Hi!
I need advice (again, i posted prior to this about taking accutane or something like spiro) and am not sure whether to ake accutane or BCP pills.
I have pcos, and get really bad hormonal breakouts mid cycle and the week before my period starts. I am 25, and i have suffered like this since i was 14. I manage the condition with healthy lifestyle and a green plant based diet, and exercise and have even managed to drop 60 pounds, however, i still breakout and it leaves marks and small scars. I was offered accutane from diff doctors (i refused at the time) and gynos/ednos offered me the pill. I take metformin which as helped with the pcos. I don't have a lot of sugar as i feel this is counterproductive to pcos and i breakout as well :-/.
I have tried various herbs etc like saw palmetto, its helped 50% but i still get the cystic acne on my chin and breakouts here and there.
I've been told that if i go on accutane my breakouts may return in future because of the pcos. non of my dermatologists (i have two) have said its a permanent cure. They said it only provides long term remission and if im very lucky it may never return.
i took diane 35 when iw as 16, it made me gain sooooo much weight and my hair shedded massively but skin cleared up.
When i was 18, i took the belara contraceptive, i dont know if i gained, i dont think i did, skin cleared pretty much but i never stayed on it. I went on it years later again for 2 months but skin went crazy, i dont know if it was because of my skin care routine but i am thinking of going back on it because i felt better on it, i am sick of waiting for the skin to clear up. it decided to blow up whenever it feels like it.
if i go on accutane, the clear skin appeals to me but i am scared of the side effects like hair loss (runs in family) and i love my hair so much i would be so depressed if it fell out. I can cover pimples with concealer and powder but its difficult to conceal hair loss. Is hair loss common..? I am also scared of the internal damage to my already out of balanced system.
on the other hand, BCP may make me gain weight (urgh!!!) which i doubt, because the pill i will take is supposed to not cause any gain, but its still homones so you never know. if i go on it, i will stay on it indefinately because it helps with my pcos symptoms and balances my moods.
please let me know what you all think.
Thank you.
High androgens = thicker hair.
I think I've posted this before...but when I was going through puberty, and had the worst acne of my life, I had THE THICKEST HAIR IMAGINABLE. Every time I got my hair cut the stylists would come and fawn over my hair. As I got older and my acne improved a little, my hair wasn't as thick anymore. Right now my hair is on the finer side.
But you know what? I've noticed that most women (with clear skin) don't have awesome thick hair. Their hair is fine or moderate.
There is a lot of relationship between hormones and hair. Men generally have thicker hair and more body hair because of androgens. Women with heightened androgens will have thicker hair...and acne.
Obviously I can't assess your hair without looking at it, but unless you were getting bald spots or parts in your hair that were 1/2 inch wide, the Diane probably was just leveling out your hormones and giving you NORMAL fine/moderate female hair.
If Diane hadn't made you gain a ton of weight as well, I would say just go on it again. Have you thought about Dianette? It is almost the same (cyproterone vs cyproterone acetate), but Dianette might be a bit milder on your body. There is also Yaz/Yasmin which has drospirenone, a derivative of spironolactone as its anti-acne agent.
My roommate went bald on her first course of Accutane...so personally if you're worried about hair loss I wouldn't recommend that route to you.
About the Belara...it contains Chlormadinone as its progestin. Chlormadinone ranks on the medium androgenic scale. It will not help your acne. It is only ranked slightly better than levonorgestrel, which is one of the worst progestins you can give to a woman with acne.
Also you may be thinking...but I thought Belara was anti-androgenic...no not really...just less androgenic than some other pills.
Here is a bit from Medscape:
The mainstays of hormonal therapy include oral contraceptives and anti-androgens, such as spironolactone, cyproterone acetate or flutamide. The efficacy of oral contraceptives and other anti-androgens in acne treatment has been comprehensively reviewed, which revealed that ethinylestradiol/drospirenone and ethinylestradiol/cyproterone are most effective followed by ethinylestradiol/desogestrel and ethinylestradiol/gestodene. Ethinylestradiol/chlormadinone is slightly better than ethinylestradiol/levonorgestrel.
