Should You Take Birth Control For Your Hormonal Acne?
If you're like me and unfortunate enough to be plagued with hormonal acne, you know the struggle is real. The struggle. Is real.
Young females with hormonal acne are not as common as young males with acne; young males tend to develop acne because of their increasing testosterone levels during puberty. However, young adult women outnumber young adult men with acne, and this is because our hormones change so much and so frequently, with puberty, with pregnancy, with every period we get, etc. Your estrogen and progesterone plummet, then skyrocket, then your follicle-stimulating hormone surges. It's a crazy ride for our bodies, no doubt.
Hormonal acne is one of the most persistent and annoying types of acne, and I can say that with confidence. Hormonal imbalances can be tricky to pinpoint, and when an imbalance isn't present, it's simply hormonal sensitivities and there's often so little we can do about that. After all, we can't just make our hormones stop doing their thang.
Well, we can, actually ...
If you've been to a doctor or a dermatologist for your hormonal acne, it's likely that they've recommended birth control to you. Dermatologists and doctors have been using birth control pills to treat acne in women for decades.
In general, birth control to treat acne is often advised for healthy women who also need contraception. It is typically started only after other acne treatments have failed to clear up the skin, or if tests have demonstrated an imbalance.
Birth control tends to help our hormonal acne in a variety of ways.
Birth control helps by changing a hormone pattern from one that shifts quickly and sharply, to one with a smoother, more even transition between levels. This can prevent breakouts and mood swings due to drastic, sudden changes in hormone levels. It also works by inhibiting the body’s own hormone production which can be beneficial if natural hormonal levels are out of balance.
Several clinical studies have shown that taking combination birth control pills (estrogen and progesterone) can result in decreased acne flare-ups, fewer pimples, less inflammation, less sebum, less severe acne, etc.
However, only three pills have actually been approved by the FDA for treating acne. All three are "combination" oral contraceptives that contain both estrogen and progesterone. In fact, birth control pills that contain only progesterone can actually make acne worse, so steer clear of those.
Each type of birth control pill used for acne contains a low dose of the same form of estrogen. But each one uses a different form of progesterone. The only birth control pills currently regulated for acne are:
Ortho Tri-Cyclen, which uses estrogen combined with a progestin called norgestimate. A progestin is a synthetic form of progesterone. The pill is available with different doses of progestin;
Estrostep, which uses estrogen combined with a progestin called norethindrone. The pill is available with different doses of estrogen; and
YAZ, which uses estrogen combined with a form of progestin called drospirenone. The FDA has concluded that birth control pills containing drospirenone may have increased risk for blood clots compared to pills containing other progestins. Other brands containing drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin (this is the pill I took for 6 years), and Zarah. The oral contraceptives Yasmin and Alesse have both been clinically shown to improve acne, but neither have been approved by the FDA yet for this use.
Studies have not shown a major difference among these three pills in terms of how well they treat acne, but again it appears that YAZ and others with drospirenone may come with increased risks.
At the end of the day, there's no right answer to the question "Should you take birth control for hormonal acne?". The answer will inevitably be very intimate and personal to your unique situation, and it is a decision you should make on your own, or in conjunction with your doctor. Always weigh the pros and the cons. For many women, the pros of birth control far outweigh any potential risks (which are often minimal). For others, the benefits may not overshadow the risks enough (for smokers, for example).
While not every pro and every con will be relevant, I've compiled a list of some things you may want to consider when deciding if birth control is right for you.
What are the pros to birth control for hormonal acne?
1. Acne, especially severe acne, can lead to embarrassment, anxiety, and social isolation. Severe acne can even lower the chances of employment in some industries. It can prevent us from forming meaningful relationships, and from truly thriving. If acne is affecting your life in such a way that you're not truly "living", consider that birth control may be a way to alleviate this.
2. Acne can and often does lead to permanent and severe scarring. For some people who scar especially easily, in particular, this can be of major concern. Acne is one thing, but when acne is mutilating our skin in the process and leaving us with indented scarring and permanent disfigurement, we need to seriously weigh the pros and cons of birth control as a treatment option.
