Birth Control and Acne

 

How Does Birth Control Affect Acne?

In some cases birth control can improve your complexion, but in other cases it can make breakouts much worse. The key factor? The type of hormones in your birth control. Find out more below!

Worsens Acne

Little Effect

Improves Acne

Improves Acne

DRSP+EE Pill

Yaz Ocella Yasmin

NGM+EE Pill

MonoNessa TriNessa

DSG+EE Pill

Apri Reclipsen

Vaginal Ring

NuvaRing

Little Effect

NE+EE Pill

Microgestin LoLoestrinFe

Patch

OrthoEvra

Non-Hormonal Contraception

Trojan Durex

NE-Only Pill

Jolivette

LNG+EE Pill

Levora Lutera

Worsens Acne

Depot Injection

Depo-Provera

Hormonal IUD

Skyla Mirena

Subdermal Implant

Implanon Nexplanon

Birth Control Method Popularity

Combined oral contraceptive

57%

Hormonal IUD

23%

Subdermal Implant

7%

Vaginal Ring

5%

Depot injection

4%

Other

2%

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Questions & Answers

What causes acne?

Acne is often caused by many different factors, including diet, hormones, stress, environment, medications, and more. Hormonal contraceptives are an interesting variable in that they can improve or worsen acne depending on the particular hormone(s) involved. Given the wide array of birth control options available, it can be greatly useful to know which hormones can affect the skin and how.

How are hormones involved in acne?

Many different hormones contribute to the development of acne, but sex hormones (androgens) play a particularly important role. Both males and females produce androgens, but males naturally produce higher levels of androgens (such as testosterone); therefore, androgens are often referred to as "male hormones."

Androgens stimulate the sebaceous glands in our skin to produce and secrete sebum, or oil. When skin looks and feels "oily," it's due to sebum. Sebum is important—it helps protect and moisturize the surface of the skin and hair.

However, when the sebaceous glands work overtime (for example, during puberty), the extra sebum can get trapped in the hair follicle or pore, and the dead skin cells that should be sloughing off normally also become trapped in the sticky sebum. Many people see these blocked pores as small skin-colored bumps, or comedones.

These blocked pores can sometimes lead to bacterial growth, as bacteria feed on the sebum, which leads to inflammation, as the body fights the bacteria. The result is the inflammatory acne that many of us have experienced!

What does "hormonal contraception" mean?

Hormonal contraception refers to birth control methods that contain female hormones. These hormones work on the body's reproductive system to help prevent pregnancy. A hormonal birth control method may contain one hormone (a progestin) or a combination of two hormones (an estrogen and a progestin).

Birth control pills that have both an estrogen and a progestin are often referred to as combined oral contraceptive pills (COCs), while birth control pills that contain only a progestin are often referred to as progestin-only contraceptive pills (POPs).

There are other hormonal contraceptives besides pills, such as vaginal rings, implants in the arm, and intrauterine devices (IUDs).

What are estrogens and progestins?

While both males and females produce estrogens, females generally tend to have higher levels, as estrogens are primarily produced by the ovaries. This is why estrogens are often referred to as "female hormones." Estrogens serve a number of functions in the body, and in women, they play a large role in regulating the menstrual cycle. The estrogens in hormonal contraception mimic the effects of the body's own natural estrogen. Contraceptives that contain an estrogen component are often helpful for treating breakouts because estrogens can help suppress the production of male hormones (androgens).

The progestins in hormonal contraception are synthetic hormones that mimic progesterone, another sex hormone produced by the body. Progestins and progesterones are also generally regarded as "female hormones," as they play a major role in preparing the body for and maintaining pregnancy. As evidenced in the graph above, different types of progestins may improve (or worsen) acne.

Many women note that their acne tends to get better or worse based on where they are in their menstrual cycle. Around 7 to 10 days before the onset of a woman's period, estrogen and progesterone levels decrease, while androgen (male hormone) levels stay the same. This hormone fluctuation contributes to the common phenomenon of premenstrual acne, or "PMS acne," that many women experience.

How does birth control affect acne?

Any contraceptive that contains both an estrogen and a progestin may theoretically help acne and oiliness, as they can suppress the effects of androgens ("male hormones") in the body.

However, some pills can be better (or worse!) for acne because of the specific progestin they contain. Certain progestins have more androgenic (male hormone-like) effects on the skin than others.

For example, pills containing the progestin drospirenone are generally the most helpful for the skin, followed by those containing norgestimate or desogestrel. These progestins have low androgenicity; that is, they have low male hormone-like effects. Pills containing levonorgestrel or norethindrone are the least likely to help acne due to their higher androgenicity; in patients who are looking for help with acne, these are best avoided.

What is an IUD?

