Oral contraceptives are one of the most effective methods for preventing pregnancy. Commonly called birth control pills (or just “the pill”), they’re also becoming a popular treatment for another condition that affects many women: acne. When other acne treatments have not been successful, birth control pills may be the answer.
Exactly how does birth control help with acne? Birth control affects hormones, and hormones play a major role in acne. Hormones called androgens promote the production of sebum, an oil made by your skin. Too much sebum can lead to clogged pores and bacterial growth, which create breeding grounds for acne.
Women usually produce low levels of androgens, but hormonal changes related to their menstrual cycle can raise androgen levels and, consequently, trigger acne breakouts. For some women, acne persists throughout their cycle. Even during perimenopause, when a woman’s body prepares for menopause, hormonal changes can continue to promote acne.
Birth control pills that contain both the hormones estrogen and progesterone reduce functional androgen levels, thereby reducing sebum production and acne. Pills that contain only progesterone (the “mini-pill”) can actually make acne worse.
“Certain types of birth control pills can help treat blackheads, whiteheads, pimples and cystic acne,” says Jonathan Dunn, MD, an OB-GYN at Scripps Clinic Carmel Valley. “They can be especially effective in treating stubborn hormonal acne along the jaw, lower face and neckline when other treatments, such as topical creams and oral antibiotics have not helped.”
The Food and Drug Administration (FDA) has approved three types of birth control pills for acne treatment, and all have shown similar effectiveness in treating moderate acne. While all contain the same form of estrogen, the forms of progesterone differ. The three approved pills are:
- Ortho Tri-Cyclen combines estrogen with a synthetic form of progesterone, called a progestin. The progestin in this pill is norgestimate and is available in different levels.
- Estrostep combines estrogen with a progestin called norethindrone. It is available with different doses of estrogen.
- YAZ combines estrogen with a progestin called drospirenone.
“The best choice for one woman may not be right for another,” says Dr. Dunn. “Some women need higher levels of hormones for the most effective results with fewest side effects, while others do better with lower levels.”
Birth control pills don’t clear up acne overnight. It may take several months of treatment before acne starts to clear, and flare-ups are common at the beginning of birth control acne treatment. Your doctor may prescribe topical treatments along with birth control pills.
If you’re a woman who needs both contraception and acne treatment, birth control pills may be ideal. When used as directed, most birth control pills have an effectiveness rate of close to 99 percent. However, a dermatologist may prescribe birth control pills for acne even if contraception is not a concern. The pill also may have other benefits, such as shorter and lighter periods and less painful menstrual cramps.
Birth control pills today have lower levels of estrogen and progesterone than in the past, which reduces the risk of medical problems. However, women taking the pill may still have higher risks of some side effects including:
- Heart attack or stroke
- Blood clots in the lungs or legs
- High blood pressure
- Migraine headache
- Depression and mood changes
- Breast tenderness
- Bleeding between periods (breakthrough bleeding)
In some cases, switching to a different pill may relieve side effects, such as breakthrough bleeding and headaches. Your doctor can help determine which pill is best for you.
Some women should not take birth control pills if they have certain health conditions or lifestyle habits that may raise their risk of problems. Generally, you should avoid birth control pills if you:
- Are over age 30 and smoke
- Are pregnant or breastfeeding
- Are obese
- Have heart disease, high blood pressure or a history of blood clots
- Have a history of breast, uterine or liver cancer
- Have a history of migraines with aural or visual symptoms
“Women who are considering birth control pills for acne treatment should talk to their primary care physician, gynecologist or dermatologist about their options,” says Dr. Dunn. “We can help you determine if this is the right treatment for you and which pill would be most appropriate for your individual needs.”