Dermatologists Say This Is the Best Birth Control for Acne

Best birth control for acne

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For some people, acne isn't just a pesky skin issue; it's chronic irritation. Instead of dealing with the occasional breakout or two, the skin is consistently red, inflamed, and sometimes even painful to the touch. It's at this point that many look to birth control as a way to treat and control flare-ups.

But just like taking any other prescribed medication, you need to do your research and talk to a doctor before using birth control for acneic skin, especially when you consider that not all birth control works the same or provides the same skin-clearing results. In fact, a 2016 Journal of Drugs in Dermatology study found that combination birth control pills (those that contain versions of both estrogen and progesterone) are generally best at clearing skin, while hormonal injections, implants, and intrauterine devices (IUD) tend to worsen acne.

To make sense of the science, we spoke to several dermatologists and an OB/GYN. Read on to learn about the best types of birth control for acne and when it might be right for you.

First, Understand How Birth Control Works

Sara Twogood, MD, an OB/GYN and co-founder of Female Health Education, explains that combination hormonal birth control contains two hormones: estrogen and progesterone. Taking the pill provides the body with both these hormones which suppresses ovulation. A typical menstrual cycle includes menstruation (a period), a follicular phase, ovulation, and a luteal phase, which are all driven by fluctuations in hormones from the brain and ovaries. The pill stops these fluctuations, which stops ovulation.

How Birth Control Can Improve Acne

Birth control works by affecting your body's hormone levels, which is why along with preventing unwanted pregnancy, it can also impact other hormonal-related issues like acne.

"When women's hormone levels shift from a more female profile (for example, with estrogen and progesterone) to a more male profile (for example, testosterone) during our cycles, this has an effect on oil production and acne," says Dr. Kanchanapoomi Levin.

"When the hormone profile is more male dominant, a couple of skin changes occur: The sebaceous glands (the glands that make oil) become more active, there is an increase in dead skin cells, and the skin cells become stickier. This environment is perfect for acne flares! Some women are more sensitive to circulating testosterone and develop hormonal acne," she says. Taking birth control pills can stabilize these hormones and decrease the amount of testosterone in your body.

The Best Types of Birth Control for Acne

Melissa Kanchanapoomi Levin, MD, an NYC-based dermatologist and clinical instructor at Mount Sinai, says Ortho Tri-Cyclen, a popular brand of birth control, has been cleared by the Food and Drug Administration (FDA) for the treatment of acneic skin. Along with Ortho Tri-Cyclen, Estrostep and Yaz are two other brands of birth control cleared by the FDA for acne treatment. Yaz, in particular, contains the progestin drospirenone, which is known to be especially effective in the reduction of hormonal acne.

While certain brands of birth control carry the FDA's approval as an acne treatment, others are still prescribed off-label with some success. Other times, people prescribed oral contraceptives for other indications find that a bonus "side effect" is an overall reduction in their acne symptoms.

All oral contraceptive pills can have the effect of being anti-androgenic, meaning that they can lower the level of androgens like testosterone in the body, says Dr. Twogood. Androgens are one factor that leads to the development of hormonal acne, so blocking them can help to improve acne over time.

Dr. Twogood adds that "there are no set requirements or parameters for starting birth control pills for acne. The decision about when or if starting the pill to help control acne should be individualized." Nava Greenfield, MD, of Schweiger Dermatology Group in NYC, agrees: "Each person may respond differently to different forms of oral contraception, so finding the one that works for you is important."

Types of Acne That Birth Control Can Treat

Acne can take the form of a blackhead, whitehead, a small mark, or even a cyst, but it's the underlying cause of your acne that determines whether birth control might be an effective treatment.

"While teenage or inflammatory acne is commonly treated with oral antibiotics if appropriate, for hormonal acne, the failure rate of antibiotics is 70% to 80%," Dr. Kanchanapoomi Levin tells us. That's where hormonal medication (aka birth control) can come into play.

If home treatment doesn't help your breakouts, or if you're finding yourself with large, hard, or pus-filled bumps, you may want to consider seeing your doctor as you might be experiencing hormonal or cystic acne, both of which commonly require medical treatment. Other signs that you're dealing with hormonal acne as opposed to good old-fashioned inflammatory acne include breakouts that follow a cyclical pattern with your menstrual cycle and acne that pops up mainly along your jawline or chin.

