This article is aimed at the female audience. Women in their 20s and early 30s are more likely to get acne, often for the first time in their life. This is known to be hormone-related, and it is the primary reason why adult women have more acne than adult men. Teenage girls, particularly as they approach maturity, experience hormonal acne highs, and lows that are often less noticeable than those experienced by adult women.
Male hormones, or androgenic hormones, play a significant role in the contribution of acne formation. Females do contain male hormones, although they have them in smaller proportions than men. These male hormones can also accelerate the onset and persistence of acne in adults; in a nutshell, androgens stimulate the sebaceous glands, causing them to enlarge and produce excess oil, which causes inflammatory acne.
When other therapies, such as topical creams and antibiotics, aren’t cutting it, certain oral contraceptives can assist in preventing the acne-causing response to your androgens. Many oral contraceptives (birth control pills) prevent androgens from stimulating your sebaceous glands, which generate the oil that causes acne.
When the pill alone isn’t reducing acne or if you have some of the masculinizing symptoms of excess androgens, such as excessive hair growth or thinning scalp hair, hormonal therapy with an anti-androgen may be used in conjunction with birth control pills.
Controlling Hormonal Acne With Birth Control Pills
If you’ve tried everything else and still can’t get rid of your acne, you might want to look into controlling hormonal acne with birth control pills. The pill helps balance out the estrogen and progesterone surges in your body. If you meet the following criteria, oral contraceptives may be an appropriate option for you:
- You want to use birth control pills because you’re sexually active.
- To regulate your menstrual cycle, you’ll need oral hormonal medication.
Many women with mild to moderate acne who want to use contraception may find that taking the pill alone is enough to control their acne. A birth control pill combined with topical and oral medicines can also help moderate to severe acne.
Anti-androgens or physical therapies, such as laser or lights, are other therapeutic options that you and your doctor may examine if you’re hesitant to use the pill or use other birth control methods for moral or religious reasons.
Other hormonal birth control methods, such as the birth control patch and ring, have an unpredictable effect on acne and can even exacerbate it. Depo-Provera, a synthetic progesterone injectable, can sometimes worsen acne.
Birth control pills for acne include both negative and positive side effects. Consult your doctor to see if it is appropriate for you.
Suppression of the menstrual cycle and acne
Since the 1960s, oral contraceptives have been available. They stop ovulation and make it harder for a fertilized egg to attach itself to the uterus wall.
Treating hormonal acne with birth control works by blocking the effects of androgens on the sebaceous glands. Estrogen, which regulates menstruation, is found in oral contraceptives. In addition to preventing ovulation, estrogens found in birth control pills can aid with acne by:
- Reducing androgen secretion in the ovary
- Preventing androgens from driving your sebaceous glands to create excessive amounts of oil
Estrogens might decrease the quantity of free testosterone in your body (androgen). They achieve this by raising the amount of sex hormone-binding globulin (SHBG), a protein that “mops up” free testosterone, holds on to it, and prevents it from stimulating your acne-producing oil glands to generate additional oil.
When treating hormonal acne with birth control pills, the most effective oral contraceptives for acne control comprise a combination of estrogen and progestin (synthetic progesterone).
The progestin-only pill, or minipill, is an effective oral contraceptive with fewer adverse effects than the combination pill. Its impact on acne, however, is unpredictable. Progestins can cause androgenic effects (acting like male hormones). Some of the newer progestins have reduced androgenic activity, which means they’re less likely to worsen your acne and may even improve it.
Birth control pills containing estrogen are not for you if you are over 35 years old, suffer from migraine headaches, or smoke cigarettes.
What are the best contraceptive pills for acne treatment?
Even if you don’t have any signs of increased testosterone production, oral contraceptives may help your acne. Although most women with acne have normal testosterone levels, the story can be lowered and blocked if you take the appropriate drug.
Most dermatologists advise taking low-dose oral contraceptives or contraceptive combinations with low androgenic potential. In healthy women, these medicines raise SHBG levels, lowering androgen levels.
The oral contraceptives Ortho Tri-Cyclen, Estrostep, and Yasmin, are the best options for acne. In addition to estrogen, Yasmin contains the progestin drospirenone, a chemical cousin of spironolactone. The following section goes over this potent antiandrogenic hormone. According to several experts, Yasmin is widely regarded as the best over the counter acne treatment.
Several oral contraceptives are available in packets of 28 pills with easy dose schedules. The first 21 tablets are active pills, including hormones as active components. The reminder pills (containing inactive ingredients) are the last seven tablets in a 28-tablet box; they are different colors and don’t contain any hormone.