As you can see chlormadinone (Belara's progestin) is second to last, while Diane/Dianette and Yaz/Yasmin are most effective.
hi green gables!
thank you for your reply 
. When i went to my doctors two recommended belara and they also said YAZ is an alternative. She also said people gain far less weight on belara than yaz/yasmin. My mom also took Diane 35 for a long time and it caused hair shedding that hasn't recovered till today, and when she went off it, it also got worse. I don't know what it was with diane but when i took it, i experienced really bad shedding of my hair (i dont have thick hair btw, its very fine, but a lot of it) and in the shower when i was n boarding school it was COVERED in my hair. I was like, vaccuming my room daily. I also got thrombosis in my left leg, and i was taken off it for those reasons. I had to cut my hair short and wait out the growth period. I took Belara a couple of years later and i swear i never got any breakouts on it. I dont think i gained weight either. I'm going to see my doc today, about which meds would be suitable. For some reason when i came off diane, my problems tripled. I didnt experience the same with the other BCP.
it seems whatever experience my mom had, i had the same, i duno if its genetic make up or whatever. She took Yasmin, i know its not the same as YAZ but she got really fat on it and is usually on the very slim side. When she came off it, she lost weight. I am confused. I thought the diuertic effect is supposed to make you lose weight but why do so many people report gain on it? Does your body try to conserve water because it feels its losing water?
Whatever i go on, i will be sure to log on here. I still have no clue. I know what you mean about the accutane. I have two dermatologists, one is very vague about side effects.When i asked her about hair loss she said, well, whats more important, your hair or skin ? and i was like :-o?!
my other derm is very honest and says the most common side effects in her patients are - Mood changes(she said not depression but mood changes?), dry skin, eyes, lips (obviously), hair loss, aches and pains, etc. Then she said that a few patients came back 1 year or 18 months later and the acne had returned. Both tell me its not a cure.
blah 
I know 100% my acne is hormonal because after the second week of my cycle, its like BAM! my skin just goes red, spotty, etc. I know something is not right with my hormones, i've tried asking so many doctors and the holistic route but i think BCP may be the best option.
i found a geat study online of Belara vs yaz, for acne/weight etc and it seemed belara outweighed yaz in effectiveness against acne.
hi green gables!
thank you for your reply
. When i went to my doctors two recommended belara and they also said YAZ is an alternative. She also said people gain far less weight on belara than yaz/yasmin. My mom also took Diane 35 for a long time and it caused hair shedding that hasn't recovered till today, and when she went off it, it also got worse. I don't know what it was with diane but when i took it, i experienced really bad shedding of my hair (i dont have thick hair btw, its very fine, but a lot of it) and in the shower when i was n boarding school it was COVERED in my hair. I was like, vaccuming my room daily. I also got thrombosis in my left leg, and i was taken off it for those reasons. I had to cut my hair short and wait out the growth period. I took Belara a couple of years later and i swear i never got any breakouts on it. I dont think i gained weight either. I'm going to see my doc today, about which meds would be suitable. For some reason when i came off diane, my problems tripled. I didnt experience the same with the other BCP.
it seems whatever experience my mom had, i had the same, i duno if its genetic make up or whatever. She took Yasmin, i know its not the same as YAZ but she got really fat on it and is usually on the very slim side. When she came off it, she lost weight. I am confused. I thought the diuertic effect is supposed to make you lose weight but why do so many people report gain on it? Does your body try to conserve water because it feels its losing water?
