How Do I Treat Hormonal Acne
Based on the severity of your acne, different treatment options are available to reduce sebum production, pimple formation and painful inflammation:
- Blackheads and whiteheads: Topical cream .
- Inflammatory acne: Topical retinoid and/or topical antibiotic and/or benzoyl peroxide.
- Moderate to severe acne: Antibiotic and/or isotretinoin .
- Cystic acne: Steroid injection .
Limit Caffeine And Alcohol
Limiting caffeine and alcohol is another way for how to treat PCOS acne without birth control. While caffeine and alcohol may not directly cause acne, they can have an affect on the body in ways that tend to lead to higher likelihood of acne, especially if you have acne-prone skin. Both caffeine and alcohol can affect your bodys stress response. An altered stress response can have a downstream effect on the rest of our hormones. Alcohol specifically can negatively affect your GI tract and balance of beneficial bacteria in the gut, which as we discussed can have a link to skin health. Limiting caffeine and alcohol can help to prevent acne before your period.
Hormonal Acne = Hormone Imbalance
Hormonal acne is different than other kinds of acne in that its always caused by a hormone imbalance.
Different hormone imbalances can cause acne. It can be the result of too much or too little of any of your main sex hormones , but other hormones like DHEA and cortisol can play into it too.
And thats why the Pill doesnt always work for hormonal acne.
At best, the Pill can put a band-aid over imbalances, and mask the symptoms temporarily . Depending on what kind of hormone imbalance youre dealing with, the Pill can sometimes intensify your hormone imbalance symptoms and even make acne worse.
Thats why if youre struggling with hormonal acne, I dont recommend turning to the birth control pill. for more information).
Instead, you need to find the root cause of your hormonal acne and work on balancing hormones naturally.
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What Is The Best Birth Control For Acne
So weve established that a contraceptive method delivering a small amount of estrogen alongside progestin is effective in both providing contraception and reducing acne. But what about the progestin itself? Is there a certain dosage or type of progestin that will be more effective against acne?
Many progestins are androgenic, which means they boost androgens and can aggravate acne. But some progestins are actually antiandrogenic, which means they can be a powerful asset in the fight against acne.
Below is a table of antiandrogenic progestins and their associated brands of birth control. These progestins block androgen receptors, effectively preventing androgen hormones from doing their job. If you suffer from hormonal acne and want to reduce the effects of androgen on your skin, these brands should be your starting point.
There are mixed reviews regarding the efficacy of one antiandrogenic progestin over the others. One study concluded drospirenone-containing birth control pills more effective in acne reduction than chlormadinone-containing pills, while a different study concluded the opposite statement. Another study concluded that dienogest-containing formulations were equally effective against acne compared to cyproterone-containing pills.
On the flip side of the scale, progestins with high androgenic properties can make your acne worse.
To the left you can see a handy chart I compiled to help you decide which progestins to look for and which ones to avoid.
I Started Birth Control But My Skin Is No Better
Whenever you start combined birth control pill, there can be some side effects that take a month or two to resolve.
One of these can actually be a flare up of your acne. This is only temporary and should improve as hormone levels become more regulated. Combined birth control does not tend to make acne worse.
As a rule, a minimum of three to six months of therapy is required in order to evaluate whether birth control is going to work for your acne or not.â
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How Birth Control Works As An Acne Treatment
Healthcare providers have been prescribing birth control pills as an acne treatment for several decades, with the FDA even recommending several oral contraceptives as acne treatments as well as for birth control purposes.
The way birth control works as an acne treatment is simple. As a woman, your body produces a small quantity of androgenic hormones such as testosterone. These hormones are essential for optimal wellbeing and health.
Testosterone, for example, plays a role in everything from your muscle and bone health to your sex drive.
Testosterone also regulates the amount of sebum produced by your skin. When your adrenal glands and ovaries produce too much testosterone, your skin can become overly oily, resulting in more severe and frequent acne outbreaks.
Our guide to hormonal acne explains this process in more detail. Simply put, the higher your levels of testosterone and other androgens, the more likely it is that youll experience acne in the days leading up to your period.
The estrogen and progesterone in oral contraceptives lower the amount of androgens in your body. Lower levels of testosterone mean less sebum production, which means a lower risk of experiencing hormonal acne.
Potential Side Effects Of Taking Birth Control For Acne
Side effects of taking birth control pills for acne are the same as those of someone who takes the pill for contraception or any other indication. The most common short-term side effects of birth control are nausea, breast tenderness, and bloating. You may also experience longer-term mood changes and changes in libido. You should speak with your doctor about whether you’re a good candidate for this medication given your medical history and to get more information about other possible side effects.
“If a person has a history of a blood clotting disorder, is a smoker, or suffers from migraine headaches, they are not good candidates for a birth control pill,” warns Birmingham-based dermatologist , MD.
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What The Research Says
Most combined birth control pills are equally effective in helping acne breakouts. A 2012 review by Cochrane Reviews looked at 31 trials involving the use of birth control as an acne treatment.
