If you’re exploring your acne treatment options, birth control for acne has probably come across your radar several times. Deciding what kind of acne treatment to try can be a difficult, ever-changing, even emotional process. The skin care industry often portrays acne as “ugly,” “dirty,” and generally a very bad thing. Studies show that this leads to serious self-esteem issues, and can even contribute to serious mental health conditions like anxiety and depression. Trying to find that perfect product that will magically get rid of all of your acne can get exhausting, because every time you try a new product and it doesn’t work, it can feel more and more hopeless. The truth is, there’s no miracle product, but there are products that work better for certain kinds of acne or certain skin types. Birth control for acne is most effective if your acne is primarily caused by hormone fluctuations, specifically fluctuations in sex hormones. To determine if birth control for acne is a good option for you, we’ve developed a 5 step process: 1) Find out if hormones play a role in your acne; 2) Learn about how birth control can decrease acne; 3) Take into consideration the side effects of birth control for acne; 4) Talk to your general practitioner, dermatologist and/or gynecologist; 5) Weigh the benefits, risks, and likelihood for improvement with birth control for acne, and make the best decision for you.
Step 1: Find Out If Hormones Play a Role in Your Acne
The first step in deciding if birth control is the right choice for treating your acne is determining if your acne is hormonal or not. If your acne doesn’t seem to be affected by hormonal shifts, then birth control is unlikely to have any effect on your skin.
How to Tell If You Have Hormonal Acne
The easiest way to tell if your acne is hormonal is to pay attention to when your acne flares up the most. If you menstruate, your acne may be hormonal if it gets worse during the week before your period. If you notice an increase in acne in the days after eating an especially sugary or carb-laden meal, you may have hormonal acne related to a condition called Polycystic Ovarian Syndrome (PCOS). And if you’re in your teens, all of your acne may be at least partially related to the hormonal shifts that take place during puberty. If none of these categories apply to you, but you still notice seemingly random breakouts, despite taking care of your skin and typically having clear skin, you may have acne related to natural hormone fluctuations.
Changes in Hormones, Rather Than the Hormones By Themselves, Can Cause Acne
First, there is no one particular hormone that causes acne all on its own. Hormonal acne is caused by changes in our normal hormone levels, specifically, changes in testosterone and estrogen.
Generally, men and some intersex folks produce more testosterone, and women and other intersex folks produce more estrogen, but in most cases, everyone produces both testosterone and estrogen in some amount, regardless of sex. Everyone has their own “natural” levels of these hormones, and when our hormones are in our own personal normal range, it typically doesn’t cause acne. However, whenever these hormones shift to cause an increase in testosterone, either literally or relatively, acne is a common result.
What do we mean when we talk about testosterone increasing “literally or relatively”? We mean that sometimes you will produce extra testosterone, which can lead to acne because your testosterone levels increased literally. Other times you may produce less estrogen, and this can also cause acne because estrpgen typically balances out testosterone. Because there’s less estrogen to balance the testosterone, its levels increase relative to estrogen levels. Puberty, PCOS, and other causes of hormonal acne can lead to hormone fluctuations that increase testosterone both literally and relatively.
Why Does Extra Testosterone Cause Acne?
The reason extra testosterone is a problem for acne is because it causes increased oil production, one of the three main contributing factors in acne. The other two are inflammation and bacteria, the latter of which can also be affected by excess oil.
When we experience an increase in testosterone, our oil production glands go into overdrive and excess oil makes its way through our pores to the surface of our skin, where it has nowhere else to go. This causes the extra oil to back up into our pores, effectively clogging them. This can lead to whiteheads, if the pore is closed, or blackheads, if the pore is open. But that’s not all oil can do. Extra oil can also provide extra nourishment for acne-causing bacteria, also known as p. acnes. These bacteria always live on the surface of our skin, and in small numbers they typically don’t cause any problems. However, their main food source is the oil our skin produces, so when more oil is produced, the bacteria start to multiply very quickly, until their numbers are very high. At this point, the bacteria easily make their way into our pores, where they start a minor infection which leads to pimples.
Because of this increase in oil production associated with hormonal shifts, exfoliating agents like salicylic acid or skin cell regulators like retinoids (Differin, Retin-A, Accutane) can often help, but if you want to prevent hormones from creating that excess oil in the first place, birth control may be able to help.
Step 2: Learn How Birth Control Can Decrease Acne
So now if you are somewhat confident that your acne is at least partially caused by hormones, you might want to look for hormonal acne solutions, like birth control. But how exactly does birth control help with acne? It comes back to those “relative” increases in testosterone.
Birth control medication can help reduce hormone-related acne by increasing estrogen, thus making it harder to have a relative increase in testosterone. Even when your estrogen naturally drops, the extra estrogen ensures that it won’t drop low enough to make testosterone levels seem higher in comparison. However, this only works for birth control that actually contains extra estrogen. So what types of birth control can you take for acne?
