Acne usually resolves before adulthood. Some women, however, may have acne that first appears in adult life and flares up in cycles, like before or during their periods. This type of acne is called hormonal acne and is due to abnormal levels of hormones in the body. Using oral contraceptives or birth control pills for acne may be considered when conventional treatments of benzoyl peroxide, topical retinoids, or antibiotics have failed.
These pills work by by reducing the amount of androgens circulating in the body, which in turn reduces the amount of sebum produced by the oil glands. Although androgens, which include testosterone and androstenedione are known as male hormones, females produce them too in their ovaries, adrenals, and fat cells-- albeit in smaller amounts than in males. In fact, androgens are said to have more than 200 actions in women and are the building blocks of the female hormone estrogen.
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It is when androgen levels in a woman are too high that problems can arise. Masculinizing effects such as hirsutism (excess body hair), thinning hair, and acne may occur. If you suspect you have hormonal acne, you should see a dermatologist or a gynecologist so you can be tested to determine if your hormones are at appropriate levels. Your doctor may also test if your acne is related to a female disorder called polycystic ovary syndrome (PCOS), which is also associated with higher androgen levels.
Birth control pills for acne consists of synthetic versions of the female hormones estrogen and progesterone. Regardless of which formula is used, all low-dose contraceptives improve acne. In particular, three estrogen-progestin combination oral contraceptives approved by the Food and Drug Administration (FDA) to treat acne in women are:
- Ethinyl estradiol and norgestimate (Ortho Tri-Cyclen)
- Ethinyl estradiol and norethindrone (Estrostep)
- Ethinyl estradiol and drospirenone (Yaz)
Since the pills target sebum production which is only one of four the key factors that lead to acne, they are usually given in combination with other acne treatments such as benzoyl peroxide or salicylic acid for better results.
Clearing of the skin takes time. It will take at least three months before you can expect results, and before then the acne may actually get worse before it eventually improves. If breakouts occur, you should continue taking them as prescribed, as missing doses repeatedly decrease their effectiveness.
Birth control pills for acne are not for everyone. For one, just like most acne treatments, they work for as long as they're taken. Once you stop taking them, acne may return, sometimes worse than before.
The other concern is the potential side effects. Although they are generally safe and side effects are uncommon, they are not appropriate for some women. They can cause nausea, weight gain, mood swings, and water retention. Women with risk factors for cardiovascular diseases, such as those who are obese or have heart disease or high blood pressure are at higher risk when on the pill.