After looking at six new trials, the authors concluded that all combination birth control pills treated noninflammatory and inflammatory acne.
The study also suggested there was slight evidence that combination birth control pills containing drospirenone were more effective than those that contained norgestimate or nomegestrol acetate plus 17 beta-estradiol.
Combination pills containing drospirenone were then found to be less effective than those containing cyproterone acetate. This distinction isnt significant enough to favor one type of combined birth control over another, though.
In a summary of this study, the Institute for Quality and Efficiency in Health Care concluded that any claims that one pill can lead to better skin than another should be taken with caution.
A 2018 review confirmed that all of the different hormones in combination birth control pills are effective in reducing inflammation of acne.
How Does Birth Control Treat Acne
âBirth control helps treat your acne due to the way it affects your hormones, which in turn can help with acne.This is because of the relationship between hormones called androgens and acne. Androgens are male hormones, like testosterone. All genders have circulating levels of androgens that play a role in acne.
They affect the amount of oil in the glands of the skin where acne forms. Increased sebum production may cause more growth of bacteria that leads to acne,
The estrogen in combined birth control pills works in several ways to lessen the effects of androgens. With less testosterone effects, your pores produce less sebum which reduces the likelihood of blocked pores and pimples. Itâs also a less hospitable environment for the bacteria causing acne.â
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What’s The Best Birth Control For Acne
Quite frankly, there isn’t one.
Emily was experiencing the symptoms of low testosterone and lab testing showed that she was indeed lacking adequate amounts. But her acne persisted.
Thats because the pill doesnt fix acne or regulate hormones for that matter. It simply suppresses it.
And for some women, acne is worse after stopping birth control.
Over 2 years Emily had been on 5 different birth control pills and felt like her skin was getting worse. So, instead of reaching for another new prescription, it was time to take a holistic approach to her skin.
How The Birth Control Pill Works
To treat acne with the help of birth control pills you shoulduse combination birth pills that contain both estrogen and progestin hormonesthat help to remove or clear easy or mild acne to appear on the skin. But is notapproved by the U.S.
FDA for that sole purpose four different oralcontraceptives have been FDA approved to treat moderate acne if the person isat least 14 to 15 years old, has already begun menstruating, and needscontraception. They include Ortho Tri-cyclen, Beyaz, and YAZ. Birth pills aremade with synthetic hormones that stop or create a loop to stop sperm frommeeting with eggs.
Birth control pills are made to stop ovulation and preventpregnancy, for this pill, releases hormones that change the consistency ofcervical mucus to make it harder for sperm to reach the egg. Most combinationbirth control pills are synthetic forms of material that are the source ofestrogen and progesterone hormones all are good for acne treatment.
Some other birth pills that contain only estrogen hormones alsocontain progesterone and known as minipills they are also taken by women tostop pregnancy. There are lots of benefits to using birth control pills. If you areusing birth pills then you may see these benefits for your health.
Birth controls effect on acne
For stopping access to sebum it is said that you should useestrogen and progestin hormonal birth pills that are known as combination birthpills.
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How Long Does It Take For Birth Control To Help Acne
It can take as short as 4-6 weeks or as long as a few months after starting birth control pills to see a significant decrease in acne. It is common for women to experience an initial flare-up of acne after starting birth control, but this should eventually go away. The process takes a while because the body may need a few months to get used to the new hormones being introduced.
With all of that being said, women who have more severe acne will need to use topical medications like tretinoin cream or other acne treatment products to get the best results.
Probiotics For Gut Support
Is birth control bad for my gut? Can I take probiotics with birth control? If these are some of your top questions know that youre not alone. These questions are sent to me regularly from readers.
Yes, birth control is bad for your gut, as I explained. And yes, you can take probiotics while using birth control. In fact, you should take probiotics because birth control disrupts the microbiome.
In my clinical practice I recommend MegaSporeBiotic because it is a spore based organism that promotes microbial diversity in the gut. It also helps with creating healthy antioxidant status in the body. And it doesnt cause the same kind of issues a Lactobacillus species can if you have SIBO.
Balance, Prenatal Plus, and MegaSporeBiotic are all part of the post-birth control basic supplement kit that you can check out here.
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Should I Go On Birth Control To Clear My Acne
Birth control is normally prescribed for women who need contraception. If you are not seeking contraception, is it worth it to get on birth control?
While we discussed the many benefits of birth control, there are a number of other risks and side-effects that cannot be glossed over. Serious medical complications are extremely unlikely, but should always be considered when choosing a method of contraception.
Hormonal contraceptives can increase the risk of:
- Certain cancers
- High blood pressure
- Yeast infections
- Benign liver tumours
Many of these risks increase with age and smoking in particular. Birth control pills must never be used in smokers over age 35 due to the increased risk of blood clots in the legs or lungs .
