Cyproterone Acetate Is an Anti-androgen Medication That Is Normally Found as Part of a Birth Control Pill and May Be Somewhat Effective Against Acne
The Essential Info
Cyproterone acetate (CPA) is an anti-androgen medication, which means it suppresses the production of androgens (male hormones that are found in both males and females) in the body. Because excessive levels of androgens contribute to acne, anti-androgen medications, such as CPA, can help treat acne.
Doctors prescribe CPA only for women when treating acne.
It can be taken alone, but it is almost always prescribed in combination with a combined oral contraceptive (COC, or birth control pill). The brand names for this CPA-containing birth control pill are Diane-35® or Dianette®.
Several studies indicate that CPA-containing COCs help women achieve noticeable clearing of their skin, with studies revealing a 37%-90% reduction in acne. However, all COCs work to clear acne, not just those with CPA in them. Whether CPA-containing COCs work better remains an area of study.
Side Effects: Cyproterone acetate can cause side effects, such as menstrual irregularities, which are minor. In addition, CPA-containing COCs may raise the risk of a dangerous condition called venous thromboembolism (blood clot in the veins), though different studies have come to opposite conclusions on this topic, and the bulk of the research indicates that this risk is not higher in CPA-containing COCs than in most other ones. This possible risk of venous thromboembolism has caused controversy over CPA in several countries, with France banning CPA briefly in 2013.
Talk to Your Doctor: If you are a woman with acne that hasn’t responded to other treatments, and you also want to use birth control, a COC that contains CPA might be a treatment option for you. Keep in mind that any time you alter your hormones it is a serious decision, so be sure to talk to your doctor about the risks and benefits.
- CPA-containing Oral Contraceptives Are Effective in Treating Acne
- Side Effects of Cyproterone Acetate
- Controversy Surrounding Cyproterone Acetate
- The Bottom Line
Cyproterone acetate (CPA) is a progestin, which is a synthetic version of a female reproductive hormone called progesterone.
Doctors sometimes prescribe CPA to women to treat acne because it acts as an anti-androgen. Excessive levels of androgens (male hormones that are present in both males and females) often lead to an increase in skin oil production and acne. Therefore, reducing androgens can clear up the skin.1
As a 2014 article in Clinics in Dermatology states, “Androgens play an important role in [skin oil] production and excretion. This subsequently contributes to the formation of acne lesions.”2 Because anti-androgens reduce the amount of androgens circulating in the body, they can help clear up acne lesions.1
Cyproterone acetate can be taken alone, but when used for acne it is almost always prescribed in the form of a birth control pill (combined oral contraceptive – COC) that contains both CPA and an estrogen. In fact, researchers recommend that CPA by itself be prescribed only for women who no longer have a uterus or ovaries or who cannot tolerate estrogens.3
When taken alone, the recommended dose of CPA is 50 – 100mg. This is significantly higher than the dose present in COCs, which is 2mg. When taken alone, it should be started on either the first or fifth day of the menstrual cycle and stopped on the fourteenth day, just before ovulation. In contrast, COCs containing CPA should be taken daily.1
CPA-containing Oral Contraceptives Are Effective in Treating Acne
Multiple studies indicate that CPA-containing oral contraceptives are effective in treating acne, typically producing a 37-90% reduction in acne.4-6 There are no studies on CPA taken alone for acne.
Expand to read details of studies
Side Effects of Cyproterone Acetate
Cyproterone acetate can cause several side effects, including:
– Menstrual irregularities, such as bleeding more or less than normal and breakthrough bleeding (bleeding between menstrual periods)
– Breast tenderness
All of these side effects tend to lessen or disappear over time. A less common but more serious side effect of CPA is liver toxicity, which is dose dependent, meaning that it is more likely to occur with high doses.1
Venous Thromboembolism (VTE)
One serious concern when taking any COC, especially one that contains CPA, is the risk of venous thromboembolism (VTE), which is a clot in a blood vessel. Venous thromboembolism can result in serious health problems and even in death. Risk factors that increase the risk of VTE include older age, obesity, smoking, immobilization, such as long periods of bed rest or being in a cast, and some blood clotting diseases. The risk of VTE generally is low in young, healthy women, unless they are affected by any of these risk factors.2
Two studies report an increased risk of VTE when taking a COC that contains CPA.7,8 However, as we will see, other studies did not replicate these findings.
