormonal birth control pills to effectively treat both inflammatory and noninflammatory acne in women
- Due to the risk of side effects, birth control is usually recommended to treat acne in healthy women with are also in need of contraception
When testosterone levels increase in women, sebaceous (oil) glands become more active which leads to excess oil production. This oiliness clogs pores, causes a buildup of dead skin cells and increases the presence of Propionibacterium acnes, the bacteria associated with acne. Birth control for acne can regulate hormone levels, lower sebum production and reduce or eliminate acne lesions.
Hormonal fluctuations are one of the most common causes of acne in women. Some women experience acne flare-ups as their hormones fluctuate during puberty, menstruation, menopause or if they have polycystic ovary syndrome (PCOS), a hormonal disorder.
Can Birth Control Treat Acne?
Visible improvements typically occur within a few weeks to 3 months as two synthetic forms of hormones slowly enter the system and stabilize levels.
Birth control pills will not be effective against acne triggered by certain medications, cosmetics, inadequate skin care routine or by wearing too-tight clothing that doesn’t allow the skin to breathe. With this in mind, it is advised to see your doctor to determine the source of your acne.
How does it work?
Both men and women produce androgen hormones, such as testosterone, which is responsible for the development of male characteristics. These levels are naturally lower in women but can fluctuate during such times as puberty or during menstrual cycles.
Oral birth control addresses acne by regulating these fluctuations. Combination birth control, commonly known as the pill, contains both estrogen and progestin (a synthetic progesterone) to balance hormone levels by decreasing androgen circulation. This action effectively reduces sebum production and clears acne.
Best Birth Control Options for Acne-Prone Skin
Hormonal contraceptives are available in multiple forms: the pill, patch, vaginal ring, injectable, or intrauterine device (IUD).
However, oral contraceptives in the form of the pill are the most commonly prescribed and one of the most effective types of birth control for treating acne. Some women also find improvements in acne with the vaginal ring (a soft plastic ring inserted into the vagina which releases estrogen and progestin).
Three types of oral contraceptives have been approved by the U.S. Food and Drug Administration (FDA) for treating acne. Each type contains a low dose of the same form of estrogen but with different types of progestin.
- Ortho Tri-Cyclen combines estrogen with norgestimate, and is available in different doses depending on the severity of your acne and your doctor’s judgment
- Estrostep contains estrogen combined with norethindrone, and is also available in various doses according to your needs
- YAZ combines estrogen with drospirenone and is approved for the treatment of moderate acne
Studies indicate all three offer the same results in terms of efficacy; however YAZ is associated with a greater risk of serious side effects due to drospirenone’s mechanism of action.
Can Oral Birth Control Cause Acne?
Yes, some women do experience new or worsening acne symptoms as a result of birth control pills. However these cases are rare and normally occur when first starting treatment or when taking progestin-only pills, known as mini-pills.
As mini-pills do not contain estrogen, androgen levels can shift, triggering an increase in hormonal acne. It is for this reason that mini-pills are not prescribed specifically for acne.
How to treat acne caused by oral birth control
If you find your birth control is causing or worsening your hormonal acne, the best option would be to discontinue use following the guidance of your doctor.
However, If you have just begun taking the pill or switched types of pills within the last 3 months, it may be best to wait it out. It normally takes several months to resolve acne symptoms and your body also needs time to adjust to the medication.
Side Effects of Oral Birth Control
Today’s birth control pills contain lower doses of estrogen and progesterone than in the past, which translates to lower side effects. That being said, there are many side effects associated with the pill, some of them serious. It’s important to weigh the risks and benefits when considering oral contraceptives.
Common side effects include nausea, cramping, breakthrough bleeding and vaginal discharge, bloating and weight gain, headaches and migraine, breast tenderness, dizziness and decreased libido. It is worth noting that these symptoms are temporary for most women.
Serious Side Effects of Oral Birth Control
One large study found a link between birth control and a first diagnosis of depression, especially among adolescents.
Oral contraceptives are not indicated for anyone with certain medical conditions. This includes those with a history of heart disease, high blood pressure, blood clots or clotting disorders, cancer, liver disease or diabetes.
It is not advised to take the pill if you are over age 35, smoke, are obese or sedentary, as the risk factors for cardiovascular disease or other severe side effects are higher. Women who are pregnant or breastfeeding cannot take birth control as an acne treatment.
Alternative Acne Treatments
If, after discussing your options with a professional, you feel that oral birth control is a risky choice or not appropriate for you, there are several effective over-the-counter (OTC) and prescription options available.
If you are pregnant you are not eligible to take birth control; alternatively, if you don’t need contraceptives, opting for another treatment is best to avoid any unwanted side effects.
