When it comes to birth control, you have a lot of options. There are pills, patches, rings, intrauterine devices (IUDs), implants, injections — and that’s not even including barrier methods, like condoms and diaphragms.
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Some of those methods use one kind of hormone. Some use two. Some don’t have hormones in them at all.
And while all of them will significantly reduce your chances of getting pregnant, some come with other benefits, too. Benefits like keeping your cycle more regular, reducing pain associated with your period and lessening symptoms of premenstrual dysphoric disorder (PMDD).
And, yes, some birth control methods can minimize breakouts from hormonal acne.
Cue the victory music.
“Birth control can be thought of as more than something that prevents pregnancy. It really does so much more for a lot of people,” explains Ob/Gyn Erin Higgins, MD. “We call those happy side effects the ‘non-contraceptive benefits of hormonal contraception.’ And clearing up acne is one of the big ones.”
If you’re looking for birth control that also manages acne, what’s the best method for you? We talked with Dr. Higgins to get some advice.
Best birth control options for hormonal acne
If you don’t want to get pregnant and you want to clear up your acne, Dr. Higgins recommends birth control pills that contain a steady dosage of both estrogen and progestin throughout the month.
Those kinds of pills are called combination monophasic contraception. You’ll know that your pills are monophasic if:
- They don’t include a “tri-” in the name.
- The package contains three weeks of pills that are the same color. The fourth week (placebo pills) are another color.
“Polyphasic or multiphasic birth control, on the other hand, is manufactured to more closely mimic your natural cycle,” Dr. Higgins explains. “Those pills are a different color for each week of the month, which represents different levels of hormones for each week of pills.”
The U.S. Food and Drug Administration (FDA) has approved three combination monophasic contraception medications for the treatment of acne. They go by brand names including:
The FDA also approves the polyphasic pill Ortho-Tricyclen® for treating acne.
What makes combination monophasic birth control pills Dr. Higgins’ best-in-class for hormonal acne? Let’s look closer.
Why you get hormonal acne
Hormonal acne, or what some people call “period acne,” is pimple breakouts that happen in conjunction with your menstrual cycle. For some people, that means acne that flares for a few days of their cycle. For others, it lasts weeks.
Hormonal acne breakouts tend to sprout up on your chin and jawline. You might also find period pimples on your cheeks, neck and around your mouth, as well as on your shoulders and back.
But … why does it happen?
Throughout your menstrual cycle, your hormone levels change. Estrogen and progesterone rise and fall. So, too, does testosterone. (Even though some people mistakenly think of testosterone as a “male hormone,” we all have some levels of testosterone in our bodies.)
Hormonal acne is one way your body responds to changing hormone levels during the course of your menstrual cycle.
When estrogen drops, testosterone can rise. That rise in testosterone triggers your body to create excess sebum (an oily substance in skin glands). Sebum clogs pores. And … voila, acne.
What estrogen does for acne
Examples of progestin-only birth control include:
- The birth control shot (Depo-Provera®).
- Birth control implants (Nexplanon®).
- Most IUDs (excluding the copper IUD, which doesn’t use hormones at all).
- Some birth control pills (often called “the minipill”).
Combination birth control pills, however, use both estrogen and progestin to prevent pregnancy. And estrogen is the key to fighting hormonal acne.
“Estrogen works to decrease the amount of circulating testosterone in your body, so it cuts off that excess oil production,” Dr. Higgins explains.
Monophasic combination birth control pills keep a steady stream of estrogen in your body, which effectively keeps acne away. No drop in estrogen means no rise in testosterone. And that means buh-bye acne.
“I like monophasic pills for many people because it’s the same amount of hormone every single day, every single week of the month,” Dr. Higgins further explains. “You don’t get a rise and fall of hormones, which can affect your mood and contribute to symptoms of PMS, including acne. Some people like multiphasic pills. And that’s perfectly fine, too, if that works for you.”
In addition to combination pills, vaginal rings and birth control patches use an even flow of estrogen and progestin.
Dr. Higgins says the vaginal ring has a lower amount of estrogen, though, so it tends to be less effective than pills for managing acne.
Patches typically have a higher dose of estrogen than birth control pills do, so they can help to reduce acne for some people. But birth control pills are typically better tolerated than patches for a lot of people. So, birth control pills tend to be Dr. Higgins’ go-to for people looking for birth control and acne control.
Downsides of combination pills
Combination birth control pills may be your best contraception option for dealing with acne. But they may not be right for everyone, Dr. Higgins says.
Some people may prefer long-lasting contraception that they don’t have to think about every day, like the IUD or implant. After all, pills need to be taken at roughly the same time each day to be most effective, and that doesn’t work for everyone’s lives.
Combination pills aren’t advised for people who are breastfeeding (chestfeeding) or who shouldn’t take estrogen due to certain medical conditions. You may be better off with progestin-only contraception or barrier methods in those cases.
And birth control pills don’t protect you from sexually transmitted infections (STIs). Only condoms prevent pregnancy and provide protection from STIs. So if that’s a concern for you, you’ll still want to use a condom even if you’re on birth control.
Know, too, that birth control pills likely won’t clear up your acne overnight. Dr. Higgins suggests giving the pills some time to work their magic. If your acne doesn’t start to clear up after about six months, talk with your healthcare provider about other options.
Other ways to manage hormonal acne
If taking a combination pill is a non-starter for you, or if your pill doesn’t seem to be doing the trick, rest assured, there are other treatments for hormonal acne.
That includes things like a regular skin care routine, including acne-managing products, sunscreen and exfoliating techniques. Or prescription acne-fighting medications, like spironolactone (Aldactone®) or antibiotics for stubborn cases. Some people may also benefit from blue light therapy, which can kill the bacteria and clear up blemishes. A skin care expert, like a dermatologist, can help you understand what options may work best for you.
Those treatment options can be used in addition to the pill, too, if needed.
“It’s a matter of balancing your goals,” Dr. Higgins says. “If a combination pill works for you, great. If it’s not your best choice, or if you have unwanted side effects, we can adjust and find other options. There are a lot of choices out there.”