Hi there Green Gables, I don't know if you will get to answer as I see you are not around much.

I was really just wondering what your take on Cilest is? I really am not sure if this is the UK version of Ortho Tricyclen (sp?) or not.

I am basically looking into to taking BCP for my acne now that it is doing my head in again, seems a last resort but its either that or Accutane.

I am based in the UK and trying to find one that will work for me, I don't want to go on Dianette since I have been on it before and although it helped my skin previously..well I have family history with DVT and there is a high risk for the thrombosis with this pill.

Any advice would be grateful.

 

1. Type of Progestin

Every birth control uses progestin (a synthetic form of the progesterone hormone). There are many different types of progestin. It is very important that the type of progestin is LOW in androgenic activity, meaning it doesn't send your testosterone into overdrive and create acne.

Here is a list to help choose a birth control.

Neutral (won't affect acne either way)

No hormones. Copper Paraguard IUD

 

Good (can reduce acne)

Drospirenone. Anti-androgenic. Used in Yaz, Yasmin, BeYa, Gianvi, Loryna, Ocella, Zarah

Norgestimate. Low androgenic. Ortho Tri Cyclen, Tri Sprintec, TriNessa, Ortho Cyclen, MonoNessa, Sprintec.

Cyproterone acetate. Low androgenic. Diane-35, Dianette.

Chlormadinone. Low-medium androgenic. Belara.

 

Not-so-good (may not make it worse, but probably won't make it better)

Ethynodial diacetate. Medium androgenic. Zovia, Demulen.

Desogestrel. Medium androgenic. Mircette, Apri, Reclipsen, Desogen, Kariva.

Gestodene. Medium androgenic, Femodene, Femodette, Millinette.

Norethindrone. Medium androgenic. Estrostep, Ortho Novum, Loestrin, Minestrin, Brevicon, Synphasic, Ovcon, Cyclafem.

 

Bad (pizza face alert!)

Levonorgestrel. High androgenic. Enpress, Plan B, Mirena IUD, Seasonique, Lutera, Portia, Amethyst, Alesse, Seasonale, Triquilar, Triphasil, Aviane.

Nogestrel. High androgenic. Cryselle, Ovral, Ogestrel, Ovrette.

Etonogestrel. Medium-high androgenic. NuvaRing, Implanon, Nexplanon.

DMPA. Medium-high androgenic. DepoProvera.

2. Level of Estrogen

Most birth control pills add in estradiol, which is a synthetic form of the hormone estrogen. Generally, skin is clearer when a pill has a moderate to a high level of estrogen.

The new "low-dose" pills basically take an existing pill, and cut down the estrogen, so you have way more progestin circulating in proportion to estradiol. It still works for birth control, since you can prevent pregnancy with progestin alone. But cutting the estrogen is bad news for acne most of the time.

This isn't a comprehensive list, but some common low-dose BC you should avoid:

No Estradiol, all Progestin

Depo Provera

Implanon

NuvaRing

Mini-pill

Mirena IUD

Nexplanon

Ultra Low-Dose

Alesse (Aviane, Lessina, Lutera, Sronyx)

Levlite

Loestrin Fe

Mircette

Ortho Tri Cyclen Lo

Low Dose

Cyclessa

Desogen

Levlen21

LoOvral

Microgestin Fe

Nordette

Orthocept

Seasonale (Seasonique)

3. Hormone Stability

For many, the right progestin type and the right estradiol level will clear them up just fine. For others, however, an extra step is needed. Some acne sufferers have breakouts every time their hormones fluctuate, such as at ovulation (when testosterone rises), or leading up to menstruation (when progesterone rises). Many pills, since their primary purpose is to prevent pregnancy as invisibly as possible, try to replicate normal hormone fluctuations. So each pill has a slightly different set of hormones, to put your body in a cycle. Some people just cannot get clear with their hormones changing all the time. If this sounds like you, please consider trying a "monophasic" pill, which keeps your hormone levels at an even keel throughout the month.

Example: Ortho Tri Cyclen is a "triphasic" pill which varies your hormones. A better option would be "Ortho Cyclen", a "monophasic" pill that keeps them stable.

Monophasic Pills (NOT a comprehensive list, same colors from Progestin Type List)

Alesse

Brevicon

Diane-35 (Dianette)

Kariva

Ortho Cyclen (MonoNessa, Sprintec)

Yasmin

Yaz

Demulen (Zovia)

Make it easy for me, what do you recommend?

For some of you, this is just way too much information. However, don't just go to your dermatologist and tell him/her you want birth control. Many dermatologists, however educated they are, don't make very informed choices about hormonal acne. They'll just give you whatever brand is giving them free samples that month, or else their knowledge of hormonal acne is 10+ years old (concurrent with when they graduated medical school).

So, if you just want an easy answer, this my Top 6 list.

1. Yasmin (or Ocella or Zarah)

best type of progestin, monophasic, 30ug of estradiol

2. Yaz (or BeYaz)

best type of progestin, monophasic, but only 20ug of estradiol

3. Ortho Cyclen (or MonoNessa or Sprintec)

good progestin, monophasic, 35ug of estradiol

4. Diane-35 (or Dianette)

good progestin, monophasic, 35ug of estradiol

5. Demulen 1/35E or Demulen 1/50E (or Zovia 1/35E or Zovia 1/50E)

okay progestin, monophasic, 35ug or 50ug of estradiol

6. Ortho Novum 1/35 or Ortho Novum 1/50

okay progestin, monophasic, 35ug or 50ug of estradiol

Frequently Asked Questions

What about the mini-pill?