Whatever i go on, i will be sure to log on here. I still have no clue. I know what you mean about the accutane. I have two dermatologists, one is very vague about side effects.When i asked her about hair loss she said, well, whats more important, your hair or skin ? and i was like :-o?!
my other derm is very honest and says the most common side effects in her patients are - Mood changes(she said not depression but mood changes?), dry skin, eyes, lips (obviously), hair loss, aches and pains, etc. Then she said that a few patients came back 1 year or 18 months later and the acne had returned. Both tell me its not a cure.
blah
I know 100% my acne is hormonal because after the second week of my cycle, its like BAM! my skin just goes red, spotty, etc. I know something is not right with my hormones, i've tried asking so many doctors and the holistic route but i think BCP may be the best option.
i found a geat study online of Belara vs yaz, for acne/weight etc and it seemed belara outweighed yaz in effectiveness against acne.
If you think Belara will work for you, go for it.
Yasmin has more estrogen than Yaz. Too much estrogen for an individual = weight gain. Yaz is kinda like Yasmin Light.
Lots of people with acne are skinny because high androgens = skinny without trying, but also bad skin. High estrogen (and controlled androgens) = fat, but great skin without trying.
It sounds like you are high in both androgens and estrogens. You have acne yet you & your mom gain weight really fast on a fairly average dose of estrogen. This sounds like both high androgens (acne) and high estrogen (weight gain).
You may be thinking...but how can they both be high? Remember that hormones have pretty complicated relationships with each other. When you raise your androgens it doesn't necessarily mean your estrogen goes down. Also when you raise your estrogen, it doesn't necessarily mean your androgens go down. You can be low in both, high in both, low in one, or high in one.
If I were in your shoes, I would seriously look into bioidentical progesterone treatment and forget the BCP for now...when both your estrogen and androgens are out of control, it generally means your progesterone is low. Progesterone is a regulatory hormone that keeps both androgens and estrogens in check. Birth control pills generally aren't optimized for women with low progesterone.
There is also some debate about birth control because it uses synthetic versions of our hormones. All birth controls pills use progestin, not bioidentical progesterone. In some sensitive people this can be really bad.
There are some threads here about bioidentical progestereone if you're interested. Nice thing is you can get it OTC for cheap, and there are lots of support forums (outside of acne.org) on the very subject. Many women, young and old, can benefit from the right levels of progesterone.
But honestly if I had to tell you to pick Belara or Accutane, I'd go with the Belara. I actually just skimmed over the "Negative Accutane Experiences" thread on these boards. Lemme just say that drug is messed up. I don't care how many positive experiences there are, there are still way too many negative ones.
hi green gables
honestly i can tell you have a lot of experience and knowledge on this. BTW, when i have my hormones tested, they said that the androgens come on the low end, my estrogen and progesterone seem in normal ranges BUT the LH:FSH is unbalanced, and the LH is high (cornerstone of PCOS). I do think it is a progesterone problem. I asked why i have acne then, and they said in PCOS the androgen receptors are sensitve and if it doesnt show in your blood, it shows in your skin/hair. My periods are on the lighter side. They sell progesterone cream at the pharmacy but i'm too scared to use it without guidance. I have heard it is good, but also heard not to self medicate on it ?
I know what you mean about accutane i also saw the negative thread. So many people say they have perfect skin on it. I don't want to take it for a short term solution, damage my internal balance (how do i know what it will do to my insides? ) and what scares me is that on the accutane description it says the 'action of isotretion is unknown' - thats scary !!!!
my doctor told me some of her accutane patients end of looking older than they are because they look dried up and while it gives clear skin it also gives an unattractive hue. But for people with severe back, chest, facial acne she has no other options but to give it. No one is gonna pay for creams and laser therapies for all those areas, it would be a headache and financially draining.
Where i live, there isn't a lot of people who do the natural hormone thing, and prescribe bioidentical hormones. The one that i did go to, they charged me $700 for testing (some crap useless tests they were doing just to rover their rent im sure) and my mom later called and demanded the money back as they didn't even give me medication. Then when i asked them how much the medication costs per month they said $280 dollars around. Omg, like i know health is pricelss but how much is that per year!
