Ahhhh, hormones. Can’t live with them, can’t live without them. They are crucial to so many amazing things that happen in our bodies, but they can cause chaos, too.
As they relate to acne, the ones to single out are androgens — specifically, testosterone. Both genders produce estrogen and testosterone, which fluctuate — not just throughout life, but throughout the day. The overproduction of androgens, or a sensitivity to androgens, can lead to acne.
There are several ways that estrogen can help inhibit hormonal acne, but you cannot treat men with estrogen. For women, that’s a different story. You may have heard that the birth control pill can help acne — and it’s true! So will it work for you? Maybe. Read on.
Does birth control help acne?
It certainly can, especially if you have premenstrual acne flare-ups. Acne is tricky, though. Because it’s often genetic, your friend may swear the pill made her skin beautiful, and it did, but that doesn’t guarantee it will work for you. It depends on what’s causing your breakouts. For women, hormonal acne tends to show up around the chin, jawline and neck, and can sometimes be resistant to other treatments. If this sounds familiar to you, oral contraceptives may help.
How does it work?
Hormonal treatments for acne do one thing and one thing only: they help stop the overproduction of sebum (oil). Sebum lubricates and protects the skin, but too much of it can clog pores. If you’re overproducing androgens, you’ll probably overproduce sebum. Estrogen suppresses the production of androgens in the ovaries and increases the production of sex hormone-binding globulin (SHBG), which likes binding to testosterone. This combination can help limit the effects of androgens. But even if your androgen levels are normal, if your acne is unresponsive to other treatments, birth control pills may help.
Which pill should I get?
There are a few oral contraceptives that the FDA has approved to treat acne including Ortho Tri-Cyclen®, Estrostep® and YAZ®. Other formulations may work just as well, though; the key is that there’s a blend of estrogen and progesterone, not just progesterone alone, which can actually increase acne.
Studies have shown that there’s not one pill that’s much better than another for treating acne; however, YAZ has sort of dropped off the market due to a higher risk of blood clots than the others. The FDA has not pulled it completely, but following lots of lawsuits and bad press, further studies found that the unique form of progestin used (drospirenone) may in fact cause an increased risk, and a warning was issued.
At what age can I use birth control pills for acne?
In general, if you’ve started menstruating, you can use the pill for acne. If you’re getting your period but are still quite young (say 12 or 13), your gynecologist might not recommend it. Once you’re in menopause and are no longer a candidate for the pill due to the hormonal changes in your body, you would have to find another treatment for acne.
Can I use other types of birth control to treat acne?
NuvaRing® and the patch function much the same as the pill and should work the same as oral contraceptives for acne. Depo-Provera®, the birth control shot, is progestin-only (no estrogen), so it won’t help treat acne and could actually make it worse. IUDs (like progestin-only Mirena® and Skyla® or copper-based Paragard®) are made to kill sperm and do not function the right way or contain the balance of hormones needed to treat acne. Often women will think that their birth control is causing their acne, when in reality, they’ve just switched to something that is not giving them the same acne benefits.
Why opt to use the pill over an actual acne medicine?
Taking the pill just for acne probably wouldn’t be the first route you’d choose. Chances are, if you’re considering it, other treatments alone have failed and this could be the key to success. Typical side effects to think about include nausea, mood swings, weight gain and breast tenderness, but today’s lower-dose pills are far less severe than in the past. Symptoms can ease over time and the risk of blood clots for most women is very low.
How quickly can I expect results?
Using the pill will only help prevent acne; it won’t clear breakouts that you already have. This is because the pill does not target P. acnes, the acne-causing bacteria, or slough dead skin cells—it only reduces the production of sebum. Usually, it takes a few cycles, so two to three months is a reasonable time frame in which to expect results. You can use other acne medications in conjunction with the pill, though, so your dermatologist may put you on a retinoid, antibiotic or benzoyl peroxide treatment at the same time.
Besides birth control pills, there are a few other hormonal treatments to explore. They include antiandrogens like spironolactone, which serves as an androgen receptor blocker, and glucocorticoids like prednisone, which may help reduce inflammation and suppress the production of androgens in the adrenal glands. Talk to your dermatologist or gynecologist to learn more about all these options. They will take into consideration your age, health and lifestyle and try to come up with the right path to clear skin. Alone or in combination with other acne treatments, oral contraceptives might be the perfect solution for you.