Combined Oral Contraceptives
You may hear that “the pill” can help reduce acne, but which pill? There are many types of oral birth control, but only one specific type can actually make a difference in your acne. Combined oral contraceptives are so named because they contain a combination of estrogen and progestin, a synthetic form of the hormone progesterone. Many other forms of birth control medication contain only progestin, as that is sufficient to prevent pregnancy in most cases, but for birth control to help with your acne, you need the estrogen.
Although combined oral contraceptives can help with acne, they shouldn’t be used alone. If you choose to take birth control for acne, make sure it is along with a gentle, consistent skin care routine. At Exposed Skin Care, we offer Basic, Expanded, and Ultimate Kits that use a delicate balance of soothing and acne-fighting ingredients. Gentle Exposed products can keep your skin healthy and nourished while birth control helps reduce the impact of hormone fluctuations on your skin.
Other Forms of Birth Control
Some studies show that “the patch” could help reduce acne, but much less information is available on this form of birth control. Like combined oral contraceptives, the patch releases extra estrogen and progestin into your system, but the patch does so directly through your skin rather than through your digestive system. If you’re looking to use birth control for acne specifically, we recommend trying combined oral contraceptives instead, due to a much larger body of research supporting its effectiveness.
There are many other forms of birth control, but none of them have been shown to impact acne. Condoms, diaphragms, spermicide, and copper IUDs do not affect the body’s hormones, so they cannot help reduce hormonal acne, and hormonal IUDs are progestin-only, so they don’t provide the estrogen necessary to improve acne.
Step 3: Take Into Consideration the Side Effects of Birth Control for Acne
Like any medication, birth control comes with potential side effects. In many cases, side effects fade after a few months, once your body has adjusted to the new influx of hormones, but this is not always the case. Additionally, birth control could have unwanted effects on those who identify as male or, obviously, anyone who is pregnant or trying to get pregnant.
The trouble when taking birth control for acne specifically is that it wasn’t made to help with acne. Its designed purpose is to prevent pregnancy, so that is a “side effect” of sorts when you are taking it for acne. If you’re looking to start a family, birth control is not the best acne treatment option for you, even if your acne is hormonal.
Birth control can also present issues for those who identify as male, because increased estrogen can cause feminizing features, such as enlarged breasts or a loss of facial hair. This is not a universal effect, however. Some men do not notice a significant change in appearance, so birth control is still a viable option for men, if you’re willing to take a chance and see how it affects you.
Even if you identify as a woman and aren’t interested in having a baby right now, birth control comes with side effects you should know about before getting a prescription. Birth control can cause significant weight gain, heightened anxiety, breakthrough bleeding (bleeding throughout your cycle, not just during menstruation), headaches, and decreased libido. Many women only experience a few of these effects, or none at all, but if you have a condition that could be exacerbated by these side effects, like migraines or an anxiety disorder, you should talk with your neurologist, psychiatrist, or other specialty doctor before starting birth control for acne.
Step 4: Talk to Your General Practitioner, Dermatologist and/or Gynecologist
If you think your acne is hormonal and you’re willing to see if you experience any significant side effects, then the next step in the process is talking to a doctor. To get a prescription, you can see a general practitioner, a dermatologist, or a gynecologist. If you have any questions about using birth control for acne specifically, we recommend seeing a dermatologist or gynecologist, and if you want more information on the effects birth control has on your reproductive system, we definitely recommend seeing a gynecologist.
How to Ask Your Doctor About Birth Control
It can feel a little awkward to ask your doctor if you can take a specific medication—after all, they’re the professional, shouldn’t they be the one deciding what you take? But the truth is, your care is your business, and if you want to try a certain medication, you should absolutely bring it up. There are a staggering number of drugs available for any number of conditions, and it’s possible your doctor simply knows her favorites and just usually sticks with those. It doesn’t mean there aren’t other options, it just means they may not consider them right away. Also, if you’re seeing your general practitioner, they may not realize you want to treat your acne until you say something, and they are usually very open to your preferences for treatment.
Simply make an appointment with your doctor, dermatologist, or gynecologist and let them know that you’ve researched ways to treat acne, and you’re interested in trying birth control. Also, it’s never a bad idea to write down or print out your thoughts on why you want to try a new treatment or what your concerns are and bring that with you to your appointment.
Step 5: Make a Decision
The final step in deciding whether or not to try birth control for acne is just that: deciding. Once you’ve considered the causes of your acne, the potential side effects of birth control, and talked with your doctor, you should have all the information you need to make an educated decision. Remember though, your decision right now isn’t permanent. If you decide to try birth control then later realize it isn’t actually helping your acne much, you can always discontinue use, just make sure you do so with the supervision of a doctor. Similarly, if you decide birth control isn’t for you, that doesn’t mean you can’t try it in the future.