The Contraceptive Pill and Acne

Acne is a common condition that affects over 600million people worldwide. Dead skin cells and oil from the skin clog the follicles of hairs causing troublesome spots. A contribution to this is from changing levels of hormones which affect how oily the skin becomes. A possible solution for women, therefore, is to take the contraceptive pill.

How does the pill work?

The combined oral contraceptive may help to reduce acne in some individuals. The principal hormones involved in acne are androgens which are at a high level. The pill contains estrogen and progesterone. In combination, these hormones can help to stabilize androgen levels thereby lowering oil or sebum production through multiple mechanisms. This means sebum and dead skin are less likely to clog the follicles and spots are less likely to occur. You will ideally have:

Fewer flare-ups
Fewer sports
Less inflammation
Less severe acne overall

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However, it is unlikely that your acne will completely resolve and this treatment does not work for everyone. However, the combined pill can be used together with other treatments for acne (for example topical retinoids or benzoyl peroxide). The pill is also one of the most reliable contraceptives as long as it is taken regularly as prescribed.

Which preparations of the pill are better?

A recent scientific review showed no differences in efficacy between different preparations with different progesterones. This means your doctor can prescribe the combined oral contraceptive pill with a lower chance of side effects (e.g. blood clots) and they may still work effectively to reduce acne.
Pills that are effective have Ethinyl estradiol (an estrogen) and a progestin. The progestogen can be one of - norethindrone, norgestimate, drospirenone, for example, all of which are FDA approved.

What about other forms of contraceptives?

Other contraceptives with similar constituents like the injections, patch or vaginal ring which contain estrogen and progesterone may have similar effects to reduce acne like the combined oral contraceptive pill.
However, the mini-pill may make acne worse. Progesterone-only contraceptives such as the mini-pill may increase androgen levels.

After taking the combined oral contraceptive pill when will my acne get better?

A review of 31 studies with around 12,500 participants revealed it usually takes some weeks to 3-4 months for you to have some improvement. Flare-ups of spots may happen at the beginning before your hormone levels have stabilized on the pill. Gradually there may be some improvement. If you do not see an improvement or the acne has become worse do not hesitate to talk to your doctor. Through consultation, they may be able to understand why your acne is persistent or be able to prescribe an alternative treatment. For example, antibiotics may be an alternative instead of the pill to be used in combination therapy with benzoyl peroxide/ retinoids.

Am I suitable for trying the pill for my acne?

Your doctor will take into consideration all aspects of your health before recommending oral contraceptive use. There are some contraindications however that will mean the pill isn’t suitable. These include:

Migraine with aura
Smoking
Ischaemic heart disease
Stroke
Active liver disease
Recent surgery/ immobilisation
History of blood clots or breast cancer
Poorly controlled hypertension

What is the best way to improve your acne on the pill?

In order to ensure maximum benefit from taking the pill you should:

Take the right dose of the pill at the correct time as prescribed. This will help to control acne and avoid pregnancy.
Take other acne treatment as prescribed alongside the pill. As aforementioned combination therapies may be effective.
Tell your doctor about any side effects or other medications you are taking as these may decrease the efficacy of your medication or you may need an alternative medication

Summary

The combined oral contraceptive pill may help to improve acne in different ways. Usually, the contraceptives prescribed are equally as effective as each other so long as they contain estrogen and progesterone and not progesterone alone (mini-pill). The contraceptive pill can be safely combined with other treatments to reduce the chances of acne even further.