BIRTH CONTROL ACNE (30+ STUDIES): EVERYTHING YOU NEED TO KNOW (2022)14 minute read

Birth control acne. It’s a big topic.

This article covers all your bases. Whether you want to know whether birth control helps acne, causes acne, or leads to acne once you stop taking it, this article is here to help you make informed choices. You’ll also find research-backed natural solutions for acne, whether you’re taking birth control or not.

Want to be super in the know? Read the whole thing. Just looking for a specific answer about birth control acne? Use the contents to navigate to the relevant place.

 

Contents

What is birth control?
Does birth control help with acne?
Why does birth control help acne?
Which birth control helps acne?
How long does it take for birth control to help acne?
Can birth control cause acne?
Can you get acne after stopping birth control?
How to get rid of acne after coming off the pill
Takeaway points

 

What is birth control?

Let’s start with the basics: birth control is any form of contraception.

The most used form of contraception in the Western world is the birth control pill, often referred to simply as ‘the pill’ [1]. Other birth control options include injections, IUDs, implants and barrier methods [2].

In this article, we’re looking mainly at the pill. Specifically, we’re delving into combined oral contraceptive pills, which are the type used to treat acne. We’ll touch on other forms of birth control that can influence your skin’s health too.

 

Does birth control help with acne?

Yes, birth control can help your acne. But you should know two important things:

1) Not all birth control can help acne (some forms of birth control can make it worse)

2) Birth control will only help your acne while you’re taking it. Once you come off birth control, your acne will likely return.

For women, birth control pills are one of the most common hormonal treatments prescribed for acne. If your acne gets worse before your period, you have other signs of androgen excess (such as hair loss on your head or excess hair growth in other places), or if you’re over age 25 and your acne hasn’t responded to topical treatments, it’s likely they’ve been recommended to you [3].

 

Why does birth control help acne?

To understand why birth control helps acne, you need to know what is in that pill you’re taking.

Combined oral contraceptive pills are the type of birth control prescribed for acne. As the name suggests, they’re a combination of two types of synthetic hormones:

1) A synthetic form of oestrogen (or estrogen for our American friends). The most common form of synthetic oestrogen is ethinylestradiol [4].

2) A synthetic form of progesterone. These are known as progestins, and different pills contain different types [5,6].

Together, these synthetic hormones work to shut down androgen activity in your body. They do this in several ways [7,8]:

a) telling your ovaries and adrenal glands to produce fewer androgen hormones

b) blocking an enzyme (5 alpha reductase) to stop androgens from becoming more potent

c) increasing a special protein (SHBG) that binds to free androgens hanging around in your blood

The net result is that androgens are seriously repressed. And, as androgens play a key role in the acne-driving pathway, repressed androgens = fewer breakouts.

But, this point is so important that I’ll reiterate it: this will only work while you’re taking the birth control pills. Once you come off birth control, it’s likely your acne will return [3].

 

Which birth control helps acne?

A Cochrane review (a large study of studies) found that when it comes to treating acne, most combined oral contraceptives work as well as each other [9]. In other words, any combined pill will do [10].

But it often doesn’t play out like this in real life. If you’re taking a combined oral contraceptive pill and you feel it’s made your skin worse, it may be down to the form of progestin in that pill.

Here’s what you need to know:

Older-generation progestins can dock onto androgen receptors on your body’s cells. The synthetic oestrogen in the pill should cancel out this slight androgenic effect, but it may still be enough to worsen acne in particularly sensitive individuals [3].

Newer-generation progestins don’t dock on to androgen receptors as much, and some even have anti-androgen effects. This means they’re much better for treating acne [11,12].

– To make this even more confusing, progestin-only pills won’t help acne—in fact, they can make it worse—but we’ll get onto that below [13].

So, for best acne-clearing effects, you want a combined oral contraceptive pill that contains a newer-generation progestin such as norethindrone acetate, norgestimate, desogestrel, drospirenone or cyproterone acetate [10,14].