Read the package label and follow the instructions.
Levlen, Levite, Seasonale, Tri-Levlen, Triphasil, Desogen, and Alesse are other oral contraceptives with reduced androgenicity.
Diane-35 is a very effective acne-treating oral contraceptive that has been licensed in Canada and Europe for over two decades. It is still unavailable in the United States.
Patience is key. It may take at least three months of using the pill to notice favorable acne effects.
What are the side effects of oral contraceptives?
Although the first oral contraceptives had some adverse side effects, they have now been improved to lessen the dangers. Thromboembolism (blood clots in the legs) has historically been the most severe adverse effect of birth control tablets. However, today’s reduced estrogen levels have virtually removed this potential complication.
The following are possible side effects:
- The most common minor adverse effects are nausea, vomiting, stomach cramping, and bloating. As the body reacts to the medicine, it usually fades away.
- Headaches: These are usually light, but if they become severe, speak with your doctor.
- Spotting and breakthrough bleeding: While taking the pills, you may experience irregular vaginal bleeding or spotting.
- Weight gain of a few pounds: This could be attributed to an increase in your hunger. Mood swings (depression, anxiety): The pill’s hormonal disruption might induce mood swings and reduce libido.
- Breast pain can develop as a result of swollen, tender breasts.
Tell your doctor if you have or have ever experienced breast problems, such as lumps, an abnormal mammogram (breast X-ray), or fibrocystic breast disease. However, most studies show that tablets do not reduce or raise the risk of breast cancer. The key to successful breast cancer therapy and survival is early detection. Breast self-examinations are simple to perform, and the more you do them, the better you will get. Better yet, mammography, mainly when performed with the most up-to-date MRI equipment, can detect tiny tumors before you can feel them.
You should be informed about the hazards of taking the pill, and you should have frequent Pap tests and breast checks if you’re on it. A Pap smear is a test that looks for alterations in the cells of the cervix (uterine opening) that could develop into cancer.
Combination birth control pills (those that combine estrogen and progestin) have been shown in recent trials to reduce the incidence of uterine and ovarian cancer.
Treatment of hormonal acne with anti-androgens
You may require a specific anti-androgen medication rather than traditional anti-acne drugs and birth control pills to control your acne. When standard topical and systemic medications fail, anti-androgen therapy is an option. When you can’t or don’t want to take a birth control pill, or when your body produces too many androgens due to an endocrine condition.
Because there is a danger of feminizing a male baby if you become pregnant while taking either of these drugs, most healthcare practitioners recommend that you continue to take an oral contraceptive. For more information, consult your doctor.
If you’ve noticed that some of your acne medications are no longer working — oral antibiotics, topical medications, and even birth control pills — if you’ve had a relapse after taking a course of Accutane, or if your acne has suddenly become severe, your doctor will most likely evaluate you for androgen excess.
Spironolactone is the most common anti-androgen used to treat acne. Spironolactone (Aldactone), an oral anti-androgen, is used in women for whom hormonal therapy is an effective alternative or a supplement to oral contraceptives and antibiotics. It’s beneficial for women who have recurring deep inflammatory nodule breakouts. Spironolactone is an antiandrogenic agent that acts by reducing sebum production.
Spironolactone is prescribed at a modest dose of 25 to 50 milligrams per day, possibly increasing it. It could take up to three months to see any significant outcomes, but they could arrive sooner. The dosage may need to be adjusted during the first six months of treatment.
Your dermatologist or healthcare provider may order specific blood tests during your treatment with this drug.
This medication’s most common adverse effect is an irregular menstrual cycle; however, this is less likely if you’re taking birth control pills. Breast tenderness is a common occurrence. Women who have a personal or significant family history of breast cancer should talk to their doctor about the risks and benefits of taking this drug. However, despite more than 50 years of use in women, there is no evidence that it causes cancer, except in mice.
Spironolactone is a diuretic that is sometimes used to treat hypertension (high blood pressure). Suppose you’re already on high-blood-pressure medicine, such as a diuretic. In that case, you could ask your doctor to replace blood pressure medications with spironolactone. This method could help you treat both acne and high blood pressure simultaneously.
Another anti-androgen, flutamide (Eulexin), is sometimes used to treat severe female adult acne. It can cause serious liver damage, which limits its application.
To assess the efficacy of these anti-androgen medicines, you and your healthcare provider will need to use them for at least three to six months.
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