A study published in 2017 concluded a 3 to 7 fold increase of VTE risk in women who regularly use combination pills. Furthermore, this risk is evidenced to be higher in combination pills that contain cyproterone acetate and especially drospirenone, the progestin that is considered most effective against acne.
For these reasons, you should discuss the risks with your doctor and be extra cautious about starting birth control if you are over the age 35 and/or have the following conditions:
- History of blood clotting or heart issues
- History of smoking
- Uncontrolled blood pressure
- Weight gain or loss
- Irregular bleeding
Best Birth Control Options For Acne
Hormonal contraceptives are available in multiple forms: the pill, patch, vaginal ring, injectable, or intrauterine device .
However, oral contraceptives in the form of the pill are the most commonly prescribed and one of the most effective types of birth control for treating acne. Some women also find improvements in acne with the vaginal ring .
Three types of oral contraceptives have been approved by the U.S. Food and Drug Administration for treating acne. Each type contains a low dose of the same form of estrogen but with different types of progestin.
- Ortho Tri-Cyclen combines estrogen with norgestimate, and is available in different doses depending on the severity of your acne and your doctors judgment
- Estrostep contains estrogen combined with norethindrone, and is also available in various doses according to your needs
- YAZ combines estrogen with drospirenone and is approved for the treatment of moderate acne
Studies indicate all three offer the same results in terms of efficacy however YAZ is associated with a greater risk of serious side effects due to drospirenones mechanism of action.
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Birth Controls Effect On Acne
The hormones in combination birth control pills can help reduce acne. The pills decrease the circulation of androgens, which decreases the production of sebum.
The pills must contain both estrogen and progestin to be effective against acne. The minipill only contains progestin, so it doesnt improve acne.
Many combination birth control pill brands are available. Each contains its own variation of hormones. Pills prescribed for acne should contain progestin with low androgenic possibility. This means the progestin has less androgenic side effects, such as oily skin and acne.
The U.S. Food and Drug Administration has approved the following pills for use in the treatment of acne:
- Beyaz, which combines drospirenone, ethinyl estradiol, and levomefolate calcium
- Estrostep Fe, which combines norethindrone acetate, ethinyl estradiol, and ferrous fumarate
- Ortho Tri-Cyclen, which combines norgestimate and ethinyl estradiol
- Yaz, which combines drospirenone and ethinyl estradiol
However, other combination pills that arent on this list may still help to improve acne.
Why Does The Pill Reduce Acne For Some Women
The hormones contained in the Pill can play a role in reducing acne. Particularly for those suffering from hormonal acne, the Pill can lower the circulation of androgens which also decreases the production of sebum . Less oil can mean less acne for some women.
However, effective acne reduction is only seen with types of contraception that contain a combination of both estrogen and progestin. That means the minipill wonât have an impact on improving acne.
For those of us who experience breakouts in sync with our cycle, the Pill can be an effective acne treatment. When looking for acne-fighting Pill prescriptions, your doctor should recommend a Pill variation that contains progestin with a low androgenic possibility . In most cases, it will take a few months to see the full impacts so itâs important to be patient.
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Why We Develop Acne After Stopping Birth Control
There are several factors that contribute to post-birth control syndrome acne. Many of which are a direct result of what birth control has done to our bodies while on it.
Alice explained that her skin seemed oily within the first couple months of stopping the pill. What followed were small zits on her chin and jawline the week before her period. When she presented in my office she was noticing acne that was deeper and more inflamed 10 days before her period.
It seems to be coming on sooner and sooner and Im afraid my face is going to look like this all the time, she shared during her first visit with me.
There were several reasons why Alices skin was rebelling and they are common after coming off of hormonal birth control.
What Are Signs Of Hormonal Acne
Hormonal acne differs from other types of acne in that it is specifically related to hormones. While this is not always easy to distinguish, if you notice one or more of the following, the acne you are experiencing may be related to hormones.
- Breakouts that recur around the same time in the same areas of the skin every month.
- Painful, deep cysts
- Individual pimples around the chin, jawline, neck, or sides of the face.
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Hormonal Birth Control And Acne
Acne is often the result of hormonal imbalance in the body your doctor might call it an androgen-mediated problem. In other words, androgens play a key role in your body regardless of your sex or gender. Androgens, such as testosterone, boost skin cell growth and stimulate the skin to produce more oil. This can then lead to blocked pores and thus acne.
Most hormones have a counterregulatory hormone a hormone that opposes its effects. The counterregulatory hormone of testosterone is estrogen, which is commonly supplied in birth control pills. This is why many doctors recommend hormonal birth control for treating acne. The estrogen supplied in the birth control can counter the effects of testosterone.
So now we know why birth control methods are often prescribed for acne, lets go back to our original question does birth control cure or cause acne? The reality is that birth control can both cure AND cause acne. Studies show that birth control pills can reduce acne by 55% on average. However, acne may come back even worse after the pill is stopped. Birth control can also make your acne worse if it lacks sufficient antiandrogenic properties.