Confused by all these long, weird-sounding drug names? I hear you. We can also talk about it in terms of brands.

In the US, the FDA has approved three brands of combined oral contraceptive pills to treat acne—all of which contain newer generation progestins [4]. These are:

Ortho Tri-Cyclen® (contains norgestimate)

Yaz® (contains drospirenone)

Estrostep® (contains norethindrone acetate)

Yasmin®, which contains the same type of progestin as Yaz, is often used too [15].

In the UK, Dianette® (which contains cyproterone acetate) is often the first choice, though other combined pills with ethinylestradiol and cyproterone acetate are recommended too [16].

If you’re not happy with the pill you’re taking, speak to your doctor.

How long does it take for birth control to help acne?

Most studies suggest you need to take birth control pills for three to six months to see an improvement in your acne [17]. Other studies suggest that improvement takes closer to nine months [4].

It’s a long time, and it’s frustrating. While you’re waiting for the skin changes to kick in, you can experience side effects of taking the pill such as headaches, nausea, breast tenderness, up-and-down emotions and weight gain [14,18].

It’s not surprising that many women give up on the pill. In fact, more than half of women stop taking it by six months [19,20].

The result of stopping the pill is that breakouts often flare—sometimes even worse than before—which can make you feel as if you’re back at square one. If that applies to you, don’t worry! We’ll chat about what you can do in a little bit.

Can birth control cause acne?

Some women find that birth control makes their acne worse. If this includes you, it’s likely down to one of two reasons:

1) You’re taking a combined oral contraceptive pill with an older-generation progestin. Examples of older-generation progestins include norethisterone and levonorgestrel [2]. If you’re not sure what your birth control pill contains (many women aren’t), look at the product information leaflet.

2) You’re taking a progestin-only pill (often referred to as the ‘mini-pill’). Progestin-only pills don’t have synthetic oestrogen to balance their androgenic effect, which means they can make breakouts worse [13]. You also find progestin alone in other forms of birth control such as injections, IUDs and implants [2].

Some women are put on progestin-only forms of birth control because they can’t take a combined oral contraceptive pill. If you have high blood pressure, diabetes, a history of migraines and headaches, or if you’re over 35 and you smoke, this might apply to you [4]. Again, if you have any questions about the pill you’re taking, you should speak to your doctor.

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Can you get acne after stopping birth control?

Yes. A common (yet surprisingly little-known) side effect of stopping birth control is that acne can flare up.

Most women aren’t told this before going on birth control—even though it’s a common reaction. Don’t believe me? Here’s a line straight from a peer-reviewed research paper: “It is…well known that acne can reappear after stopping combined oral contraceptives” [3].

This ‘post-pill acne’ most often happens if you had acne before going on birth control, but it can also occur if your skin was clear before. There are a few reasons for this:

Surging hormones. Free from the synthetic hormones’ repressive effect, your ovaries kick back into action and their androgen production surges. As you know, androgens are key hormones in the acne-driving pathway.

Depleted nutrients. It’s also well-known (but little talked about) that the pill can deplete certain nutrients. These include folate, vitamin B12, zinc, selenium, vitamin C and vitamin E—all of which are crucial for healthy skin [21].

A weakened gut barrier. Although more human studies are needed, emerging animal research suggests that birth control pills can disrupt your gut barrier [22,23]. And, as you probably know if you’re on this site, poor gut health is associated with acne [24].

If you’ve stopped taking the pill and your skin is acting up, you have two options:

a) Wait it out. Your hormones will settle out again, though it can take a few months.

b) Take action. Embrace some dietary, lifestyle and skincare habits that can help to calm your skin from the inside out.

If you’re inclined to go with the second option (good choice!), read on.

 

How to get rid of acne after coming off the pill

If you’ve come off birth control and your skin is freaking out, don’t stress. You can take some simple yet powerful steps to help bring your skin back into balance.

 

1) Eat less sugar and cow’s dairy, but eat more vegetables

Wait! I promise this a) will have an enormous impact on your skin and b) isn’t as dull as it sounds.