"Cystic acne should be treated by a dermatologist to ensure you are getting the best and most effective care that targets the type of acne on your skin," cautions Dr. Greenfield.

How Long Does It Take to See Results?

When it comes to its effect on acne, birth control takes some time to work—in some cases as many as six cycles. It can take just a month or so to notice an improvement, explains Dr. Twogood, "however, in most studies, it took three to six months to show a reduction of acne due to birth control use." Oral contraceptives are considered long-term treatment, and acne may flare back up if the medication is stopped.

Potential Side Effects of Taking Birth Control for Acne

Side effects of taking birth control pills for acne are the same as those of someone who takes the pill for contraception or any other indication. The most common short-term side effects of birth control are nausea, breast tenderness, and bloating. You may also experience longer-term mood changes and changes in libido. You should speak with your doctor about whether you are a good candidate for this medication given your medical history and to get more information about other possible side effects.

According to dermatologist Julie C. Harper, MD, of the Dermatology and Skincare Center of Birmingham, "If a person has a history of a blood clotting disorder, is a smoker, or has migraine headaches, they are not good candidates for a birth control pill."

Who Can Prescribe Birth Control for Acne?

While any physician can write the script, "dermatologists, OB/GYNs, and primary care doctors are the usual prescribers," says Dr. Twogood.

When to Talk to Your Doctor About Birth Control

If your acne is getting especially bad and isn't responding to at-home, over-the-counter treatments, consider speaking with a specialist or your primary care physician. Your doctor can help identify the underlying cause of your breakouts and suggest a treatment plan.

While there is no harm in asking your doctor about taking birth control for your acne—particularly if you believe your breakouts are hormone-related—be prepared to follow your doctor's suggested treatment plan even if it doesn't include the pill. While birth control can be incredibly effective against certain types of acne, it's important to note that it's not the first line of defense.

Usually, dermatologists will first recommend a topical retinoid. "Topically, my feeling is everyone and their mother should be on a retinoid," says dermatologist Adam Friedman, MD, FAAD. "This first-line medication can be difficult to get covered in our current healthcare climate, so fortunately there is an over-the-counter form available called Differin Gel."

Dr. Kanchanapoomi Levin agrees: "In addition to clearing existing acne, Differin Gel will also help to prevent future breakouts from forming by increasing skin cell turnover to minimize clogging of pores," she says.

Being on birth control can help manage hormonal acne, but you still need a solid skincare routine and diet. Take it from dermatologist Dendy Engelman, MD: "As acne is an inflammatory disorder, foods that cause inflammation may also contribute to acne. Additionally, there have been major studies linking acne and diet—specifically high-glycemic-index foods and dairy."

As for your skincare routine, Dr. Friedman says it should take on a "less-is-more approach" as opposed to loading up on anti-acne products. "Many believe overwashing, exfoliating, scrubbing will improve acne, but, in fact, it will only make it worse. The inflammation that causes the visible pimple disrupts the skin barrier, impacting its ability to keep water in and harmful things out. Overwashing or using harsh cleansers can further disrupt the skin barrier, which can in turn create more inflammation and even more acne." He recommends a gentle wash, like Cetaphil Daily Facial Cleanser ($6) or Cerave Foaming Facial Wash ($11).

The Final Takeaway

While birth control can be an effective treatment for certain types of acne, it's not appropriate for all acneic skin types nor is it typically the first line of defense. If you are struggling with acne, talk to your doctor about an appropriate holistic treatment plan for you and your skin.

Article Sources
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  1. Lortscher D, Admani S, Satur N, Eichenfield LF. Hormonal contraceptives and acne: A retrospective analysis of 2147 PatientsJ Drugs Dermatol. 2016;15(6):670-674.

  2. Trivedi MK, Shinkai K, Murase JE. A review of hormone-based therapies to treat adult acne vulgaris in womenInt J Womens Dermatol. 2017;3(1):44-52. doi:10.1016/j.ijwd.2017.02.018

  3. Cleveland Clinic. Birth control: The pill. Updated July 21, 2020.

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