Acne: How effective is the contraceptive pill?

Acne is linked to changes in your hormone levels, which is why it often starts during puberty. During this time, the increased level of testosterone makes your skin greasy.

Women with hormonal acne may experience worsened symptoms during their menstrual cycle as a result of hormonal changes.

Small oil glands at the base of hair follicles (sebaceous glands) produce an oily substance called sebum. This keeps your skin and hair hydrated. These glands produce more sebum when testosterone levels are higher.

Acne occurs when there is excess sebum. The extra oil and dead skin cells block the entrance of the gland. This can then become infected by the bacteria on your skin, resulting in clogged pores, leading to acne.

As contraceptive pills contain hormones, they can affect acne by making it better or worse.

The action of the COCP depends on the levels of the hormones within them, and the balance between these.

The COCP contains the hormones, oestrogen and progestogen. In COCPs, the effects of the oestrogen outweigh the effects of the progestogen. This means there is a reduction in the production of sebum, as well as less inflammation, which improves acne.

Some contraceptives such as the progesterone only pill (or ‘mini pill’) can make acne worse.

Non-hormonal contraceptives, such as the copper IUD, generally won’t affect your skin.

Many studies have looked at how well oral contraceptive pills fight acne. Certain types of contraceptives can help treat pimples, cystic lesions, whiteheads and blackheads.

Research from studies comparing COCPs to a placebo (a pill without any hormones in it), found that oral contraceptives significantly reduced acne lesions and severity.

How effective is the pill in treating acne?

A Cochrane review was conducted to assess the effectiveness of COCPs for the treatment of acne in women. It showed that COCPs produced a 40% to 60% reduction in acne lesions. Therefore, this treatment is an effective option for women with acne.

It’s important to note that COCPs are not a quick fix for spots. The skin usually begins to improve after 3 months of taking the pill, while the biggest improvement is seen after 6 months.

You may experience a flare-up of your acne when you first start taking oral contraceptives. Your doctor may prescribe topical treatments along with birth control pills to help. If your skin still hasn’t improved after this timeframe, you should speak with your doctor.

As previously mentioned, progesterone-only oral contraceptives can make acne worse.

Other contraceptives that contain progesterone include the:

• contraceptive implant
• contraceptive injection
• hormonal intrauterine device (IUD).

This means that they have the potential to contribute to acne as a side effect.

Each person's body may react differently to various types and amounts of hormones. This is why you may need to try a range of contraceptives and communicate with your doctor to find the best contraceptive pill for you.

Some people don't get acne on the pill but may experience 'post-pill acne' after stopping birth control. This is because oral contraceptives regulate their hormones and stopping it disrupts this regulation.

Many people often wonder what the best contraceptive pill for acne is. Studies show that the following combinations of hormones have been proven to reduce acne:

There are many pros and cons of taking the birth control pill. Your doctor should fully inform you of these and ultimately, the decision is yours.

Pros:

• It may help reduce acne
• It usually makes your periods regular, lighter and less painful
• It reduces your risk of ovarian, womb and colon cancers (but may increase the risk of other types)

Cons:

• You may experience unwanted side effects such as headaches, breast tenderness, mood changes or nausea
• You may have changes in your libido
• Breakthrough bleeding and spotting are common in the first few months of using the pill

If you are wondering whether you should use oral contraceptives for acne, you should consult your doctor. Your doctor may suggest the COCP as a treatment option if you are sexually active and need a hormonal contraceptive. Additionally, if you need the pill to regulate your menstrual cycle and happen to suffer from acne, the COCP may be a good choice.

Your doctor will also need to carry out a check to ensure the pill is suitable for you.

The COCP may not be suitable for you if you are over 35 years old and smoke, or if you have certain medical conditions (such as high blood pressure, migraines, or breast cancer), a high BMI or more.

Other acne treatment options

If the COCP is not suitable for you, other treatment options are available. Other medications that can be used to treat acne include:

• topical retinoids
• topical antibiotics
• azelaic acid
• benzoyl peroxide
• oral antibiotics