Does birth control help acne?

What causes acne?

Acne is estimated to affect up to 80% of people at some point in their lives [1]. It’s closely linked to our hormones, and especially hormonal changes — that’s why it often starts showing up during puberty. 

More specifically, acne has been tied to higher levels of androgens, a group of hormones (testosterone is perhaps the best-known) that trigger the production of sebum. This is an oily substance that, in excess, can clog our pores and lead to breakouts [1]. 

Higher androgen levels can happen when hormone levels shift during the menstrual cycle, for example, during ovulation [2]. Additionally, as many as 85% of women with acne notice worse breakouts during the days leading up to their period. We can also be more prone to breakouts during other times in life when hormones go a bit haywire, such as perimenopause [3]. 

Acne is also a common symptom of PCOS, a condition that causes the production of excess androgen [4].

How does birth control help treat acne?

So, if hormones are to blame for acne, how come hormonal birth control is a treatment option? Birth control can help treat acne in two main ways: by stabilizing hormone levels and reducing the production of androgens [5]. 

Certain types of birth control, such as the combination pill, contain a combination of our two main sex hormones: estrogen and progestin (a synthetic version of the hormone progesterone). Estrogen is known to lower androgen production and, by extension, reduce oily skin, which can help keep acne at bay [5]. 

At the same time, you won’t experience the hormonal shifts that happen during the menstrual cycle if you’re on hormonal birth control — and this can also help reduce acne. Very simplified, hormonal birth control works by inhibiting ovulation, which causes the natural menstrual cycle to stop and hormone levels to stabilize. Because hormonal shifts are a common cause of acne, having steady hormone levels can reduce acne outbreaks [3]. 

Which types of birth control can help with acne?

The types of birth control that can be used to treat acne are so-called combination methods, which contain both estrogen and progesterone [5].

The combination birth control pill (what’s usually referred to as “the pill”) is the most common option, but there are a couple of other methods that also contain estrogen. These are the vaginal ring (NuvaRing) and the birth control patch. Both of these methods can help reduce acne and, unlike the pill, you don’t have to think about them every day [5]. The ring and the patch are typically worn for three weeks at a time, followed by a week’s break before they are swapped out and replaced with a new ring or patch. 

When considering using birth control to treat acne, you should take into account a number of factors, including lifestyle and preferences. The first step to finding the best birth control for acne in your specific situation is to have a conversation with your healthcare provider. They can assess your needs and medical history, and together you can discuss options to find the right fit.

Birth control pills approved for acne treatment

While there are many different types of birth control pills, only a few have been FDA-approved for this purpose. These are:

• Estrostep

• Yaz

• Ortho Tri-Cyclen [5]

However, any combination birth control pill can technically be used to treat acne, so other brands may be prescribed off-label. In fact, a recent review article that summarized the findings of 31 previous studies on treating acne with birth control found that there was no significant difference between the brands of pills used — all of the birth control pills tested were able to improve acne [6]. 

How long does it take to see improvements?

Acne treatments generally take some time to work, and the same goes if you’re starting birth control pills to manage your acne. You can expect it to take at least four weeks to see any changes, and then your skin should start to clear up after around two or three months [7]. If you’re not seeing any improvements after four to six weeks, make sure to check in with your doctor to see if you need to adjust your treatment plan.

Benefits of using birth control for acne

Aside from the obvious benefit of reducing acne breakouts, birth control also has other benefits. Using birth control means you’re protected against pregnancy (however, keep in mind that no birth control is 100% effective, and that condoms are the only form of contraception that protects against sexually transmitted infections). 

Additionally, birth control can help with some other menstrual cycle-related issues, such as heavy periods. It can also be used to treat conditions like PCOS (where acne is a common symptom) or endometriosis [8, 9].

Risks of birth control

As with any medication, birth control comes with its own set of risks. For most people, these risks are small, but certain types of hormonal birth control may not be right for everyone, and it’s helpful to understand when it shouldn’t be used. Birth control containing estrogen is typically not recommended if you have: 

• High blood pressure or a history of heart disease

• Higher risk for blood clots 

• A history of certain cancers, such as breast or liver cancer

• Migraines with aura (visual or sensory disturbances)

• Problems with the gallbladder or bile ducts

• Diabetes [10]

Additionally, this type of birth control might not be right for you if you are living with obesity, or if you’re currently smoking and are over the age of 35 [10]. 

It’s always important to speak with your healthcare provider, who can help you weigh pros and cons and find a treatment option that works for your body.

Can birth control cause acne?

Yes, acne can sometimes be a side effect of using birth control. Not all contraceptive methods contain estrogen; in fact, there are a large number of birth control methods that use only progestin (the synthetic version of progesterone). These progestin-only methods are often prescribed to those who can’t use birth control containing estrogen, and research has found that acne is a common side effect [11, 12].

So, why can progestin-only birth control cause acne when other types of birth control help? Progesterone has the opposite effect of estrogen and can encourage increased production of the androgens that cause hormonal acne [12]. For this reason, some types of birth control containing this hormone can cause skin problems or make acne worse for those already living with it. 

Progestin-only options like the hormonal IUD, implant, birth control shot, and mini pill have all been shown to increase the risk of acne [11, 12]. It’s important to note that this doesn’t mean that everyone using these methods will get acne, but if you’re interested in using them and feel concerned about breakouts, it can be worth mentioning when you talk to your healthcare provider.