An intrauterine device (IUD) is a small plastic "T-shaped" contraceptive device that is inserted into a woman's uterus to prevent pregnancy. There are two types of IUDs: the copper IUD (Paragard) does not release hormones and can last for up to 10 years, while hormone-containing IUDs (Mirena, Skyla, Liletta) can last for up to 3-5 years. The hormonal IUDs contain levonorgestrel, which is one of the more androgenic (male hormone-like) birth control hormones. Hormonal IUDs can worsen acne (and oiliness!) in a lot of people, and sometimes this happens gradually and almost imperceptibly. As the copper IUD does not release hormones, it does not have any positive or negative effect on acne.

Can I learn more about this scientific study?

Curology is an online dermatology practice that specializes exclusively in acne and anti-aging treatment. Through daily consultations with acne patients, it quickly became evident that birth control can significantly affect the skin, and sometimes more so than other factors like diet, stress, and skincare routine. Therefore, the dermatologists set out to investigate the relationship between birth control and acne. The study was approved by the Institutional Review Board (IRB) of UC San Diego, and all patient data was anonymized.

The study was carried out by two Curology dermatologists in cooperation with two other physicians from UC San Diego and Rady Children's Hospital in San Diego. The study analyzed the patient-reported effects of hormonal birth control on acne from 2,147 patients who were using a hormonal contraceptive at the time of their initial consultation for acne

This is the single largest study to date that observes how different types of birth control affect acne. Many of the conclusions have been summarized above, and the full abstract of the study is available here.

Who should I talk to about birth control?

Because there are many factors to consider when choosing a birth control method (not just your skin!), it is important to discuss the benefits and risks and what is right for you with your in-person provider (e.g. OB/GYN, pediatrician, primary care provider, campus health provider, etc.). Usually, your provider will ask about your medical history, including what medications you may already take. They may also check your height and weight and take your blood pressure. Birth control pills that contain an estrogen are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

How can I get acne treatment?

Acne is one of the most common skin conditions affecting men and women worldwide. There is no shortage of treatments available both by prescription and on the shelves at your local drugstore. It can be difficult to navigate the seemingly endless options, and it is easy to feel frustrated and not know where to start. Your primary healthcare provider may be able to prescribe certain medications or even refer you to a dermatologist.

For those who would prefer to get their skincare online, Curology is an all-inclusive service that sets you up with a licensed medical provider to communicate with via messaging and high-resolution photos. Curology provides you with personal dermatology advice and a customized prescription medication shipped to your door.

Learn about Curology

 
Curology Bottle

$19.95 per month

Includes custom medication, formula tweaks, and free messaging with your medical provider. Try it free, just cover shipping.

DRSP+EE Pill

Drospirenone, Ethinyl estradiol

Examples: Beyaz, Gianvi, Loryna, Nikki, Ocella, Safyral, Syeda, Vestura, Yasmin, Yaz, Zarah

Effects on Acne

3%

31%

40%

26%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Birth control pills containing drospirenone and ethinyl estradiol appear to be the most effective contraceptives for improving acne. Drospirenone works against the male-like hormones that can make acne worse and has low androgenicity (male-hormone-like effects), so it can significantly improve hormonal acne in some women.

Birth control pills are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

NGM+EE Pill

Norgestimate, Ethinyl estradiol

Examples: Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Sprintec, Tri-Sprintec, TriNessa, Mononessa, MonoLinyah, Tri-Linyah, Ortho Cyclen, Previfem, Tri-Previfem, Tri-Estarylla

Effects on Acne

6%

41%

36%

17%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Birth control pills that contain norgestimate and ethinyl estradiol are fairly good for acne, as norgestimate has minimal male-hormone-like effects, and ethinyl estradiol can help block the production of male hormones. The only birth control pills that tend to be better for acne are those containing the drospirenone (Yaz, Yazmin, etc.). When there is an option between triphasic (as in Ortho Tri-Cyclen) and monophasic (Ortho-Cyclen) progestin doses, acne sufferers may benefit more from a triphasic pill, although these monophasic pills can also be very helpful for acne.

Birth control pills are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

DSG+EE Pill

Desogestrel, Ethinyl estradiol

Examples: Apri, Reclipsen, Azurette, Mircette, Novynette, Velivet, Desogen, Emoquette, Enskyse, Marvelon, Ortho-Cept 28, Kariva, Pimtrea, Viorele

Effects on Acne

2%

53%

29%

15%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Birth control pills that contain desogestrel and ethinyl estradiol are neither the best nor the worst for the skin. In some women, these pills can help acne, though generally, not as much as pills with drospirenone.

Birth control pills are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

Vaginal Ring

Etonogestrel, Ethinyl estradiol

Examples: NuvaRing

Effects on Acne

4%

62%

19%

14%

Makes it worse

Not much effect

Helps a bit

Helps significantly

The vaginal ring (NuvaRing) contains etonorgestrel and ethinyl estradiol. It is inserted into the vagina, where the hormones are released over three weeks, and then it is removed for one week. Etonorgestrel has moderate male-hormone-like effects, so the NuvaRing tends to help the skin more than norethindrone- and levonorgestrel-containing pills, but not as much as drospirenone-, norgestimate-, and desogestrel-containing pills (which do not tend to have male-hormone-like effects).

