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Last updated March 26, 2020. 4 minute read

Birth control and acne: the relationship explained

Cases of acne can range from mild to severe depending on the person, but individual cases can also worsen or improve over time. Some people suffer from longer and more severe breakouts. When over-the-counter treatments aren’t working, one option you may consider is birth control for acne.

Linnea Zielinski Written by Linnea Zielinski
Reviewed by Dr. Mike Bohl, MD, MPH

The pill and the pimple. It sounds a little like a fairy tale, like The Princess and the Pea. It’s fitting, though, since the miraculous zit-banishing benefits of “the pill” or hormonal birth control may just feel like you have a fairy godmother granting your secret wishes. But for others, the promise of popping a pill for perfect skin may just sound too good to be true.

Vitals

  • Acne happens when oil glands or hair follicles become plugged with a buildup of bacteria, dead skin cells, and oil.
  • Androgens, types of hormones, influence how much oil your glands produce.
  • Hormonal birth control pills that use synthetic estrogen and progesterone can influence androgen levels.
  • But birth control comes with potential side effects, which is why it’s generally a last line of defense against acne.

Most of us have wished away a particularly painful or prominent zit. It’s estimated that 85% of people experience acne, also referred to as acne vulgaris, at some point in life (Chiu, 2003). Acne vulgaris is a chronic inflammatory condition that affects the skin’s oil glands and hair follicles. When these glands and follicles become plugged with a buildup of bacteria, dead skin cells, and oil, spots and pimples that may be painful occur. There are multiple types of blemishes, too, including whiteheads, blackheads, and cysts, and they’re not limited to your face, either. Acne can show up anywhere, including your face, neck, chest, shoulders, and back.

Cases of acne can range from mild to severe depending on the person, but individual cases can also worsen or improve over time. Some people suffer from longer and more severe breakouts. When over-the-counter treatments aren’t working, one option you may consider is birth control for acne.

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Birth control as acne treatment

Excess oil can cause acne, but oil production differs from person-to-person based on skin type. Our sebaceous glands, which are responsible for sebum production and determine how oily your skin is, also change how active they are at different points in life. That’s why women can experience worse acne during hormonal changes. Androgens, type of hormones, fluctuate over time. They rise during puberty, which is thought to be why breakouts are more common during this stage in our lives. As these hormone levels rise, sebaceous glands can become bigger and produce more sebum. If pores are blocked, you get whiteheads or blackheads. And if there are bacteria that proliferate, you get inflammatory acne.

For these reasons, many acne treatments target oil production. Some over-the-counter products such as moisturizers and cleansers aim to reduce oil buildup on acne-prone skin. But birth control targets the same cause in a different way.

How it works

There are different types of birth control, but some combination oral contraceptive pills are the ones approved by the U.S. Food and Drug Administration (FDA) to treat acne. It’s worth noting that even though some intrauterine devices (IUDs) contain hormones, they are not approved for the treatment of skin problems such as acne. Combination birth control is a type of birth control that contains synthetic forms of both the hormones estrogen and progesterone. Other pills only contain one synthetic hormone: progestins. But even within the subset of combination birth control pills, there are variations. Combination pills will have different ratios of the two different hormones, depending on the brand.

Combination birth control helps clear up acne by reducing the amounts of androgens, hormones that act on our sebaceous glands, circulating in the body. Lower levels of androgens mean less sebum production, which in turn decreases how clogged your pores can become. This effect doesn’t happen, however, unless the birth control pill you take contains synthetic versions of both estrogen and progesterone.

Not all combination pills are approved to treat acne

The FDA has only approved some combination birth control pills to treat acne. Those pills include:

  • Beyaz (drospirenone, ethinyl estradiol, and levomefolate calcium)
  • Estrostep Fe (norethindrone acetate, ethinyl estradiol, and ferrous fumarate)
  • Ortho Tri-Cyclen (norgestimate and ethinyl estradiol)
  • Yaz (drospirenone and ethinyl estradiol)

Yaz is easily confused with Yasmin. They contain the same hormones, drospirenone, and ethinyl estradiol, but in different amounts. Despite the similarities in ingredients, Yasmin is only approved to prevent pregnancy and cannot be prescribed to address severe acne.

But even within this list, some may be more effective than others at helping you achieve clear skin. A review of 31 clinical trials found that all the combination birth control pills approved for the treatment of skin problems were effective at decreasing non-inflammatory (whiteheads and blackheads) and inflammatory acne (cystic acne, papules, and pustules) (Arowojolu, 2012). 

But within this group, there were oral contraceptive pills that were more effective. But the researchers note that all possible treatments improved the frequency and severity of acne lesions, and the differences were not big enough to influence prescription decisions (Arowojolu, 2012).

Potential risks and side effects

Before talking to your dermatologist about a birth control prescription, you should be aware that these pills do come with potential side effects, whether you’re taking it for birth control or acne. Oral contraceptive pills may cause headaches, mood swings, nausea, spotting, and weight gain. Hormonal birth control has been proven effective against hormonal acne because of how it addresses androgenic hormone levels in the body, but is not suggested for everyone. Birth control does increase your risk of blood clots, so people with preexisting clotting conditions should avoid these medications (Trivedi, 2017). And these blood clots can potentially cause deep vein thrombosis (DVT), heart attack, and stroke. A healthcare provider can tell you if you’re a good candidate.

Other acne treatments

Before considering birth control for acne, your dermatologist may want you to try other acne treatments. Over-the-counter or prescription treatment options are available, such as moisturizers and cleansers that aim to reduce oil buildup on acne-prone skin. These products will use glycolic acid, salicylic acid, or benzoyl peroxide as their active ingredient. There are also products that should be used as spot treatments and may be most helpful if you struggle with fewer large zits rather than general breakouts.

If you’re still struggling with adult acne and have tried over-the-counter acne treatments, it may be helpful to visit a dermatologist who can help craft a skincare routine tailored to your skin type.