Last Updated on September 20th, 2019
Birth control for acne, but is it right for you? If you notice that your acne tends to get worse during the week before your period, then birth control may be able to help. Estrogen, progesterone, and testosterone are the main hormones involved with acne related to the menstrual cycle, and their varying levels can cause everything from ovulation to pimples. Certain forms of birth control, like the Pill or the Patch, can help even out these hormone levels, preventing ovulation and reducing acne.
But they aren’t meant for everyone. They can have feminizing effects, generally making them a poor choice for men, there are quite a few side effects that can come with birth control1, and obviously if you are pregnant or trying to get pregnant, they are very counterproductive. If you are of a reproductive age, comfortable with feminine features, and don’t mind putting off pregnancy for a while, birth control for acne could be an effective supplement to your daily skincare routine. In this article, we’ll explain how these hormones work throughout the menstrual cycle and how they can cause acne, explore what kind of birth control options can help with acne, list some side effects to look out for, and answer a few frequently asked questions about using birth control for acne.
Article Table of Contents
Most people with hormonal acne say that the week before their period is when their acne is at its worst. This is called premenstrual acne, and it’s incredibly common. To understand why so many people have premenstrual acne, we have to look at the hormones involved. Hundreds of hormones go into almost every bodily process, but the three main hormones associated with premenstrual acne2 are estrogen, progesterone, and testosterone.
You may have heard that estrogen is a “female” hormone and testosterone is a “male” hormone, but everyone makes them both, just in different amounts. Many women (but not all) create more estrogen and less testosterone, many men (but not all) create more testosterone and less estrogen, and nonbinary or intersex folks can make any number of combinations of the two. At the end of the day, what causes acne is not based on the amount of any particular hormone that you make, it’s the ratio between the hormones.
Estrogen, progesterone, and testosterone levels pretty much hold steady until puberty. This is your baseline level, the amounts of hormones that are “natural” for your body. Although we use the word “natural,” that doesn’t mean there aren’t a number of natural reasons to actively change those levels. It just means that is the level your body naturally produces without outside influence. As you age, this natural level will change and your body will adjust. If you do not menstruate, your hormone levels will likely even out after puberty.
If you do menstruate, however, this natural level will remain unstable throughout most of your reproductive years as your hormones fluctuate in order to ovulate and menstruate. Before we explore how birth control can regulate these fluctuations, let’s take a look at various hormone levels throughout the menstrual cycle.
The first day of your menstrual cycle is the first day of your period, but we aren’t going to start there. Instead, we’re going to start around day 5. This is when your estrogen levels begin to climb as your body prepares for ovulation. Your pituitary gland sends a hormone called follicle-stimulating hormone (FSH) to your ovaries. This, like the name implies, stimulates the follicles in your ovaries that are responsible for developing a viable egg. Essentially, it initiates the process of ovulation. When the ovaries detect the presence of FSH, they start producing more estrogen.
When estrogen levels spike, usually around day 15, the pituitary gland releases luteinizing hormone (LH) which causes the follicle to break open and release the egg, and signals to the ovaries to start producing progesterone, as well as estrogen. Progesterone thickens the inner lining of the uterus to make it easier for a fertilized egg to implant.
After being released, the egg travels down the fallopian tube toward the uterus. At this point, from ovulation to about day 20, estrogen and progesterone levels are both high. But if the egg is not fertilized or does not attach to the uterus, progesterone and estrogen levels plummet and once they reach their lowest point, around day 28, the extra lining is sloughed off and menstruation begins, bringing us back to day one.
You may be wondering what testosterone is up to this whole time, if it’s supposed to be important in premenstrual acne. Throughout the menstrual cycle, testosterone typically stays low, spiking slightly around ovulation and returning to a low level. Even though it stays at a relatively stable, low level, it plays a major part in premenstrual acne because of its ratio with the other hormones involved.
So how do all these changes lead to acne, especially in that week before your period? Researchers believe that progesterone plays a role in premenstrual acne, but as of 2018, there is not significant evidence that can definitively explain what it might be. Current research does explain the roles of estrogen and testosterone, however. When the difference between estrogen and testosterone is larger (i.e. when estrogen levels rise), acne decreases, and when the difference is smaller3 (i.e. when estrogen levels fall) acne increases.