And on the side effects sheet which they made me sign prior to tests it has all these nasty side effects (even death WTF) and it said they will not be liable at all, standard i know but i thought its side effect free potentially ? I know these people left me with a bad experience and not all placs are like that but they really ripped me off. They try to sell you 'elite' packages' and tell you they will cure you, but the only way is to take elite packages, which run up thousands.
your roomate went bald on accutane????
Hi LilyRose - I'm curious if you are considering Spironolactone? It seems I am similar to you - I have low androgens as well, but am hoping spiro will help by blocking the androgen receptor at the skin level. My endo says that although my serum androgens are low, that the enzymes in the skin are most likely overactive converting testosterone to DHT causing my facial hair and acne problems. Similar to what your doctor told you. It gives me hope that Diane worked for you - although it doesn't contain Spiro it's progestin is another type of competitive antagonist of the androgen receptor - like Spiro is. Any more thought to what you're going to do? I also considered Accutane - but I hate messing up my skin's healing ability especially if the acne is just going to return anyway.
hi ! got back from the dermatologist this evening. I am going to post what she said while it is fresh in my mind. I also had a phone call to my gyno this afternoon to let her know what my decision might possibly be (BCP) and i will tell you what she told. I think a lot of the answers will help everyone in a similar situation to me. But both were very honest.
What did they say? I'm on the edge of my seat:)
hi ! got back from the dermatologist this evening. I am going to post what she said while it is fresh in my mind. I also had a phone call to my gyno this afternoon to let her know what my decision might possibly be (BCP) and i will tell you what she told. I think a lot of the answers will help everyone in a similar situation to me. But both were very honest.
basically i got back from the dermatologist. I've been seeing her for well over a year, whe i first saw her she told me to take accutane because my acne was bad. I didn't take it, she did some laser facials and stuff and it cleared up. But it still came back you know, on and off.
anyway, this is the feedback she gave about accutane and using it -
me: Do you think I should go on BCP pills or accutane?
doc :it's up to you, but since you have a hormonal condition and its obvious that all the cysts form on the lower half of the face as well as chin, then BCP pills.
me: Is YAZ or Belara better?
doc: some swear by YAZ, some by belara. I have the general feedback that all my clients are happier with Belara. I think Belara. It works well for clearing skin.
me: will i break out ?
doc: you might get a few for the first 5-6 weeks but it will clear and go away.
me: I sometimes get depressed and start crying before my period. Do you think BCP will help as it says it does, and this is a problem for me as well.
doc: you will definately feel better on BCP FYI with accutane, you will notice an increase in mood swings. not depression but you will experience an increase in mood swings.
me: i am scared of taking accutane because of the hair loss.
doc: you have lovely hair. you have to be aware that a side effect of accutane is hair loss, you have to be prepared if you take it.
me: why does the hair fall out on accutane?
doc: the dryness of the follicle causes weakening and the hair will fall out very easily. it affects all the hair follicles, including eyebrows etc. There is evidence that accutane triggers the androgen receptor and makes it more sensitive to testosterone. some womene experienced increased hair growth in areas they never had before.
me: thats what i am trying to escape though. does it cause dryness in private areas and make you constipated?
doc: its a possibility. dryness especially if you are female. it also causes rectal and vaginal bleeding.
me: even at a low dose?
doc: don't think that you can just go on a low dose and be cured. This is not how it works. you must be on 0.5g/kg or 1g/kg (i think thats what she said) and work up to your cumulative dose. otherwise it will not work. I estimate 20mg-30mg for you for the full effects. you cannot put the lowest dose in your body and suffer for no effect you have to have the right dose for it to be effective.
me: it has a lot of side effects (my mom butted in at this point and said, look, i don't think you're gonna sleep while taking that drug, just forget it, too many issues).
doc: there are side effects but doesnt mean you will get them all. the number one drug in which dermatologists have cases against in court is accutane. I don't like giving it, i am the last doctor to give it and when i do i am meticulous about how i give it and there is a lot of precautions we must take. it gives marvelous results with skin, but i think you should consider going on Belara.
