The ESK blog
Will the pill help my hormonal breakout?
19 August 2024
Dr Ginni Mansberg
Tackling Acne with Oral Contraceptive Pills: The Lowdown
Have you ever wondered whether oral contraceptive pills (OCPs) can be a game-changer in managing acne? They’re often worth a shot! In the right person.
Hormones to the Rescue Hormonal therapies, including OCPs, are super effective for adult female acne (AFA) patients. These pills are not just about birth control—they’re a skin-saving secret weapon too!
The thing is that they are contraceptives first. They do also help with cycle control and might even help with period pains. But because there are some risks (scroll down for more) we wouldn’t use the pill as a first line treatment for acne, EVEN if it’s hormonal!
How Does the Pill Work to Combat Acne? Combined OCPs combine oestrogen with a progestin (artificial progesterone). This oestrogen-progestin dynamic duo prevents the release of an egg (at least when taken properly). That’s their main job.
They also work to reduce acne by altering the balance between your body’s natural oestrogens and your male- type hormones or androgens. They do this just by upping the total oestrogen COMPARED to androgens which stay the same.
Plus, higher oestrogen as a result of taking the pill encourages your body to make more sex hormone globulin. This protein tightly binds sex hormones – both oestrogen and progesterone AND your androgens. When they’re bound, androgens are less active.
What's the best pill for acne?
As you know, all combined pills contain oestrogen and a progestin but the difference between pills often comes down to the progestin.
The Progestin Lineup
- Norethisterone: One of the older progestins, it's reliable and gets the job done, but is not particularly famous for being an acne warrior. Big advantages- it works as a stellar contraceptive and it’s CHEAP!!
- Levonorgestrel: This one's a bit of a classic too. It's commonly used and highly effective and, like norethisterone, it’s cheap.
- Cyproterone: Often found in popular brands like Diane. It's a solid pick for acne-prone skin because it has anti-androgenic properties. The problem is the relatively higher risk of blood clots- albeit being rare overall.
- Nomegestrol: Pills containing nomegestrol combine hormones that- while artificial- are chemically identical to natural hormones made by your body. Acne is listed as a possible side effect of this pill.
- Drospirenone: The real MVP for acne. Found in pills like Yaz and Yasmin, it's known for its strong anti-androgenic effects, making it a top choice for those battling breakouts.
There are others, too. But these are the most commonly prescribed pills in Australia.
So, Which Progestin is Best for Acne?
Having discussed all the different progestins and their role in managing acne, the evidence from studies that any particular pills has the edge for managing acne isn’t great. Some studies do give the crown to cyproterone or drospirenone-containing pills, but others don’t concur and overall, women are advised to try the pill that works for them.
Quadruple Benefits Beyond clearing up your skin, OCPs are contraceptive, can also help reduce dysmenorrhea (those awful menstrual cramps) and make your periods more regular. So, it’s like getting four benefits for the price of one!
Safety First Before starting on OCPs, it’s crucial to have a thorough check-up. Your healthcare provider will check that the pill is safe for you.
There are several groups of people who should not take combined oral contraceptive pills. These include:
- Women at a High Risk of Blood Clots: COCPs can increase the risk of blood clots, so they are generally not recommended for women who have had blood clots before or who have a high risk of developing them. You might need to run this by your GP.
- Women with Breast Cancer (past or current): Women with a history of breast cancer especially those sensitive to oestrogen are advised against taking COCPs, as the hormones in the pill could potentially stimulate cancer growth. A history of liver cancer also rules out the pill.
- Smokers Over 35 Years Old: Smoking increases the risk of cardiovascular problems, and this risk is further elevated when combined with COCPs. Therefore, women over 35 who smoke are typically advised to use other forms of contraception. Mind you, the best option is to ditch the cigarettes!!
- Women with high blood pressure: High blood pressure AKA hypertension can be worsened by the hormones in COCPs, so women with hypertension are usually advised against taking the pill- even if it’s under control at the moment.
- Women with Certain Heart or Liver Conditions: Conditions like heart disease, certain heart valve disorders, and severe liver disease can be exacerbated by the use of COCPs.
- Women with Migraine with Aura: Women who experience migraines with aura are at a higher risk of stroke when taking COCPs and are generally advised to avoid them. If you haven’t had one for 5 years or more we can cautiously proceed.
- Women Who Have Just Given Birth: In the first 6 weeks after childbirth your risk of blood clots is already relatively high so we wouldn’t add the pill in then. We can however, safely give you the progesterone only minipill.
So, there you have it! Oral contraceptive pills aren’t just for birth control—they can be a fantastic option for managing acne, especially when combined with the right medical advice and lifestyle tweaks. If you’re considering this route, chat with your doctor to see if it’s the perfect fit for you. Here’s to clearer skin and smoother cycles!