Zits, spots, pimples, blemishes, whatever you may call them, the painful, red, unsightly bumps on the face caused by acne are a distressing problem for millions of Americans. Acne is a skin condition that can last well beyond the teenage years. Adult women especially can be affected by acne due to fluctuating hormone levels. Dermatologists may prescribe birth control pills for acne when other treatment fails. Continue reading to learn more about acne birth control pills, including how they work, the side effects of taking birth control pills, and which are the best types of birth control for acne sufferers.

Do birth control pills help with acne?

Physicians have been prescribing birth control pills for hormonal acne for decades. The birth control pill is a standard treatment option for patients with hormonal acne. It can be a very effective treatment for patients who have not responded to topical acne treatments. 

How does birth control treat acne?

Acne develops when hair follicles in the skin become clogged with sebum (oil) and dead skin cells, leading to the formation of blackheads, whiteheads, and pimples. In adult women, fluctuating hormone levels at various stages of life, such as puberty, menstruation, and menopause, can lead to acne breakouts. Acne can also be worsened by hormonal fluctuations in women diagnosed with polycystic ovarian syndrome (PCOS).

Specifically, increased androgen levels (for example, the male hormone testosterone) are to blame for hormonal acne in women. An imbalance in androgens leads to increased oil or sebum production that can clog pores and cause acne.

Birth control pills help with acne by preventing spikes in androgen levels. By regulating hormones, they prevent the sebaceous glands in the skin from making too much oil, clogging the pores, and causing acne. 

What is the best birth control for acne?

There are various forms of hormonal birth control available, including IUDs (Mirena, Skyla, Liletta, Kyleena), implants (Nexplanon), rings (NuvaRing), Depo-Provera shots, and oral contraceptive pills. Birth control pills are of two types—combination pills that contain both estrogen and progestin hormones and minipills that contain only progestin. 

To treat acne, dermatologists use combination birth control pills. Combination birth control contains estrogen and progesterone, for example, drospirenone and ethinyl estradiol. The estrogen component in oral contraceptives is essential for acne treatment. Progestin does not work on its own. In fact, minipills that contain only progestin hormones can worsen acne and are not approved for acne treatment.

Which oral contraceptive pills are best for acne?

As noted, dermatologists prescribe combination oral contraceptives which contain both estrogen and progestin to reduce the production of sebum and improve acne. The United States Food and Drug Administration (FDA) has approved four combination birth control pills for acne treatment—Estrostep Fe, Ortho Tri-Cyclen, Yaz, and Beyaz. It can take some experimentation to discover which is the best birth control pill to help your acne. The type of progestin in the pill may also affect how well it works in treating acne. 

How long does birth control take to clear up acne?

It takes time for a birth control pill to regulate the hormone levels in the body. For this reason, it can take several weeks to months for birth control pills to help with acne. Studies have shown that most patients see some improvement in their skin after three months of acne treatment with oral contraceptives. The most significant improvement in hormonal acne breakouts is typically observed after roughly six months of treatment with birth control. 

Does birth control make acne worse before it gets better?

Birth control is not a foolproof acne treatment or cure. Sometimes, birth control can make acne worse before it clears up your skin. Unfortunately, there is no way to predict what will or won’t work for you. Also, it may take trials of various birth control pills to find the one that will help your acne without minimal side effects. Your dermatologist or gynecologist will discuss other acne treatment options with you if taking birth control pills does not help.

Is the Yaz birth control pill good for acne?

As noted above, the Food and Drug Administration (FDA) has approved four birth control pills containing estrogen and progesterone to treat acne. These types of birth control include different hormones (estrogen and progestin). 

• Yaz combination birth control pill contains drospirenone, a synthetic form of progesterone. 
• Ortho Tri-Cyclen includes a type of synthetic progesterone called norgestimate.
• Estrostep contains ethinyl estradiol and norethindrone, which lower testosterone (androgen) levels. 

Studies have shown that drospirenone (the progestin in Yaz) is the most effective among the FDA-approved birth control pills in treating and preventing acne. However, individual results can vary.

Notably, oral contraceptives such as Levora and Lo Minastrin Fe that contain levonorgestrel and norethindrone, respectively, have been found to be the least effective in controlling acne. In addition, some birth control pills may actually cause acne flare-ups, for example, Lo Loestrin, which contains hormones like norethindrone acetate (a type of estrogen).

The bottom line is that while birth control pills can help acne, however, they all have different levels of effectiveness and side effect profiles. Therefore, before you take birth control pills for acne, it is important to talk to your doctor and get medical advice. 

Will I benefit from birth control pills for hormonal acne?

Every patient responds differently to birth control. You should work with your dermatologist or OBGYN to decide on the best acne treatment for you. Using birth control pills is an option, but it isn't without risks. Various factors need to be considered. One of the major side effects of hormonal contraceptives is the increased risk of blood clots. Supposedly, if you have high blood pressure and a history of blood clots or a family history of clotting disorders, your dermatologist or OBGYN may decide that the possibility of acne-free skin is not worth the increased risk of side effects. Other side effects to consider are breast tenderness and weight gain. Your doctor will guide you to evaluate the risks and the benefits of using birth control for acne. Keep in mind that birth control pills with a slightly lower estrogen component are available as an option. 

The only way to find out if birth control pills will treat your acne without side effects is to be examined by a healthcare provider then try one or more oral contraceptives if you are deemed an appropriate candidate for this type of acne treatment.
 

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925193/

2. https://jddonline.com/articles/dermatology/S1545961616P0670X