With that in mind, let’s take a look at hormone levels during the week before menstruation starts. It’s at that point that the body realizes that an egg has not attached. As a result, estrogen and progesterone start to nosedive. Again, we aren’t sure how progesterone plays in exactly, but when estrogen decreases, testosterone takes a more prominent role, and causes premenstrual acne.
Testosterone is an androgen, and when androgen levels rise or balancing hormones (like estrogen) drop, it can cause increased oil production. If you have oily skin, you know that this leads to acne, but why exactly does oil cause acne? There are three main causes of acne, and oil production is one of them, so it’s a pretty big factor. Acne is caused by everything from your age to your period, but at the skin level, the three main causes are inflammation, bacteria, and oil production.
When testosterone causes your skin to produce more oil (also called sebum), it can clog pores, leading to blackheads and whiteheads. But it can also contribute to pimples and cysts because the bacteria that causes acne consumes sebum as a food source. When there’s more oil, the bacteria can multiply even faster which increases the likelihood of pimples or cysts.
There are many kinds of birth control, from condoms to IUDs, but this article is going to focus on something called combined oral contraceptives, more commonly known as the Pill, because it is the most effective option if you want to try birth control for acne. We want to point out that not all birth control pills will help with acne, you need a combined oral contraceptive (COC). This is because this kind of birth control contains the right kind of hormones for preventing ovulation and acne.
Birth control pills in general work by introducing synthetic (man-made) hormones into your system. Specifically, most use synthetic estrogen and synthetic progesterone (usually called progestin). The reason COCs are best for treating acne is because they include synthetic estrogen along with progestin4, while non-COCs sometimes include only progestin. Because researchers still aren’t sure whether progesterone makes acne better or worse, a progestin-only pill is far less likely to be the best birth control for acne.
On the other end of the spectrum, there are also high-estrogen pills, but these are not recommended for acne either. Although the increased amount of estrogen may clear acne more significantly at first, introducing too much estrogen to your body is a bad idea. Having a consistently high estrogen level can make your body extra sensitive to testosterone, and since hormone-induced acne is all about the ratio between estrogen and testosterone, that is not good for your skin. If you become extra sensitive to testosterone, even minor increases could cause breakouts.
So what do COCs do? They prevent pregnancy by stabilizing hormones throughout the menstrual cycle. The extra estrogen and progestin provided by a COC prevent the ovaries from releasing an egg. This stabilization can also help prevent acne because it prevents more significant rises and drops, thus keeping the ratio between estrogen and testosterone more stable.
Even though birth control for acne can help, it comes with real risks5 and some serious side effects. For instance, if you are over age 35, if you smoke, or if you have high blood pressure and/or high cholesterol, birth control could put you at risk for heart disease. Birth control has also been known to worsen mood disorders, anxiety disorders, and other mental illnesses. On the flip side, some people say birth control helps with their mental health, so the important thing is just to monitor yourself for worsening or returning symptoms, and maybe ask a loved one to keep an eye on you as well.
Birth control can also increase your risk of blood clots in the legs, gallbladder disease, and liver issues, and there are many conditions that make using birth control for acne a bad idea. If you have diabetes, lupus, or a history of heart problems, you should speak with your doctor, but birth control may not be a good idea for you.
Some common side effects include: weight gain, headaches, stomach pain, appetite changes, and more, although some side effects lessen or disappear after continued use of the Pill.
Birth control for acne isn’t your only hormonal option. There are other medicines that can adjust your hormone levels to reduce acne, but because they have a significant risk of causing deformities in a potential fetus, you are required to take the Pill as well. If you find that the Pill reduces your oil production somewhat, but you still notice a significant difference in your acne before or during your period, you could try an anti-androgen. These are medications that suppress androgen production, like testosterone. Limiting the production of testosterone widens the gap between testosterone levels and estrogen levels, which could reduce oil production even further.
Spironolactone is an anti-androgen commonly prescribed for acne, although acne is not one of its official uses. It is a diuretic, typically prescribed for hypertension and congestive heart disease because it suppresses a hormone associated with the absorption of sodium and potassium, and can play a large role in various heart and blood pressure problems. Along with that hormone, it also blocks androgens, so dermatologists have started prescribing it to treat hormonal acne. According to several studies, spironolactone is effective in treating acne6 to a certain extent, but it is does not seem to be any more effective than the Pill on its own.
