Birth control and 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.

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."

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).

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.

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.

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. It’s possible that the small amount of hormones in IUDs could worsen acne, but not necessarily! If you seem to get more acne after getting an IUD, the usual acne treatments, especially Curology, should treat it effectively. However, if your acne proves stubborn, you may want to talk with your gynecologist or other local healthcare provider about your options. As for the copper IUD, it doesn’t release hormones, so it won’t have any positive or negative effect on acne.

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.

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.

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.