Sugar and cow’s dairy increase levels of the hormones insulin and IGF-1, which in turn ramp up androgen activity in your body [25]. And, as your androgen hormones are already surging when you come off the pill, it’s a good idea to dampen the effect where you can.

Eating lots of fibre-rich vegetables will further help to steady your hormones, along with dampening skin-damaging oxidative stress [26].

So, here’s what to do:

– Eliminate sugary drinks and cut down on any foods that are sweet, white or fluffy (white bread, I’m looking at you)

Swap out cow’s milk for plant-based milk, and reduce your intake of other forms of dairy

– Load half your plate with colourful vegetables at each meal

For further tips on how to approach sugar and dairy in your diet, head to this article. You can also read about other foods that are good for your skin here.

Bonus tip: Eat flaxseed

Remember how oral contraceptive pills can increase SHBG, that special protein that binds to androgens in your blood? Well, food can do that too!

Studies show that eating ground flaxseed daily can increase SHBG levels [27]. You can imagine SHBG like it police: it patrols your blood, rounding up the free androgens and stopping them from running amok. And, as you know, reduced androgen activity = fewer breakouts.

The best part? Flaxseed achieves this without any side effects.  If you’d like to give it a try, eat 2 tbsp freshly ground flaxseed daily. This habit may be particularly helpful if you have PCOS.

2) Supplement with a prenatal formula and probiotics

Yes, you can take a prenatal formula even if you’re not looking to get pregnant! A good formulation should help replace a lot of the nutrients that the pill has depleted.

Make sure the formulation contains 15–30mg zinc, as several studies have found this trace mineral to be particularly effective at clearing skin [28].

Probiotics can help to support your gut health too. Look for a blend with Lactobacillus strains, as these have been found to enhance skin quality [29]. Want to know more? Head to this article for the full lowdown on the best probiotics for acne-prone skin.

Please note: if you’re pregnant or breastfeeding, or taking any medication (including the birth control pill), please check with your doctor before starting any new supplements.

 

3) Use skincare with zinc, EGCG or niacinamide

Your sebaceous glands and hair follicles act as tiny, independent hormonal organs [30,31,32], which means the products you apply directly to your skin can play an important role in keeping hormonal breakouts under control.

Zinc and EGCG (green tea extract) can control androgen activity when applied to the skin [33,34]. If you find your skin has become more oily after coming off birth control, topical niacinamide (a form of vitamin B3) can help with that too [35].

With skincare, less is more. Use just a few targeted products, and make sure you protect your skin’s microbiome and skin pH.

Embrace these habits, and your skin should start to calm in a few weeks to a few months. For best effect, follow these steps for three months before you come off birth control. This will help to make your skin less reactive as you withdraw from the pill.

 

Takeaway points

We’ve covered a lot of ground here. Let’s recap:

– Birth control can both help acne and worsen acne. Its effect depends on the type you’re taking.

– Combined oral contraceptive pills with a newer-generation progestin can help acne. Examples include Ortho Tri-Cyclen®, Yaz®, Estrostep®, Yasmin® and Dianette®.

These pills clear acne by repressing androgen activity in your body, but they will only work while you’re taking them. Once you come off birth control, your acne will likely return.

– Combined oral contraceptive pills with an older-generation progestin, and progestin-only birth control, can worsen acne because they have an androgenic effect in your body.

– Your acne can flare after stopping birth control because of surging hormones and nutrient depletions. Compromised gut health may play a role too.

– To clear skin after stopping birth control:

a) Cut down on sugar and dairy, but eat more vegetables

b) Take a prenatal supplement and a probiotic

c) Use skincare with zinc and EGCG (green tea extract)

– For best effect, follow the above steps for three months before you come off birth control.

Nutritional Therapist Fiona Lawson

Fiona Lawson is a former national magazine editor turned registered nutritionist and skin specialist. She holds a BANT-registered qualification in Nutritional Therapy, and she is currently working towards her MSc in Nutritional Medicine.

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