Although this article is primarily about the Pill, we wanted to mention the Patch as well because it works in much the same way. A birth control patch is applied to your skin once a week and slowly releases synthetic hormones that way, directly into your skin and into your bloodstream, no pill required. Most patches release the same synthetic hormones that the Pill does, so there is a good chance that the Patch could treat acne just as effectively as the Pill. However, we don’t want to promote it too much, because unlike the Pill, there is not much research that has been done about using the Patch for acne.
Additionally, there are some drawbacks for the Patch that aren’t a problem for the Pill. The Patch was not made with everyone in mind. For instance, it is supposedly made to “blend in with skin,” but it only comes in one color: beige. Although the patch can be applied to several places on the body that are less noticeable in day-to-day interactions, like the lower back, upper arm, abdomen, or buttocks, if it is exposed, it will stand out on dark skin. It is also less effective if the user weighs over 198 pounds7 (an oddly specific number, we know, but that’s what all the research said). Also, because it is an adhesive patch, it can irritate sensitive skin. In order to stay on all week, it uses a powerful adhesive, so even skin that isn’t sensitive could run into problems. These issues make it a less attractive choice for a lot of people.
Birth control for acne has been proven to improve hormonal acne in many cases, but be aware of the fact that it will not clear your skin entirely, and it can take quite a bit of time to work. By the best estimates, birth control can clear 60% of blemishes after 6 months. Using birth control for acne is most helpful when it’s combined with a full acne treatment system, like Exposed Skincare. There are a lot of acne systems on the market right now, like Proactiv or Murad, among others, but we recommend Exposed because their formula makes sense.
To treat acne, most systems use ingredients like benzoyl peroxide and salicylic acid. Exposed does too, they’re great acne-fighting ingredients. The problem is, many systems use too much of these ingredients. They clear acne right away, they seem like miracle products, but then your acne comes back. That’s because the concentration of these ingredients is too harsh8 and it is irritating your skin. This causes inflammation, the biggest cause of acne. These kinds of products are counterproductive.
Exposed, on the other hand, uses relatively low concentrations, and they also utilize natural ingredients that help soothe the skin and reduce acne, like green tea extract and tea tree oil. When combined with the right amount of benzoyl peroxide and salicylic acid, they make a gentle but effective formula for all skin types. Using birth control for acne can reduce your oil production, and Exposed Skincare can help take care of the other two main causes of acne, bacteria and inflammation.
What should I expect when going to the dermatologist to ask for birth control for acne?
It can be nerve-wracking to ask your doctor for a particular treatment. Usually it’s the other way around: you present your symptoms and they provide a solution. But if you’ve done your research and you think birth control for acne is a good fit for you, then you should feel free to bring it up with your doctor. If they have a significant reason for not wanting to prescribe it, they’ll tell you, but otherwise, most doctors want you to have the care that you want.
If you are under 18 in the United States, and want to keep your birth control usage confidential from your parents, many states have laws protecting you. Some parents do not believe in birth control or may not approve of their teenager being sexually active. Even if a teenager really just wants to use birth control for acne, some parents may not believe them, or might disapprove of using birth control for acne anyway. But if you feel safe, it’s usually best to discuss it with your parents. It might be awkward to talk about birth control and sex, but parents can surprise you, and it is much easier to get birth control with your parents help. For some people, this isn’t a safe option. If don’t want your parents to know, make sure you ask your doctor about confidentiality, and you might want to call your insurance to make sure no paperwork about your visit or prescription gets sent to your parents. If the paperwork is unavoidable, Planned Parenthood usually has inexpensive options.
If you are over 18 and feel nervous about talking to your doctor about using birth control for acne, that’s understandable too. They’re the medical professional, it can feel strange to bring up a treatment recommendation to them. But if they haven’t suggested it and you’re interested, you should speak up. Many dermatologists prescribe birth control, and it has been proven to have an impact on acne.
Is there any way to prevent breakthrough bleeding when taking birth control for acne?
Breakthrough bleeding is any spotting or bleeding that occurs not during your period, and it is a relatively common side effect when starting birth control. It often goes away with time, if you take your birth control every single day, and it helps even more if you take it at the same time each day.
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