Convo with gyno, was a quick one:
me: which pill is better for acne, YAZ or Belara
doc: both, Yaz is very low dose and is very good. Belara is also good.
me: which one should i take.
doc: were you happy with Belara? it is up to you. everyone reacts differently.
me: i was happy but never gave it a chance to work fully.
doc: you can try either, belara can give quite good results for acne.
me:which one is stronger in terms of acne control.
Doc: yaz is very good for acne, belara has a slightly stronger effect on acne but it is how you react at the end of the day.
me: Ok i will think about which one, but which one doens't cause weight gain?
doc: they are both low dose pills, you will probably not gain but you may experience fluid retention the first few weeks.
me: so which one is better for acne and weight?
doc: belara.
me: Thanks
it seems belara is popular. my mom mentioned i should try YAZ because i already tried belara twice before. not sure which one i should take, still haven't made up my mind but i need to soon. I wish other girls taking yaz could give me advice.
hope this helps. Anything else that comes up, please ask!
BTW
i have had spiro in my cupbaord for 1 year. I took it for 1 week, and i don't know why but i REALLY had bad fluid retention on it and i swear my clothes were tighter.
i thought it was supposed to have the opposite effect , so many ppl here are swearing by it calling it a miracle drug?
I asked the gyno about spiro, she said they usually give it with BCP pills as it can cause irregular periods/bleeding patterns and stuff. It is effective though for hormonal acne. My endo was the one who gave it to me a year ago but she kept urging me to take it with BCP pills. I guess they take them together.
When my spire dose was first upped to 100mg I did have some fluid retention and about 2-5 pounds weight gain. Most people wouldn't have noticed it, but because of my lifestyle (semi-professional dancer and teacher, I'm active about 7 hours a day), I noticed it right away. I started watching my potassium intake (spiro makes you retain potassium, so you need to be careful about eating too many potassium rich foods, like bananas), and my body adjusted after about a month. The fluid retention stopped and the weight dropped back off.
Like I said before, spiro does increase estrogen slightly, which can cause some side effects like a bit of weight gain initially. It was a little scary for a month wondering if I was going to uncontrollably gain weight, but honestly I think most people adjust nicely eventually.
Spiro causes irregular bleeding in about 22% of patients. The irregularity usually stops after about 3 months with most and goes back to normal. If it's a problem after 3 months most docs will prescribe birth control as well to control that. I never had bleeding issues and I already use a copper IUD for birth control, so I didn't need BCP.
Hey, I was just reading about accutane on here and what the derm said to you about it being a very negative drug. I would like to share my experience on it and what my derm said to me.
Like you, I was very nervous about taking it. I have very thick full hair and when the derm said hair loss can happen I was very put off. However, he also said 99% of patients who take it are very happy with results and have no regrets. He told me to expect dry skin, dry lips and all the other common side effects but they should all improve once you have done your course. In the end as my acne was severe and getting me down I decided to take the plunge.
After the course, I can safely say it was the best decision I made. It cleared cysts which had been there for 4 years straight and my skin was pretty much perfect while on it. Even after I finished the course, I got acne but it was in a lot milder form than before. I doubt it will ever become as bad as it was. As for side effects, I did not go bald, end up depressed or have any other nightmare side effects. I think just cus one girl went bald on accutane, that should not put every other girl off. It doesn't happen to evey girl I can assure you that.
I'd say don't write it off completely, as you have hormonal acne which is hard to treat as it is, if you ever consider even just one course it may not be a permanent cure, but it can fast track your journey to clear skin. If initially you can just clear the stubborn acne, then when you are off it you can return to spiro or BCP to sort of maintain the results. The accutane will help as if you do have acne again it will won't come back straight away as bad as it was before and you can treat it a lot easier if it is milder in the long run.
I know this is quite a old thread but I wanted to add my two pennies in. I hope this helps.