Birth control (oral contraceptives) and acne

How do oral contraceptives (OCs) help with acne? As a general rule, OCs reduce androgens (male sex hormones) which are partly responsible for acne formation. Women with acne tend to have higher levels of androgens.^1-5 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
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.^1,3
3. The progestin component of OCs lower androgen levels.²

Which work best? The FDA has approved only a select handful of birth control pills for patients with acne who also desire contraception. They include Ortho Tri-Cyclen, Estrostep, and Yaz. However, all birth control pills tend to produce 30%-60% reduction in acne lesions, and research remains inconclusive on which works best.^3,6-11

What are the side effects? There are many side effects. Some of the more common include nausea, headache, breast tenderness, breakthrough bleeding, bloating, fatigue, irritability, 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.^10,12

Do antibiotics cause birth control pills to fail? While this is a largely held belief, and women have indeed become pregnant with the combination of birth control pills and antibiotics (tetracyclines), pregnancy rates were no higher than is seen from birth control pill failure alone. According to an overview article published in the International Journal of Women's Health, "Currently, there are no pharmacokinetic data or randomized controlled clinical trials supporting that oral antibiotics decrease the efficacy of oral contraceptives, with the notable exception of anti-tuberculosis drugs like rifampin."³

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.