Taking the contraceptive pill for acne

Studies have shown that a combined contraceptive pill, which contains both oestrogen and progesterone, is generally a more effective option for treating acne than those with just 1 hormone. This is because the combination of hormones can regulate the levels of your male sex hormones (androgens) that increase oil production in the skin, leading to clogged pores and breakouts. The pill can help reduce this oiliness and help clear the skin over time.

Some combined pills that could help treat your acne are:

• Yasmin
• Lucette

On the other hand, some studies suggest that the progesterone-only pill (also known as the mini pill) can increase your androgen levels and make acne worse. Although other studies have contradicted this, doctors do not usually prescribe the mini pill to treat hormonal acne.

How well your acne responds to the pill depends on the type of pill you take and how your body reacts to the hormones. Not everyone who takes a contraceptive pill for acne will get the same effects, and you may find regular acne treatments far more suitable.

ZAVA's doctors can help find the right contraceptive pill for you. They can also discuss alternative treatments for acne and ensure you are aware of the potential side effects of taking the pill.

Hormonal acne is caused by hormones called ‘androgens’. They work by stimulating growth of the sebaceous glands and increasing how much sebum (oil) is produced. If you have high levels of androgens or your body is overly sensitive to them, the sebaceous glands produce excess sebum. This clogs up the follicles on the skin and causes spots.

Puberty can also affect our hormone levels, making hormonal acne even more common during this time.

The contraceptive pill can help with acne by affecting the hormone levels in your body, including androgen levels, reducing the production of sebum. Less sebum can lead to clearer skin and fewer spots.

However, for some people, taking the pill does not improve their acne. It varies from person to person and depends on how your body responds to the hormones. It is also possible to experience increased acne when you start taking the pill.

It can take between 6 and 12 weeks before you see any improvement in your skin. This is because your body can take some time to respond to the new hormone levels. If there are no improvements after a few months, your doctor may try a different pill or an alternative treatment for your acne.

You can usually use your existing treatments for acne alongside taking the pill, but you should check this with your doctor first.

In some cases, your current treatment may impact how effective the pill is at preventing pregnancy. For example, if you use antibiotics like tetracyclines to treat your acne, you may need to use additional contraception, such as a condom. This is because tetracyclines can impact how your body processes oestrogen and make the pill less effective.

Also, isotretinoin, which is a retinoid medication prescribed for severe acne, can make progesterone-only contraception less effective.

Topical acne treatments do not significantly affect your contraception. However, some creams that contain antibiotics may slightly reduce the effectiveness of your contraception.

As with all hormonal contraceptives, you can get side effects when taking the pill for acne. While many people get no side effects, for some people, they can be severe or more frequent than with other acne treatments.

The most common side effects of the pill are:

• nausea and being sick
• stomach problems
• headache
• mood swings
• painful breasts
• spotting

Occasionally, depression, hair loss, and exhaustion can happen too.

Rarer but severe side effects of taking the pill include:

• liver tumours
• breast cancer
• blood clots (thrombosis)

The possibility of these side effects mean the contraceptive pill may not be safe for some people to take. See the section on “When should I not take the pill for acne?” for more information.

You can find a complete list of the side effects for each pill in the patient information leaflet included with the treatment.

You should not take the pill for acne if you:

• are allergic to any of the ingredients
• are pregnant
• have a BMI over 35
• smoke (in some cases)
• regularly get certain types of migraines
• have existing or previous thrombosis
• have high blood pressure
• have had a pulmonary embolism
• have liver disease
• have breast cancer

You should always inform your doctor of any medical conditions, family history of breast cancer or heart problems when requesting the pill for acne. Your doctor should be able to check which pill is most suitable for you, or suggest an alternative treatment for acne which is safe for you to take.

If the contraceptive pill is not suitable for you and you are concerned about your acne, don’t worry, there are a range of alternative options to treat it.

Acne creams and gels

Acne creams and gels, such as Differin or benzoyl peroxide, work by targeting the key factors that can contribute to acne. They help to reduce excess oil on the skin, kill bacteria, and exfoliate the skin.

Tablets or capsules

Antibiotic tablets can be prescribed alongside topical treatments in more severe cases. Unless you are pregnant or breastfeeding, you will most often be given a tetracycline like lymecycline. They work by killing the bacteria that contribute to acne as well as reducing inflammation.

Tinctures

Tinctures are made of concentrated herbal extracts, which are used by applying a few drops to the underside of the tongue using a dropper or small syringe. They are believed to work by delivering concentrated plant extracts that have anti-inflammatory and antimicrobial properties. However, such herbal treatments are not proven to work, so they are unlikely to improve acne symptoms. Their safety may also not have been properly researched, so there can be risks involved in trying them

If you have mild acne, over-the-counter treatments available from the pharmacy might be all you need. But if you have moderate-to-severe acne, you may need to take prescription medications. These can be either oral or topical and may contain an antibiotic, antibacterial, or retinoid.

Yes, in some cases, a side effect of taking hormonal contraception can be acne. This can sometimes be the case with the progesterone-only pill, as some studies suggest it can increase your androgen level, which can make the skin more oily. You may also notice your acne worsen temporarily when you first start taking the pill and other forms of contraception, as your body adjusts to any hormone changes.

Sometimes, the pill can make acne symptoms worse. However, combined contraceptive pills can often have a significant benefit in the treatment of acne. Some pills that have a positive link to helping acne are:

• Yasmin
• Lucette
• Rigevidon
• Cilest
• Levest
• Dianette
• Yacella

Yes, acne can come back, or worsen, when you stop taking the pill. This is because your body has to adjust to a change in hormones, and the effect of the pill on your androgens decreases, potentially leading to oily skin and breakouts.

There are a few things you can do to help treat acne that is caused by your birth control. You may consider talking to your doctor about changing the type of birth control you are using, for example, if you are using the mini pill you may consider switching to the combined pill or trying a non-hormonal option.

You can try treating your acne with over-the-counter treatments that contain benzoyl peroxide or salicylic acid, which can help to cleanse the skin and reduce the number of bacteria. If these are not effective, your doctor or a pharmacist may prescribe stronger medications like topical or oral antibiotics.

If you do decide to stop taking birth control because it’s causing acne, you must use an alternative contraceptive method to avoid pregnancy.

Yes, your acne can sometimes get worse before improving. This is due to your body adjusting to new levels of hormones, which can cause a flare-up of acne. Some people may experience an initial, temporary flare-up before their acne starts to improve. It can often take 2 to 3 months to see a noticeable improvement.

If your acne does not improve or continues to get worse, consider talking to your doctor about adjusting your birth control or looking at alternative acne treatment.

Yes, other forms of contraceptives can help with acne. Hormonal contraceptives, like the vaginal ring or contraceptive patches, contain oestrogen and progesterone, and can improve acne.

On the other hand, hormonal contraceptives that only contain progesterone, such as the implant, injection, and hormonal intrauterine device (IUD), can make acne worse, as they can lead to an overproduction of oils on the skin.

Non-hormonal contraceptives like the non-hormonal IUD, or copper coil, do not typically worsen or cause acne and are often a good option to consider as an alternative if you are struggling with hormonal acne from other contraceptives.

For more guidance on the range of contraceptives available, check out our guides:

➤ A Comprehensive Guide to the Contraceptive Pill Brands

➤ The Ultimate Guide to Different Types of Contraceptive Methods