Oral Contraceptives for Acne
Oral contraceptives (birth control pills) may be prescribed for women for the treatment of acne.
The use of birth control pills has been shown to lead to fewer acne flares, fewer acne lesions during flares, and less inflammation.
Oral contraceptives are usually prescribed after other acne medications have failed to sufficiently treat acne. They may also be prescribed for a woman who is evaluating contraceptive options and would benefit from long-term control of acne.
How Do Oral Contraceptives Control Acne?
Many women experience a worsening of their acne prior to and during menstruation due to changing hormone levels. These fluctuating hormones, called androgens, cause the skin to produce more sebum (oil). Acne lesions develop as the sebum builds up and becomes trapped in the pores of the skin. Birth control pills lower the levels of androgens in your body and results in less sebum and less severe acne.
Oral Contraceptive Options
At present, there are several birth control pills that have been FDA approved for the treatment of acne. These are "combination" oral contraceptives that contain both estrogen and progesterone. (Note: birth control pills that contain only progesterone can actually make acne worse.)
Each type of birth control pill used for acne contains a low dose of estrogen and different forms of progesterone. Brands that have been approved for the treatment of acne include the following:
- Ortho Tri-Cyclen®. (norgestimate and ethinyl estradiol) Ortho Tri-Cyclen® combines estrogen and varying doses of progestin called norgestimate.
- Estrostep®. (norethindrone acetate and ethinyl estradiol) Estrostep® combines estrogen with a progestin called norethindrone.
- YAZ®. (drospirenone and ethinyl estradiol) YAZ® combines estrogen with a form of progestin called drospirenone. Drospirenone is also found in Yasmin® and other brands. Women who use birth control pills with drospirenone may have a higher risk of getting a blood clot.
Studies have shown these medications to be relatively equal in their ability to treat acne.
Other birth control pills, such as Alesse®, have both been shown to improve acne, but have not been specifically FDA approved for this use. If your acne is under control while taking another oral contraceptive, you will probably be advised to remain on the same medication. However, if you are about to start birth control pills to control acne, you will probably be prescribed one of the brands that has been FDA approved for this purpose.
Taking Oral Contraceptives for Acne
You may need to take birth control pills for several months to gain the full benefit of treatment. This means that your acne may flare once or twice after starting therapy. After several months, the acne flares should become less frequent and less severe.
Other acne medications, such as topical retinoids or antibiotics, may be prescribed in combination with birth control pills, particularly in the first few months.
Risks of Oral Contraceptives
Birth control pills prescribed today have lower doses of estrogen and progesterone than earlier formulations. This results in a lower risk of side effects. Nonetheless, the use of oral contraceptives is associated with a variety of side effects, including a greater risk of developing heart attack, stroke, and dangerous blood clots in the legs or lungs (pulmonary embolism). Other risks include high blood pressure, migraine headaches, and depression or other mood changes.
Common, but less serious side effects include breast tenderness, headaches, breakthrough bleeding, or an initial, temporary flare-up of acne.
Talk to your doctor about what to expect and particular risks about which you should be aware.
Deciding to Use Birth Control Pills
Your doctor will take into account several factors before recommending birth control pills as a treatment option. Key factors include your age, severity and duration of your acne, results of past acne treatments, and your interest in taking a form of hormonal contraception.
Birth control pills are generally not prescribed for those over 35 years old who smoke, women who are currently pregnant or breastfeeding, or for those who are severely obese. Women with a history of heart disease, blood clots, cancer, liver disease, or migraine headaches are also advised not to use birth control pills.
Tell your doctor about any other medications you are taking. Some medications, such as oral tetracycline, doxycycline or minocycline, can reduce the effectiveness of birth control pills as a form of contraception and increase the risk of having an unwanted pregnancy. This may warrant the need for other forms of contraception.
Talk to your healthcare about the benefits and risks of birth control pills, and whether they are a reasonable treatment option for you.
Take your medication exactly as directed by your doctor.
Read the medication guide that you receive with the medication for a complete list of possible side effects.
Speak with your doctor if you are concerned about possible side effects that you may be experiencing.