Contraceptive Pills for Acne Treatment: Myth or Reality?

Does contraception help with acne?

Yes! Some contraceptive pills, also known as oral contraceptives, can help improve acne in women. If your acne doesn’t respond to other treatments, including oral antibiotics and topical creams, your doctor might prescribe a contraceptive pill for acne.

Acne is the result of excessive production of oil, or sebum, by the sebaceous glands in your skin. Excess sebum clogs your pores, along with dead skin cells and dirt, and contributes to the growth of acne-causing bacteria.

The production of sebum is influenced by the level of androgens in your body. Androgens are male sex hormones produced by adrenal glands and the ovaries. An androgen imbalance during your teenage years can lead to higher levels of these hormones, which in turn can result in excessive sebum production.

Acne can manifest in various forms including whiteheads, blackheads, nodules, pimples, small red and tender bumps, and cystic lesions. 

The following are common causes of acne:

• Hormonal changes that occur during puberty and adulthood (also known as hormonal acne)
• Medications
• Using the wrong makeup for your skin type

Taking contraceptive pills that contain both progestin and estrogen may reduce the androgen levels in your body. This can result in decreased production of sebum, reducing the severity of acne. 

Best contraceptive pills for acne

Which contraceptive pill is best for acne? In the last decade, there has been an increase in the number of contraceptive pills available on the market. So far, the US Food and Drug Administration (FDA) has approved only four types of contraceptive pills for acne. All four are combined pills containing progestin and estrogen. In fact, contraceptive pills that only contain progesterone may actually make your acne worse. 

All of the contraceptive pills approved for acne treatment have the same form of estrogen, but the form of progesterone can vary. 

The FDA has approved these four contraceptive pills for acne to treat moderate acne in female-bodied people who:

• Are at least 14 or 15 years of age
• Require contraception
• Have started menstruating

If you try one of these pills, it may take a couple of months before your acne starts to improve. You might also have an initial flare-up when you start taking contraceptive pills for acne.  

If you suffer from severe acne and have other associated symptoms such as excessive facial hair, obesity, or irregular periods, your doctor might check for polycystic ovary syndrome or any other conditions. 

Advantages and risks of contraceptive pills for acne

Do contraceptive pills help with acne? According to research, taking combination contraceptive pills can result in:

• Reduced flare-ups
• Less inflammation
• Fewer pimples
• Less severe acne

Today’s oral contraceptives contain lower doses of progestin and estrogen hormones than they used to. This has reduced their side effects significantly. However, people who take contraceptive pills may still develop side effects.

Some side effects of taking contraceptive pills are:

• Nausea
• Stomach cramps
• Vomiting
• Bloating
• Weight loss/gain
• Headaches
• Dizziness
• Fainting
• Breast tenderness
• Menstrual irregularities

More severe possible side effects of taking contraceptive pills include stroke, blood clots in your legs or lungs, and heart attack. If you are a smoker, older than 35, or have a history of hypertension, deep vein thrombosis, or heart disease, then your risks of developing serious side effects are much higher. 

Other acne treatments

The right acne treatment depends on the severity of your condition and how you react to different therapies. The first thing to try is over-the-counter products such as lotions, creams, and cleansers. If these don’t help clear your acne after several weeks, then your doctor may prescribe stronger medications. 

Topical medications

Common topical prescription medicines for acne include:

• Retinoids and retinoid-like drugs: Retinoids are derivatives of vitamin A and include tretinoin, tazarotene, and adapalene. They are available as lotions, gels, and creams. They work by preventing hair follicles from becoming clogged.
• Antibiotics: These work by killing excess acne-causing bacteria and decreasing redness. Some examples are clindamycin and erythromycin.
• Azelaic acid: This acid occurs naturally in whole-grain cereals and has antibacterial properties. Azelaic acid can be prescribed for pregnant and breastfeeding women. 

Oral medications

• Antibiotics: Oral antibiotics are given to reduce moderate-to-severe acne. The first choice is tetracycline, including doxycycline or minocycline. 
• Anti-androgen agents: The drug Spironolactone may be given to adolescent girls and women if their acne isn’t responding to oral antibiotics. It blocks the effects of androgens on the sebaceous glands. 
• Isotretinoin: This is a strong drug used to treat severe acne. It may cause serious side effects, so its use should be closely monitored by the doctor prescribing it. 

Therapies: Your doctor may use certain therapies to treat acne either alone or in combination with medication. Such therapies include chemical peels, laser therapy, extraction of blackheads and whiteheads, and steroid injections. 

Content created in association with UNFPA, the United Nations sexual and reproductive health agency.