Topical and oral treatments target both inflammatory and noninflammatory acne by killing acne-causing bacteria, regulating sebum production and clearing cells of oil, debris and skin cells. They are effective for mild, moderate or severe acne.
Oral antibiotics are available OTC and in prescription strength and effectively kill acne-causing bacteria. They are recommended for moderate to severe cases of inflammatory acne.
Amoxicillin is an effective antibiotic but is prescribed for short-term use only to prevent antibiotic resistance. Side effects include nausea, vomiting, dizziness and rash.
It is available in many forms, including lotions, washes and gels. It kills bacteria, clears dead skin and excess oil from pores, and prevents new lesions from forming.
Salicylic acid is a beta hydroxy acid (BHA) that penetrates deep within pores to dissolve excess oil and keep pores clear. It is available in OTC as well as prescription strength in multiple products such as lotions, creams and pads.
This acid works best for pimples and blackheads that are associated with noninflammatory acne; it is not an antibacterial and it can’t regulate oil production.
Retinol is made from vitamin C, belongs to a class of retinoids, and is found in OTC serums, gels and creams. It provides a strong anti-inflammatory effect, deeply exfoliates skin and accelerates skin cell turnover. It is therefore appropriate for both inflammatory and noninflammatory acne.
Retinol is effective in clearing breakouts and preventing new lesions from forming.
The synthetic estrogen and progestin found in oral birth control pills can regulate sebum production and as a result, reduce or eliminate acne lesions. Typically, birth control is only recommended as an acne treatment for healthy women who are also in need of a contraceptive.
Three types of combination oral contraceptives have been FDA-approved for treating acne. When first starting treatment, acne may worsen as the body slowly becomes accustomed to the medication. It is also important to remain patient, as it can take up to 3 months before you notice a visible improvement.
Taking hormonal birth control for acne is not advised for women with certain medical conditions. It is also important to consider the risks and potential side effects of taking oral birth control pills as there are both mild and serious side effects associated with oral contraceptives.
As an alternative, there are many safe, time-tested OTC and prescription medications available. Whatever treatment you choose, with consistent use and patience, you should see improvements in your skin.
- Ju Q, Tao T, Hu T, Karadağ AS, Al-Khuzaei S, Chen W. Sex hormones and acne. Clin Dermatol. 2017 Mar – Apr;35(2):130-137. doi:10.1016/j.clindermatol.2016.10.004
- Salvaggio, H. L., & Zaenglein, A. L. (2010). Examining the use of oral contraceptives in the management of acne. International journal of women’s health, 2, 69–76. doi:10.2147/ijwh.s5915
- Lortscher D, Admani S, Satur N, Eichenfield LF. Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients. J Drugs Dermatol. 2016 Jun 1;15(6):670-4. ncbi.nlm.nih.gov/pubmed/27272072
- Trivedi, M. K., Shinkai, K., & Murase, J. E. (2017). A Review of hormone-based therapies to treat adult acne vulgaris in women. International journal of women’s dermatology, 3(1), 44–52. doi:10.1016/j.ijwd.2017.02.018
- FDA. (2010) YAZ. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021676s009lbl.pdf
- Cooper DB, Mahdy H. Oral Contraceptive Pills. [Updated 2019 Nov 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430882/
- Stegeman BH, de Bastos M, Rosendaal FR, van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013 Sep 12;347:f5298. doi:10.1136/bmj.f5298
- NIH: National Cancer Institute. (2018) Oral Contraceptives and Cancer Risk. https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet
- Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016 Nov 1;73(11):1154-1162. doi:10.1001/jamapsychiatry.2016.2387
- Zeichner, J. A., Baldwin, H. E., Cook-Bolden, F. E., Eichenfield, L. F., Fallon-Friedlander, S., & Rodriguez, D. A. (2017). Emerging Issues in Adult Female Acne. The Journal of clinical and aesthetic dermatology, 10(1), 37–46. ncbi.nlm.nih.gov/pmc/articles/PMC5300732/
- Decker, A., & Graber, E. M. (2012). Over-the-counter Acne Treatments: A Review. The Journal of clinical and aesthetic dermatology, 5(5), 32–40. ncbi.nlm.nih.gov/pmc/articles/PMC3366450/
- Leyden, J., Stein-Gold, L., & Weiss, J. (2017). Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and therapy, 7(3), 293–304. doi:10.1007/s13555-017-0185-2
- Guzman, A. K., Choi, J. K., & James, W. D. (2018). Safety and effectiveness of amoxicillin in the treatment of inflammatory acne. International journal of women’s dermatology, 4(3), 174–175. doi:10.1016/j.ijwd.2018.03.006