3. Studies have found that oral contraceptives can lower the risk of ovarian and uterine cancers, ease symptoms of severe PMS, reduce the risk of developing multiple sclerosis, and improve female pattern hair loss. In 2007, research conducted by Karolinska Institute in Sweden found that birth control pills can even be used to treat bulimics.
4. Birth control pills approved for use in acne have a high success rate, when used at the right dose.
What are the cons to birth control for hormonal acne?
First introduced to the American public for contraceptive use in 1960, "the pill" freed a generation of women from the fear of unwanted pregnancy. Today's birth control pills contain lower doses of estrogen and progesterone than they did in the past. This has significantly lowered their medical risks. Still, women taking oral contraceptives do have a higher risk of certain things.
The pill's relationship to blood-clot risk and stroke is well-documented, and the risk increases when a woman is a smoker, and over the age of 35.
The pill may increase risk of hypertension (high blood pressure) and other cardiovascular problems
The pill may increase risk of liver and gallbladder disease
The pill is also associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormone-binding globulin (SHBG). SHBG changes in "Discontinued-Users" did not decrease to values consistent with "Never-Users." Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation. It is unknown whether exposure to the synthetic estrogens of oral contraceptives induce gene imprinting and increased gene expression of SHBG in the liver in some women.
Birth control pills are not advised if you have any of the following conditions:
History of heart disease, hypertension, blood clots in your legs or lungs
Blood clotting disorder such as factor V Leiden deficiency
History of cancer, especially breast, or liver cancer (the risk for cervical cancer returns to normal levels after the woman has been off it for 10 years).
Liver disease, diabetes, or migraine headaches
You also shouldn't take oral contraceptives if:
You're a smoker over age 35
You're severely obese or physically immobilized
Keep in mind that you may need to take an oral contraceptive for a few months before your skin starts to clear. And an initial flare-up of acne is common when a woman first starts taking birth control pills.
And alas, the final con is that birth control pills are not a cure for hormonal issues. They do not address the underlying issue of the imbalance. They simply offer a way to manage the symptoms. However, this isn't necessarily a bad thing. As I said earlier, sometimes we just have the type of skin that is sensitive to hormonal changes, and until we get past menopause there's not much else we can do to prevent hormonal changes. In this case, it becomes the only option outside of general lifestyle management which can work for some, and not at all for others.
Some people come to me concerned about starting birth control because of my experience with it. Let me set the record straight once and for all.
I was put on birth control because I was sexually active, not because of my acne. At the time I was put on the pill, I was only experiencing a few hormonal pimples from time to time. Nothing severe, nothing disfiguring, nothing leaving scarring. After 6 years on the pill (Yasmin), my skin began to break out, and I wanted to get off the pill for personal reasons. My skin did experience a major breakout, one that lasted a very long time and left me with a lot of scarring. However, this was due to the fact that I was on the pill for so long and did not allow my body to go through normal hormonal changes. My hormones were like a baby giraffe learning to walk on its own legs for the first time - things were highly unstable. Like that baby giraffe using its legs, it was almost as if I was using my own hormones for the first time ever. After all, I had depended on exogenous hormones for 6 years.
Eventually, things worked out for my skin. I still suffer from hormonal breakouts, and I am positive that I would be experiencing them regardless of whether or not I went on the pill. I don't believe that the pill "permanently messed up" my hormones. There may have been a "learning period" or transition period, but my hormones, I feel, are no longer affected by my 6 years on the pill. For all I know, had I not been on the pill I would have struggled with acne all through those 6 years instead of having flawless skin (I didn't even wash my face - I used to sleep with makeup on every night!).
Don't let someone else's experience with birth control affect your decision. Look at the studies, the risks, the benefits, and make an educated decision for yourself.
If, at the end of the day, you decide that you don't want to take the pill to tackle your hormonal acne, then check out my blog post on healing hormonal acne naturally.
*Please note: If you have severe acne along with irregular periods, excess facial hair, or obesity, your doctor may do further testing for a medical condition called polycystic ovary syndrome or other hormonal condition.