Acne breakouts when stopping birth control

It’s quite common to experience acne breakouts when you stop birth control [13]. It even has a name: post-birth control acne or post-pill acne. Once again, the explanation comes down to hormones.

If you’ve used birth control as acne treatment, the effects will go away when you stop. Androgen levels that were suppressed by the estrogen will start rising again, potentially leading to new breakouts. 

However, post-birth control acne can also happen even if you haven’t had any issues with breakouts before. Since acne is usually caused by hormonal shifts [3], breakouts can appear as the synthetic hormones clear your system and your body adjusts to its regular rhythm. This typically goes away on its own in time.  

Other ways to manage acne

While birth control pills are commonly prescribed to treat skin problems, you are not limited to these solutions. Here are some other ways to treat acne:

• Topical retinoids: These work by exfoliating the skin to remove dead skin cells and preventing the build-up of oil and bacteria inside hair follicles. You can get them over-the-counter as gels, creams, or serums, but they can also be prescribed [12].

• Benzoyl peroxide: An anti-bacterial and anti-inflammatory treatment that you can get over-the-counter, usually in the form of a cream or gel. It’s often used together with antibiotics or retinoids [12]. 

• Topical antibiotics: These come in the form of a lotion or gel that is applied to the skin, killing the bacteria that can infect hair follicles [12].

• Oral antibiotics: These are taken orally and are usually used in combination with a cream, gel, or lotion to treat more severe acne, such as cystic acne [12].

• Azelaic acid: This is usually offered as an alternative to those who are sensitive to topical treatments or retinoids. It works in a similar way, killing bacteria and removing dead skin [14].

• Spironolactone: A type of steroid that blocks the androgens that cause oily buildup in the skin. Spironolactone requires a prescription [15].

• Isotretinoin (Accutane): This option works by reducing oily buildup in the skin. It’s typically used for severe acne or if other treatments haven’t worked, since it can have some serious side effects. Because isotretinoin should not be used during pregnancy, we recommend speaking with your healthcare provider if you are planning a pregnancy and are currently taking or are interested in taking isotretinoin [16].

As always, when it comes to medical treatments, it’s best to discuss your options with your healthcare professional. They can help you weigh benefits against potential side effects and find the best fit for you.

Skincare routine for acne management

While many of us are more prone to skin changes than others, and it may feel like there’s not much we can do, there are steps you can take in your routine that may help support your skin and prevent acne. We’ve collected some tips here [17]:

• Keep your skin clean: Though it’s a myth that acne is caused by poor hygiene, cleaning your skin daily (try not to do it more than twice per day) helps keep your pores from becoming clogged. Use a mild soap or cleanser, or wash with water that's not too hot or cold.

• Remove makeup before going to bed: Continuing on the cleaning theme, make sure you don’t sleep wearing makeup — it can clog your pores and make acne worse.

• Shower soon after exercising: Sweat can irritate the skin and exacerbate acne, so it’s best to wash off sweat right away after you’ve finished exercising. If you prefer to shower at home after the gym, you can always quickly rinse off your face with water before leaving.

• Use mild skincare products: Choose mild products suitable for acne-prone skin (you can always ask at the pharmacy or local store if you’re unsure). Avoid harsh products that irritate your skin, as well as oil-based skincare or makeup products. 

• Avoid squeezing spots or blackheads: We know it can be tempting, but squeezing spots can make them worse and even cause scarring.

• Wash your hair regularly: Oil from our hair can make its way onto our face and cause acne. Shampooing regularly and keeping your hair out of your face can help. Our hair is also affected by hormones (similar to our skin), so you may notice that it’s more greasy at certain times of your cycle.

• Protect your skin from the sun: Spending too much time in the sun can cause skin damage, and this can actually make acne worse (plus, some acne treatments can make your skin more sensitive to sun damage). The best course of action is to stay out of the sun when it’s the strongest, wear SPF if you know you’ll spend time in the sun, and you can also protect your skin with clothing and by using sunscreen for acne-prone skin. These steps are also beneficial for those who don’t have acne.

• Eat a healthy diet: Some research also suggests that diet can be a helpful tool for managing acne. Limiting your intake of refined carbs and instead opting for a low-GI diet (foods with low-glycemic index, or GI, are less likely to raise blood sugar levels). Choosing protein-rich food, plenty of whole grains, healthy fats, fruits, and vegetables, as well as consuming less dairy, may help improve acne [18]. Again, this is individual, and only you will know what works for your body. 

Keep track of acne with Natural Cycles

Coming off the pill and opting for hormone-free birth control can feel like an extra worry if you’ve struggled with acne in the past — especially if birth control has been part of your treatment plan. While there’s no one-size-fits-all when it comes to contraception, you should always consider what works best for you and your body.

You may find it helpful to monitor breakouts alongside changes in your diet or lifestyle, to better understand what works for you. At Natural Cycles, we’ve made it easy to track skin changes along with other lifestyle factors, such as diet and stress, so you can spot patterns, record breakouts, or notice when your skin is naturally at its best. With this power comes the knowledge of how your skin changes throughout the cycle. Why not see if Natural Cycles could be right for you?