For women, acne, especially severe acne, can lead to embarrassment, anxiety, social isolation, and permanent skin scarring. Severe acne can even lower the chances of employment in some industries.
Dermatologists have been using birth control pills to treat acne in women for decades. However, only three pills have actually been approved by the FDA for treating acne here.
In general, birth control to treat acne is often advised for healthy women who also need contraception. It is typically started after other acne treatments, such as topical creams and oral antibiotics, have failed to clear up the skin. Here is information about the risks and benefits of taking birth control pills for acne. It can help you make an informed decision about what's right for you.
How Does Birth Control Treat Acne?
As every teenager knows, there's a clear relationship between hormones and acne. Some women experience premenstrual flare-ups of acne as their hormone levels shift during their cycle. And for some, acne simply persists through the years, even after menopause.
Acne is triggered by an excess production of sebum. Sebum is an oil made by glands in your skin. Along with skin cells, sebum can clog pores and promote the growth of bacteria that contribute to acne. Androgens, a group of hormones that includes testosterone, stimulate your skin to produce sebum.
A woman's ovaries and adrenal glands normally produce a low level of androgens. Higher levels of androgens can lead to excess sebum. Taking birth control pills that contain both estrogen and progesterone lowers the amount of androgens in your body. This results in less sebum and less severe acne.
Types of Birth Control to Treat Acne in Women
The last decade has seen an explosion in new types of birth control. But so far, only three types of birth control pills have been approved by the FDA for treating acne. All three are "combination" oral contraceptives that contain both estrogen and progesterone. In fact, birth control pills that contain only progesterone can actually make acne worse.
Each type of birth control pill used for acne contains a low dose of the same form of estrogen. But each one uses a different form of progesterone.
The FDA has approved the following types of birth control for acne:
- Ortho Tri-Cyclen uses estrogen combined with a progestin called norgestimate. A progestin is a synthetic, or manmade, form of progesterone. The pill is available with different doses of progestin.
- Estrostep Uses estrogen combined with a progestin called norethindrone. The pill is available with different doses of estrogen.
- YAZ uses estrogen combined with a manmade form of progestin called drospirenone. The FDA has concluded that birth control pills containing drospirenone may have increased risk for blood clots compared to pills containing other progestins. Other brands containing drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin, and Zarah.
- Studies have not shown a major difference among these three pills in terms of how well they treat acne.
Treating Mild to Severe Acne
These three oral contraceptives have been approved for treating moderate acne in women who:
- Are at least age 14 or 15 (depending on the brand)
- Have already started menstruating
- Need contraception
In actual practice, doctors prescribe birth control for the full spectrum of acne, from mild to severe.
In addition, doctors may prescribe additional birth control products for acne.
For example, the oral contraceptives Yasmin and Alesse have both been clinically shown to improve acne. But neither one has been approved by the FDA for this use.
If you're already taking an oral contraceptive that's working well in treating acne, there's no need to switch brands. But if you are taking birth control pills for acne for the first time, it's best to use one of the three types now approved for acne treatment.
You may need to take an oral contraceptive for a few months before your skin starts to clear. And an initial flare-up of acne is common when a woman first starts taking birth control pills.
Birth control pills work on only one acne-related factor -- excess sebum. Doctors often prescribe other forms of acne treatment -- topical medications or antibiotics -- to be used alongside them for best results in clearing the skin.
If you have severe acne along with irregular periods, excess facial hair, or obesity, your doctor may do further testing for a medical condition called polycystic ovary syndrome or other hormonal condition.
Benefits of Birth Control for Acne
Several clinical trials have shown that taking combination birth control pills can result in:
- Decreased acne flare-ups
- Fewer pimples
- Less inflammation
- Less severe acne
Many women with severe acne take oral contraceptives with other acne treatments. For women who also want contraception, taking birth control pills for acne also offers one of the most reliable forms of contraception, as long as the pills are taken on schedule as prescribed.
Risks of Oral Contraceptives
Today's birth control pills contain lower doses of estrogen and progesterone than in the past. This has significantly lowered their medical risks. Still, women taking oral contraceptives do have a higher risk of side effects, including heart attack, stroke, and dangerous blood clots in the legs or lungs.
Other risks include:
- Hypertension (high blood pressure) and other cardiovascular problems
- Liver and gallbladder disease
- Migraine headaches
- Depression and mood changes
Who Should Avoid Birth Control Pills
A decision to take birth control pills needs to take into account your medical history. Certain medical conditions could become worse if you use an oral contraceptive. Birth control pills are usually not advised if you have any of the following conditions:
- History of heart disease, hypertension, blood clots in your legs or lungs
- Blood clotting disorder such as factor V Leiden deficiency
- History of cancer, especially breast, uterine, or liver cancer
- Liver disease, diabetes, or migraine headaches
You also shouldn't take oral contraceptives if:
- You're a smoker over age 30
- You're currently pregnant or breastfeeding
- You're severely obese or physically immobilized
Tips for Maximum Benefit
Here are tips for getting the most benefit from your acne treatment:
- Continue taking other acne treatment prescribed by your doctor. An oral contraceptive targets only part of the acne problem.
- Be sure to precisely follow the schedule for taking birth control pills. Doing so provides the maximum benefit and safety.
- Talk with your doctor about possible side effects of the birth control you're considering. These can include breast tenderness, headaches, breakthrough bleeding, or an initial, temporary flare-up of acne. It's important to know what to expect.
- Tell your doctor about any other medications you're taking. Some can interfere with the effectiveness of an oral contraceptive and lead to an unwanted pregnancy. Taking some types of birth control pill together with oral rifampin (an antibiotic) may make it necessary to use a back-up form of contraception.