A common hormonal therapy used to treat acne is oral contraception. Birth contraceptives are extremely effective in treating mild to moderate acne breakouts. However, not all pills can help you manage acne.
Which birth control pills are the best to treat acne? Who can use them and do they have any side effects? In this article, learn all you need to know about birth control for acne treatment, how it works, and the potential risks. Keep reading.
In This Article
Acne, Birth Control, And Hormone Levels
Acne is a skin condition characterized by blackheads, whiteheads, and pimples. It can either be inflammatory or non-inflammatory. One of its main causes is the increase in androgen hormone levels like testosterone, during puberty, in both women and men (1).
Menstrual cycles may also cause acne due to hormonal changes. During puberty, increased androgen levels enlarge the follicular glands. The androgens most linked to acne are testosterone, dihydrotestosterone, dehydroepiandrosterone, and insulin growth factor. High levels of these androgens may lead to acne breakouts. They may also occur if the estrogen and progesterone levels are lower than normal androgen levels. Prepubertal girls also may suffer from acne due to high levels of dehydroepiandrosterone sulfate (4).
Acne mostly occurs during adolescence. But it can also occur in older women and pregnant women. Those with Cushing’s syndrome, hirsutism (excessive hair growth), or polycystic ovary syndrome may also experience acne breakouts (1). The skin condition can also occur during menopause (called acne climacterica). It happens when testosterone levels are greater than estradiol and progesterone levels. Women also experience acne during their late reproductive years due to decreased estrogen levels and no change in androgen levels.
Hyperandrogenemia is a disorder seen in 5-10% of women during their reproductive ages (2). It occurs due to androgen levels or impaired inactivation of androgen. Polycystic ovary syndrome can be a cause of this disorder.
Birth control or hormonal contraception (oral contraception) can be used to treat medical issues like acne vulgaris caused by hyperandrogenemia (3).
Now that we know what causes acne, we discuss the role of birth control in treating skin conditions in the next section.
How Does Birth Control Help Treat Acne?
Birth control contraceptives, specifically combined contraceptives, contain estrogen and progestin. Estrogen can reduce active androgens and prevent testosterone production. Progestin decreases testosterone activity, preventing it from producing dihydrotestosterone (another androgen hormone) (3). The combination of both prevents the formation of other androgen hormones like dehydroepiandrosterone.
Research supports the use of combined oral contraceptives and antiandrogen therapies to treat acne in females above 14 years of age (4).
Types Of Birth Control
The two major types of hormonal contraceptives are combined hormonal contraceptives and progestin-only contraceptives (3). These two inhibit androgen production.
1) Combined hormonal contraceptives
Combined hormonal contraceptives comprise two components — estrogen and progestin. They are available as patches, vaginal rings, and pills, and help manage skin changes.
- Chlormadinone acetate was effective in treating mild to moderate acne after 3-12 months of treatment. A study showed a decrease in the number of patients facing acne from 46.5% to 14.9% after 13 cycles of treatment. They did not see the need to seek dermatological help or buy concealers. (3)
- Drospirenone showed improvement in patients after 6 months of treatment. It was more effective than chlormadinone in treating acne, hydration. and skin quality. (3)
- In two separate studies, dienogest was found to improve acne breakouts in 52% and 66% of patients, respectively. It was more effective than drospirenone and chlormadinone acetate due to its high antiandrogenic activity. (3)
2) Progestin-only contraception
These contraceptives are available as pills, injections, intrauterine devices, and implants. They do not help improve skin issues and may even worsen skin. An implantable rod (a contraceptive medical device), the size of a thin matchstick containing progestin, may cause acne as a side effect (5).
The FDA has approved only three medications for treating acne — ortho Tri-cyclen, Yaz, and Estrostep (4). Doctors may prescribe many combined oral contraceptives, but not everyone can use these to treat acne.
Who Can Use Oral Contraceptives
People with polycystic ovary syndrome (disorder causing enlarged ovaries) or adrenal hyperplasia (disorders limiting hormone production in adrenal glands) may experience acne. Using oral contraceptives to treat acne in women with these disorders reduces hyperandrogenemia risk and improves skin quality.
Combined hormonal contraceptives can be used to treat mild to moderate acne in most women. Sometimes, doctors may suggest certain tests to check for risks.
While it is clear that contraceptives are effective in treating acne, not all can use them. Read to know more.
Who Should Avoid Birth Control Pills To Treat Acne
Combined contraceptives should not be given to women in the late reproductive stage if they smoke or have hypertension and a BMI higher than 35 kg/m2 (3). They may be at a higher risk of cardiovascular disease and brain stroke. They should take the lowest dose of ethinyloestradiol (Estrogen component).
The World Health Organization states that oral contraceptives should not be given to women who are pregnant, breastfeeding, and have a history of deep venous thrombosis. Women who have liver disease, migraine, breast cancer, hypertension, diabetes mellitus with vascular changes, and long-term immobilization also should avoid them (3). The WHO suggestions also apply to those smoking after the age of 35 years.
As with all medications, using oral contraceptives for acne treatment may also have some adverse effects. We have discussed them in the next section.
Side-Effects Of Birth Controls For Acne
Oral contraceptives may have serious side effects. In one case, a 23-year-old fitness trainer suffered a brain stroke after using them for 3 weeks (3). She recovered after thrombolytic treatment (drugs that dissolve blood clots in major arteries and veins)
Some people who take oral contraceptives may be at a greater risk of venous thromboembolism (blood clots in deep veins) (4). Most combined hormonal contraceptives and spironolactone are safe and can be used to effectively treat adult acne in women. They can be used as monotherapies and adjuvants (applied after initial therapy to boost the body’s immune response). (4)
However, clinical examinations and screenings must be conducted to assess the risk of venous thromboembolism in patients before prescribing medication.
Acne can also be a result of stress, depression, or anxiety. Consult a doctor before taking contraceptives. Some contraceptives may affect the mood of women, which may lead to stress, anxiety, and depression.
Menstrual cycle irregularities, headaches, and emotional strain are a few other side effects. Two separate studies showed oral contraception may result in depression, and one found that it may lead to ovarian cyst formations (4).
Using birth control can help reduce acne and even boost self-esteem in terms of one’s appearance. While oral contraceptives can be used to effectively treat acne, the right screening must be done to reduce the risk of any adverse effects. You may use combined hormonal contraceptives for better results. Make sure you do not take progestin-only contraceptives as they may worsen skin further. More importantly, consult your doctor before you take oral contraceptives for acne treatment.
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