Many people only think about the pill as a contraceptive (to prevent pregnancy) but it can also help some women to control their acne.
The pill can treat acne by blocking the stimulatory effect that androgens (male hormones) have on the sebaceous glands of the skin. It works by decreasing oil or sebum production and can be used when acne doesn't respond to topical treatments or if it comes back after a course of oral antibiotics.
In women over 25 years old or those experiencing premenstrual flare-ups of acne, the pill may be particularly useful.
Taken daily, the hormones in the pill prevent the ovaries from ovulating (releasing eggs). Pregnancy is prevented because there are no eggs to fertilise. The pill also causes changes in the lining of the uterus and the mucus of the cervix, which also reduces the chances of pregnancy.
The progestogen component of a combined oral contraceptive pill is most important in determining whether an oral contraceptive pill is likely to improve or worsen your acne.
Very low dose pills
The pills with proven benefits in acne include low oestrogen dose pills containing 20mcg ethinyloestradiol along with the following progesterones:
- Low dose (100mcg) levonorgestrel, such as Loette and Microgynon 20 (pills containing higher doses of levonorgestrel, e.g. 150mcg, can worsen acne)
- Drospirenone (3mg) – an example is Yaz
There are fewer side effects with low dose pills and good contraceptive protection (i.e. not getting pregnant), but it is important to take this pill about the same time every day.
Breakthrough bleeding is a more common problem for females taking a low dose pill. When used alone, low dose pills are usually only indicated for mild to moderate acne, but could be used in combination with other treatment options for more severe forms of acne.
Low dose pills
This type of pill (dienogest 2mg, Valette) has a particular benefit for women with hormonal problems including oily skin, acne, PCOS and menstrual irregularities.
Other oral contraceptive pills
Combined oral contraceptive pills containing 35mcg ethyloestradiol 2mg and cyproterone acetate (an anti-androgen) have also proven useful in managing acne. They include Brenda-35 ED, Estelle-35 ED, Diane-35 ED, Juliette-35 ED.
These pills are also more likely to be associated with mood changes, depression, weight gain, changes in libido, and fluid retention, and carry the greatest risk of increasing the risk of deep vein thrombosis. This risk is increased if you are a smoker and have a BMI >30 (obese, not just overweight).
Other contraceptive pills that have been shown to improve acne include those containing the progestogens desorgestrel (e.g. Marvelon), gestodene (e.g. Minulet) and drosperinone (e.g. Yasmin).
Minipill and contraceptive implants
The minipill and contraceptive implants are more likely to worsen rather than help acne due to their effects on the menstrual cycle. These are progestogen only pills or implants (e.g. Depo-Provera, Depo-Ralovera, Microlut, Mirena and Implanon).
Spironolactone: a non-contraceptive hormonal agent
Spironolactone (e.g. Aldactone, Spiractin) is a non-contraceptive anti-androgen that has proven benefit for acne on its own or in combination with the pill. It is particularly useful for females with excessive body hair (hirsutism) or androgenetic alopecia (male pattern hair loss in a female). After starting spironolactone, you’ll usually notice a reduction in skin oils in the first four to six weeks and see the full benefits by the second and third month.
Taking the oral contraceptive pill
Having chosen a convenient dose time, for example after breakfast or after dinner, try to stick to it. During the first 14 days of the first cycle only, you will need to use additional non-hormonal methods of contraception (e.g. condoms).
Taking the pill:
- Start on the first day of menstrual bleeding
- Take your first pill from the highlighted section
- Press out the pill marked with the appropriate day of the week
- Take a pill each day always following the direction of the arrows
If you are using the pill as an acne treatment, it will need to be taken for at least six months. It’s often prescribed for prolonged periods to control acne. In 8-12% of females, acne can continue into the late 20s and even 30s, so the pill can be used to suppress acne until its natural resolution.
- Common side effects of the oral contraceptive pill include nausea, vomiting, abdominal pain, headaches including migraines, breast tenderness/enlargement and vaginitis, including thrush
- You should still continue to cleanse, treat and moisturise your skin whilst on the pill
- You should expect to see an improvement in your acne after being on the pill for eight to12 weeks
- Your pimples should continue to improve from three to 12 months
- The pill can be taken for as long as acne and/or contraceptive treatment is needed. If you stop treatment, you may find that your acne returns, although not as severely as before (as you get older, the chance of acne returning is reduced)
- If you have diabetes, suffer from migraine, have epilepsy, are overweight, a heavy smoker or have high blood pressure, your doctor may wish to discuss whether to put you on the pill. You will also need to discuss if there is a family history for breast cancer as the pill may not be appropriate in these cases
- The pill can reduce incidence of ovarian and uterine cancer, pelvic inflammation, some diseases of the breast, iron deficiency anaemia and rheumatoid arthritis