Believe it or not, some dermatologists don’t like to refer to hormonal contraceptives as “birth control.” Take Katharine O’Connell White, MD, MPH, an Assistant Professor of Obstetrics and Gynecology at Boston University School of Medicine and the director of the Family Planning Fellowship at Boston Medical Center, who explains that preventing pregnancy is just one of the countless ways reproductive health specialists use birth control to help their patients.
“Birth control has so many benefits beyond contraception that I actually hate that we call it the birth control pill,” she says. “For so many, it’s the lighter bleeding pill, the no cramps pill, the prevent cancer pill, the control endometriosis pill.”
Hormonal contraceptives can help manage a variety of conditions, from unruly periods to polycystic ovarian syndrome (PCOS). But did you know hormonal birth control that contains both estrogen AND progestin could actually be a key part of your skincare regimen? For many patients, Dr. White says, hormonal birth control methods are frequently the first line of defense against acne.
Can the pill really help with my acne?
It sure can! “We have been using the pill for years to help control acne,” says Dr. White. She attributes its effectiveness to the pill’s ability to rein in high testosterone levels that may be causing breakouts. Testosterone is a reproductive hormone associated with our sex drive, mental health, bone and muscle mass, fat storage, and red blood cell production. Yes, large amounts of testosterone are stored in male testes, but, fun fact: a small amount of testosterone is in our ovaries too! Overproduction of this hormone can lead to breakouts.
“If you’re able to lower testosterone levels, this actually lowers sebum production, which then decreases acne,” Dr. White says. Sebum is a combination of oils and waxes that protects and moisturizes the skin, but too much can clog pores and lead to acne.
Can every form of the pill prevent acne?
“Combined oral contraceptives, so the kinds that have estrogen and progesterone in them (which is the vast majority on the market) will decrease testosterone levels,” Dr. White explains, noting that some oral contraceptives are better studied than others. A few have received FDA approval as acne treatments because the companies that manufacture them invested in studies showing that patients who took pills had decreased acne compared to those who didn’t. But, Dr. White says, just because a pill doesn’t have FDA approval for acne treatment doesn’t mean patients won’t experience the skin care benefits. “In theory, all birth control pills should have this benefit.”
Dr. White notes that permanent forms of birth control, like a hysterectomy or getting your tubes tied, will not have any effect on acne. However, as a person reaches menopause, they could see more severe breakouts due to changing hormones. Although some health conditions (such as high blood pressure) might make it unsafe for certain patients to use hormonal birth control, Dr. White recommends hormonal birth control to healthy patients with acne, regardless of their age.
“I recommend the birth control pill as the first line for anyone who is battling acne, and just because [someone] is older doesn’t mean they shouldn’t take the pill,” she says. “If someone is what we call perimenopausal, so getting into those years before menopause, is healthy, and has acne, I would recommend a birth control pill. There’s nothing that says you can’t be on the birth control pill right through menopause, as long as it’s healthy for you overall.”
Okay, so most pills can help. What about other types of contraceptives?
Pills aren’t the only way patients can obtain hormonal birth control, of course. Currently, there are four hormonal IUDs on the market: Mirena, Kyleena, Skyla, and Liletta. According to Dr. White, 7-14% of patients in clinical trials of these methods reported acne, and only 1% of patients cited acne as a reason why they discontinued use. Though these are low numbers, the results of these trials are less definitive than studies that found all combination birth control methods to be effective in reducing acne.
“I believe it’s because with the IUD, there are very few hormones that get released into the bloodstream,” Dr. White explains. “We know that the progesterone-only methods of birth control — which are the IUDs, the implant, the injection, and one type of birth control pill — overall have higher instances of acne than what we call the combined methods, which are most birth control pills, the patch, and the ring. So I would say with the IUDs, it’s not a very common complaint, but it is absolutely noted that it can happen.”
For patients who don’t want to take a pill every day but want more of a guarantee that their birth control will affect their acne, there are other methods out there. Dr. White says birth control patches and the Nuvaring are often overlooked in conversations about contraception and skincare, but they use the same combination of estrogen and progestin found in birth control pills, so she says they should function the same.
“They should work the same as the birth control pill for acne, even though they’re not as well-studied,” she says. “But a very large review of lots of different studies showed that ring users have less acne than birth control pill users. Again, there’s less circulating hormones with the ring than pills, and I think you’re looking for that sweet spot of just enough hormones to control your testosterone levels, and not so much hormones to cause other side effects.”
But I’m on the pill and it’s not helping my skin!
If hormonal birth control isn’t yielding the skin care results you want, Dr. White says to heed caution before blaming your contraception for breakouts. She says the science doesn’t add up to conclude that breakouts are caused by combination birth control methods, but she’ll never deny a patient’s individual experience and it is always possible that a certain method isn’t right for an individual’s chemistry.
“I think sometimes the formulation that might be in a certain pill is just not sufficient to decrease the sebum the skin is producing,” she says. “The most common thing I see is that a person has been on birth control for a long time, decides to change to an IUD because it’s so much easier to use, and then all of a sudden their skin goes crazy. But I suspect in those cases, it’s not because of an IUD, it’s because of the lost benefits of the pill,” says Dr. White — aka a sudden decrease of hormones in your body.
For patients experiencing skin care crises as they switch birth control methods, Dr. White recommends either trying one of the pills approved by the FDA to treat acne, or trying a combination of a non-hormonal copper IUD paired with hormonal combination birth control pills.
“The benefit of this is that the IUD is providing near-perfect protection against pregnancy, and then you take the pill for your skin,” she explains. “And then if you forget every once and a while, it’s ok, at least from the pregnancy perspective.”
Above all, Dr. White tells patients to listen to their bodies. If someone is feeling any intolerable side effects of birth control, they should stop and try something else. Patients have so many options for hormonal birth control methods these days, and though it may take some time, Dr. White says, everyone can and will find the one right for them.
“Birth control is supposed to make your life better, not worse,” she says. “There are too many methods out there for you to feel stuck with the one that you’re on.”