Best Birth Control for Acne

In most of the modern world, most women control reproduction with oral contraceptives. An interesting side effect of birth control pills is that they also help clear up premenstrual acne, although some brands of birth control are better than others.

What Does a Birth Control Pill Have to Do with Acne?

Throughout a woman’s reproductive years, her hormones are constantly in flux. Estrogen levels increase during the first half of each menstrual cycle, thickening the lining of the uterus to prepare for the possibility of conceiving a child if the egg or eggs released during ovulation (usually about 11 or 12 days into the cycle) are fertilized by sperm within 24 hours. Then a woman’s body produces more estrogen either to prepare the lining of the uterus for the embryo or to thicken it so it can slough off as the cycle repeats itself.

Estrogen clears up acne. Progesterone makes acne worse. The effects of progesterone are greatest right before the menstrual period, so many women experience premenstrual acne. About once a month they break out in whiteheads. These whiteheads don’t become blackheads unless the dried sebaceous oil or sebum in a pore is thick and exposed to the air. If whiteheads are removed from the skin fast enough, they never become blackheads. And a pore that pops out in a pimple usually was clogged a month or so earlier. Other kinds of skin infections can break out literally overnight, but a pimple usually is a white head that was missed the month before.

Birth control pills clear up acne by changing the balance of estrogen and progesterone. Oral contraceptives usually contain both estrogen and progesterone (the latter hormone in the form of progestin, a synthetic chemical that works in a woman’s body the same way as progesterone), but taking birth control pills increases a woman’s estrogen more than it increases her progesterone. Most oral contraceptives don’t interfere with the menstrual cycle itself, but they increase estrogen enough that acne partially clears up. The problem is that estrogen isn’t without side effects.

The Side Effects of Estrogen

As most women know, increasing estrogen levels is not an entirely uncomplicated good thing. High-estrogen birth control pills and estrogen replacement therapy can increase the risk of blood clots and cardiovascular disease. They increase the risk of estrogen-receptor positive cancers of the breast and endometrium.

Taking too high a dose of estrogen can also cause acne, by making a woman’s skin more sensitive to the testosterone released by her ovaries. Newer brands of the Pill, however, are strong enough to prevent the release of an egg during ovulation, but mild enough that they do not increase the sensitivity of the skin to testosterone. These brands of oral contraceptives mainly work by increasing the activity of sex hormone binding globulin, which keeps testosterone in an inactive form in a woman’s bloodstream. The  reduced activity of testosterone caused by taking these brands of the Pill can help clear up the skin, but may also lower sex drive.

Do Birth Control Pills Really Work for Controlling Acne?

Most clinical studies find that taking contraceptives gets rid of between 35% and 60% of the total number of acne blemishes, whiteheads, blackheads, and pimples, that break out in the 3 to 5 days before a woman’s period. Changing brands of contraceptives won’t get rid of 100% of blemishes. Changing brands of contraceptives for skin care concerns will just make treating acne easier. Oral contraceptives never get rid of 100% of blemishes.

Which brands of oral contraceptives work best? Ultimately, you need to make that decision with your doctor, but some brands of the Pill that are approved by the US Food and Drug Administration as treatments for acne include:

  • Estrostep,
  • Ortho-Tri-Cyclen, and
  • YAZ.

The women who get the greatest response to birth control pills for acne are women who have a condition known as polycystic ovarian disease or PCOS. In this condition, the ovaries overproduce both estrogen and testosterone. The excess estrogen causes its problems, including fluid retention, perimenstrual weight gain, and mood swings, and, even worse, makes the skin super-sensitive to the excess testosterone. There are some thing women who have PCOS can do to get rid of the blemishes that are especially bad around their menstrual periods (or the time of month they should have their menstrual periods but don’t).

Cut down on sugar in the diet. Part of the problem of PCOS is that the ovaries get flooded with sugar from the bloodstream. This happens because the rest of the body develops insulin resistance, shutting off receptor sites on the outer membranes of cells that otherwise would respond to insulin and send sugar inside, resulting in so much oxidation that the cell could be damaged by free radicals of oxygen generated as the sugar was metabolized for fuel. The ovaries don’t have the ability to reject sugar from the bloodstream, so they go into high production of estrogen and testosterone.

Be sure to moisturize. Most women have moister skin during the first half of their menstrual cycles and drier skin during the second half of their menstrual cycles. Dry skin is tighter, and shrinks around pores. This happens at the same time testosterone is increasing sebaceous oil production inside them. Moisturizing the skin opens pores so they never form whiteheads and blackheads in the first place.

Consider 2.5% benzoyl peroxide. Benzoyl peroxide doesn’t do very much to stop whiteheads and blackheads, but it kills the acne bacteria that cause pimples. Just be sure not to use any product that contains so much benzoyl peroxide (usually 5% or more) that you experience drying, flaking, peeling, itching, or burning skin.

Ask about antibiotics. Antibiotic creams also reduce the number of acne bacteria on your skin. They don’t totally eliminate bacteria, however, and sometimes the most resistant and nastiest acne bacteria are the ones that survive antibiotic treatment. These bacteria can cause rebound acne when you eventually stop the treatment. The best way to prevent rebound acne is to come off antibiotic creams gradually, using them every other day or every three days until you stop entirely, and using benzoyl peroxide as a backup while you taper off antibiotic treatment.