Birth control (oral contraceptives) and acne

How do oral contraceptives (OCs) help with acne? As a general rule, birth control pills reduce androgens (male sex hormones) which are partly responsible for acne formation. Women with acne tend to have higher levels of androgens. More specifically:

1. OCs reduce the level of free testosterone in a woman’s body by coaxing the ovaries and adrenal gland to produce less.
2. OCs increase the level of SHBG (sex hormone-binding globulins), which inhibit the conversion of free testosterone into dihydrotestosterone (DHT). In short, there is less DHT in the body.
3. The progestin component of OCs lower androgen levels.

Which work best? While all birth control pills have a more or less beneficial effect on acne, research shows that some may be better than others. Full comparisons between all combinations of ingredients are not yet available, but current research is pointing to the following:

• Ethinylestradiol/Drospirenone
  Ethinylestradiol/Cyproterone
• Are slightly
  better than…
• Ethinylestradiol/Desogestrel
  Ethinylestradiol/Gestodene

• Ethinylestradiol/Chlormadinone
• Are slightly
  better than…
• Ethinylestradiol/Levonorgestrel
  Ethinylestradiol/Norethindrone

• Ethinylestradiol/Norgestimate
• Are slightly
  better than…
• Placebo

What are the side effects? There are many side effects. Some of the more common include nausea, headache, breast tenderness, breakthrough bleeding, mood changes, dizziness, weight gain, loss of libido, high blood pressure, and vaginal infections. Less common and more serious side effects include blood clots, heart problems (exacerbated by smoking), and possibly increased cancer risk. Talk to your doctor for more information.

Note: Oftentimes after a pregnant woman gives birth to a child, she will see an increase in acne. This same effect occurs after stopping birth control pills. If you experience an unexplained breakout about 3 months after stopping birth control, a likely culprit is that your hormones are returning to their normal levels. This breakout should only be temporary until your hormone levels balance out again.