NuvaRing may not be suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

NE+EE Pill

Norethindrone, Ethinyl estradiol

Examples: Microgestin, Loestrin, Loestrin Lo, Junel, Gildess, Larin, Lomedia, Generess, Balziva, Zenchent, Necon, Cyclafem, Nortrel, Ortho-Novum, Alyacen, Tri-Norinyl, Tilia, Tri-Legest

Effects on Acne

8%

62%

22%

8%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Birth control pills that contain norethindrone and ethinyl estradiol are neither the worst nor the best for the skin. Norethindrone can help acne in some women, though they can also make it worse. Pills that contain a different progestin, such as drospirenone or norgestimate, can be much better for the skin.

Birth control pills are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

Patch

Norelgestromin, Ethinyl estradiol

Examples: Ortho Evra, Xulane

The transdermal patch (Ortho Evra, now discontinued, and Xulane) contains norelgestromin and ethinyl estradiol.

The number of patients using the transdermal patch in this study was too small to allow for detailed analysis of its effect on acne. However, based on this relatively small sample size, it appears that the patch has little (or at times, positive) effect on acne.

The Xulane patch is not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

Non-Hormonal Contraception

Examples: Condoms, copper IUD (Paragard), vasectomy (male sterilization), tubal ligation (female sterilization)

Non-hormonal intrauterine devices (IUDs), such as the copper IUD ParaGard, do not release any hormones, so they have no known effect, positive or negative, on acne. Similarly, other non-hormonal birth control methods such as condoms have no effect on acne. Some women may notice a change in their skin when they switch to a non-hormonal birth control method, however these types of changes are generally due to stopping the previous method of contraception.

NE-Only Pill

Norethindrone

Examples: Ortho Micronor, Jolivette, Camila, Errin, Heather, Jencycla, Lyza, Micronor, Nor-QD, Nora-BE

As progestin-only pills (or “minipills”) do not contain an estrogen, they do not tend to have a helpful effect on acne. They most commonly contain the progestin norethindrone, which can worsen acne due to its male-hormone-like effects.

The number of patients using progestin-only pills in this study was too small to allow for detailed analysis of their effect on acne. However, based on this relatively small sample size, it appears that they have little (or at times, negative) effect on acne.

LNG+EE Pill

Levonorgestrel, Ethinyl estradiol

Examples: Levora, Lutera, Amethyst, Amethia, Amethia Lo, Camrese, Camrese Lo, Daysee, Introvale, Quasense, Seasonale, Seasonique, Quartette, Alesse, Aubra, Aviane, Falmina, Lessina, Orsythia, Sronyx, Altavera, Chateal, Jolessa, Kurvelo, Levlen, Macrogynon, Microgynon 30, Neovletta, Nordette, Portia, Enpresse, Trivora

Effects on Acne

10%

65%

19%

6%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Birth control pills that contain levonorgestrel and ethinyl estradiol can make acne worse because levonorgestrel can have male-hormone-like effects in the skin. Pills that contain a different progestin, such as drospirenone or norgestimate, can be much better for the skin.

Birth control pills are not suitable for all women, especially those who are over 35 and smoke or have a history of stroke or blood clots.

Depot Injection

Medroxyprogesterone acetate

Examples: Depo-Provera

Effects on Acne

27%

63%

5%

5%

Makes it worse

Not much effect

Helps a bit

Helps significantly

The depot injection (Depo-Provera) is a progestin-only contraceptive injection that slowly releases the progestin medroxyprogesterone over a 12 week period. As medroxyprogesterone is one of the more androgenic (male-hormone-like) progestins, it often worsens acne in women, especially if used over time.

Hormonal IUD

Levonorgestrel

Examples: Mirena, Liletta, Skyla

Effects on Acne

36%

54%

7%

3%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Hormonal intrauterine devices (IUDs), such as Mirena, Liletta, and Skyla, are progestin-only contraceptives that steadily release the progestin levonorgestrel for up to 3 to 5 years, depending on the device. As levonorgestrel is one of the more androgenic (male-hormone-like) progestins, these hormonal IUDs often worsens acne in many people, and sometimes it happens gradually and almost imperceptibly.

Subdermal Implant

Etonorgestrel

Examples: Nexplanon, Implanon (discontinued)

Effects on Acne

33%

60%

7%

1%

Makes it worse

Not much effect

Helps a bit

Helps significantly

Subdermal implants, such as Nexplanon, are progestin-only contraceptives that are inserted into the upper arm and steadily release the progestin etonorgestrel for up to 3 years. Like other progestin-only contraceptives, such as Mirena and Depo-Provera, subdermal implants tend to worsen acne due to their male-hormone-like effects in the skin.

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