For years, dermatologists have prescribed hormonal birth control to help patients with acne. But for every group of patients that it has helped, it seems like there are plenty of others who say their skin got worse on birth control.
“Hormonal birth control provides external hormones that help regulate your menstrual cycle and can affect your skin,” Joshua Zeichner, MD, a New York City dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center, tells Yahoo Lifestyle. “Depending on which hormones are used, acne can be improved or aggravated.”
Hormonal birth control can generally be divided into two categories: Combined contraceptives, which contain estrogen and progestin, and progestin-only contraceptives, Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies, tells Yahoo Lifestyle. Combined contraceptives include things like the pill, the patch, and the ring, while progestin-only options include the mini pill, the shot, and hormonal IUDs.
Combined methods “work by suppressing ovulation, so they shut down ovarian production of estrogen, progesterone, and testosterone,” Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine, tells Yahoo Lifestyle. “So, your testosterone levels fall. And, in general, testosterone is the bad actor for acne.”
The estrogen component in particular is important, Greves says. “It increases sex hormone-binding globulin, which binds androgens (male sex hormones like testosterone) and estrogen, keeping those androgens from going to the skin,” she explains. “If those androgens are bound up, they can’t wreak havoc on your skin.” Androgens stimulate oil production in your skin, which can lead to acne flares.
Some forms of progestin actually have androgenic activity, which “can actually promote acne,” Minkin explains. “The progestins to look out for in these pills include norgestrel, norethindrone acetate, and levonorgestrel,” she says.
However, there is a progestin that’s considered “the least androgenic progestin,” Minkin says. It’s called drospirenone, and it’s the progestin in Yaz and its generic forms. “Drospirenone is considered to be the best progestin ingredient in treating acne because it does not have any androgenic effect, meaning that it does not stimulate oil production,” Zeichner says.
There are actually four birth control pills that are approved by the Food and Drug Administration to specifically treat acne, Zeichner says: Yaz, Beyaz, Estrostep, and Ortho Tri-Cyclen. “But ultimately, the choice and birth control pill depends on your gynecologist,” he says. (Unless, of course, your dermatologist is the one prescribing it to you.)
If you start using a new form of hormonal birth control and your skin seems to react poorly, it’s recommended to wait a while — about three months — to let your body get used to it, Zeichner suggests. “It is important to be patient after starting birth control,” he says. At the same time, “continue to treat the skin with your traditional acne medications, be it topical or oral, along with the birth control.”
He adds: “After three months of continuous use, if the birth control is not helping your acne, it is important to speak your dermatologist about alternative treatments.”
Still, if you feel like you can’t wait, it’s OK to talk to your doctor sooner about switching your method of birth control. “There is no harm in switching,” Minkin says.
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