Expand to read details of studies
Two other studies found that the risk of VTE is not higher in CPA-containing COCs when compared to most other COCs.9,10
Expand to read details of studies
We can conclude from these studies that the risk of VTE increases when taking a CPA-containing COC but that this risk probably is not any greater for CPA-containing COCs than for most other ones, except those containing levonorgestrel.
Controversy Surrounding Cyproterone Acetate
Despite the mixed research results, the possible increased risk of VTE in people taking a CPA-containing COC has caused controversy in several countries.
One scientific article describes many women switching from a CPA-containing COC called Diane-35 to a different COC following a television documentary which highlighted the possible risks of CPA.11 Another article describes a temporary ban on the sale of Diane-35 in France, which was afterwards lifted.12
Expand to read details of articles
The Bottom Line
If you are a woman with acne that hasn’t responded to other treatments, and you also want to use a birth control pill, choosing a pill that contains CPA might be a treatment option for you. Be sure to talk to your doctor about the risks and benefits of this medication.
- Bettoli, V., Zauli, S. & Virgili, A. Is hormonal treatment still an option in acne today? Br. J. Dermatol. 172 suppl 1, 7 – 46 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25627824
- Lam, C. L. & Zaenglein, A. L. Contraceptive use in acne. Clin. Dermatol. 32, 502 – 515 (2014). https://www.researchgate.net/publication/263857122_Contraceptive_use_in_acne
- Hammerstein, J., Meckies, J., Leo-Rossberg, I., Moltz, L. & Zielske, F. Use of cyproterone actetate (CPA) in the treatment of acne, hirsutism and virilism. J. Steroid Biochem. 6, 827 – 836 (1975). https://www.ncbi.nlm.nih.gov/pubmed/126335
- Del Marmol, V., Teichmann, A. & Gertsen, K. The role of combines oral contraceptives in the management of acne and seborrhea. Eur. J. Contracept. Reprod. Health Care 9, 107 – 124 (2004). https://www.ncbi.nlm.nih.gov/pubmed/15449823
- Palombo-Kinne, E., Schellschmidt, I., Schumacher, U. & Gräser, T. Efficacy of a combined oral contraceptive containing 0.030 mg ethinylestradiol/ 2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/ 2 mg cyproterone acetate. Contraception 79, 282 – 289 (2009). https://www.ncbi.nlm.nih.gov/pubmed/19272497
- Arowojolu, A. O., Gallo, M. F., Lopez, L. M. & Grimes, D. A. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst. Rev. 7, CD004425 (2012). https://www.ncbi.nlm.nih.gov/pubmed/22786490
- Vasilakis-Scaramozza, C. & Jick, H. Risk of venous thromboembolism with cyproterone or levonorgestrel contraceptives. Lancet 358, 1427 – 1429 (2001). https://www.ncbi.nlm.nih.gov/pubmed/11705493
- Seaman, H. E., de Vries, C. S. & Farmer, R. D. The risk of venous thromboembolism in women prescribed cyproterone acetate in combination with ethinyl estradiol: a nested cohort analysis and case-control study. Hum. Reprod. 18, 522 – 526 (2003). https://academic.oup.com/humrep/article/18/3/522/626070
- Seaman, H. E., de Vries, C. S. & Farmer, R. D. Venous thromboembolism associated with cyproterane acetate in combination with ethinyloestradiol (Dianette): observational studies using the UK General Practice Research Database. Pharmacoepidemiolog. Drug Saf. 13, 427 – 436 (2004). https://www.ncbi.nlm.nih.gov/pubmed/15269926
- De Bastos, M. et al. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst. Rev. 3, CD010813 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24590565
- Mintzes, B., Morgan, S. & Bassett, K. L. Medicine by media: did a critical television documentary affect the prescribing of cyproterone-estradiol (Diane-35)? CMAJ 173, 1313 – 1315 (2005). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283492/
- Arie, S. European Commission orders France to lift ban on acne pill. BMJ 347, f4932 (2013). https://www.bmj.com/content/347/bmj.f4932