There are several different brand names for the mini-pill. A mini-pill uses only progestin and has no estrogen at all. Mini-pills are a terrible choice if you have acne, as they frequently cause acne in people who never had it in the first place. Some of the implant types of birth control, such as the Mirena IUD, also only use progestin, and can increase acne.

But my friend is on ______ and her skin is great! Even though it's on your bad list!

Look, I am just here to provide information and some general principles. There are always exceptions, and new information is coming out all the time. Feel free to ask questions, but in the end, you're gonna do what you want...if it doesn't work out in the end, well I won't say I told you so.

Green Gables, I have PCOS and I am currently taking zovia. I have taken zovia for a while and it seems to help my PCOS symptoms including acne and oily skin somewhat, but not as much as I would like. I cannot take yaz or yasmin. Do you think ortho cyclen would be more helpful than the zovia? I'm trying to decide if it's worth making the switch.

Hey all -

I was just on Apri birth control for two months and my acne was absolutely horrific. I had mild breakouts before getting on a birth control, but Apri made my skin disgusting. It also gave me a crazy appetite and I've gained about 8 pounds since I started taking it. After calling my doctor, I switched over to Ocella today and just took my first active pill. Any thoughts on Apri vs Ocella for anyone who has taken either? I know that all bodies are different so Ocella may work for me and not others or vice versa, but I'd like to hear what people have to say.

- K

This post has so much great info, I'm hoping someone can give me some advise though. I'm 34, and recently went back on birth control after being off it for a few years after I had my son. I'm on Tri-cyclen 28. Been on it for 3 mths. It's great for clearing up acne, but I'm having a really tough time with migraines, particularly on the end of the 3 rd week and starting the 4th week which is the plazbo week. I was thinking of switching to the mini pill but it sounds like everyone here says it causes acne. Is there a pill that would be better at decreasing the chance of me getting these horrible migraines every month. I'm not as concerned about actual birth control as I am with keeping my skin clear. Is there a birth control that has lower hormones and you take them for 28 days vs. Mine each week the hormones fluctuate and the last week is just a placebo. Advise pls. Thanks

Thank you for this! Very interesting and helpful.

I first went on birth control when I started getting really bad cramps and found out that my hormones were all screwed up (one doctor said I had PCOS, but there weren't any cysts so another doctor disagreed).

The doctor put me on Loestrin, which helped me with my cramps but also my acne. Recently I had to switch to Junel because I couldn't afford Loestrin any more.

BC has improved my acne, but I still get hormonal acne. Is it possible that switching to something like Yaz would improve my skin?

I used to be on Junel, seekay. I loved it! I had almost, if not completely, clear skin (I didn't think much of it because at the time, my acne had been mild. I went on it for bad cramps and birth control purposes, and I had no side effects whatsoever. My skin did get better, I remember.). I went off BCP for two years.

Now I'm on Aubra (which has levonogesterol) and it's been absolutely horrendous. I've been on it a month and just started a new pack. I can't tell if it's making my acne worse, but it's no better (topical treatments are helping, but I had a terrible breakout this past month). I got it for free from Planned Parenthood, and was uninformed. I was desperate for birth control. I think they prescribed it because they were worried about my tension headaches turning into migraines. I'd rather get migraines and have clear skin... Now I have headaches, nausea, bad cramps, breakthrough bleeding, bloating (I feel pregnant but I'm 99.9% certain that is not the case), and acne.

Don't go near this pill. That is, unless you discuss it with your doctor and they recommend it for you. Everyone's body responds differently to hormones. I will be discussing new options when I have my first dermatology appointment next week.

Thank you for this! Very interesting and helpful.

I first went on birth control when I started getting really bad cramps and found out that my hormones were all screwed up (one doctor said I had PCOS, but there weren't any cysts so another doctor disagreed).

The doctor put me on Loestrin, which helped me with my cramps but also my acne. Recently I had to switch to Junel because I couldn't afford Loestrin any more.

BC has improved my acne, but I still get hormonal acne. Is it possible that switching to something like Yaz would improve my skin?

I'm going crazy trying to find a BC method that works for me I need some help. I started on Ortho tri cyclen Lo and it broke me out like crazy so I switched from a few different ones including Aviane and sronyx because different times my pharmacy would be out of one or the other. They both break me out too and all of them give me crazy mood swings and ridiculous increase in appetite and food never seems to get me full. I'm always hungry. Even when I'm on a strict diet and working out, I couldn't lose weight and I was tired of the hormones, so I went on the paragard copper IUD. I was so beyond happy with it, my face was clear again but unfortunately it expelled itself after 3 weeks so I had to get it taken out and no choice but went back on avaine. I never break out but now constantly am when I'm on the pill and the increased appetite came back. I NEED to find a pill ASAP that won't break me out and givee all the side effects. I have to go on a pill because my body is sensitive to everything else. I just don't know which one and I'm tired of trial and error with all of these. I'm not sure with the levels of hormones in all of these though that my body is okay with and doesn't freak out with.

Guys, I just started my third week of Yaz. Along with topical treatments (BP wash, clindamycin and differin). my skin is 99% clear of active pimples. I'm irrationally terrified of developing a blood clot though, so this isn't perfect. Everytime I have any random pain in my leg I get worried. However, I feel like a new woman. Just a little fatigue and that's normal in the wintertime. I'm probably vitamin d deficient.

Hi Greengables,

Could I ask your advice please mercilon which has made my acne worse I think my Dr has prescribed Marvelon I wondered what you thought of this ? any advice would be lovely

Dianette was amazing for my skin but the doctor advised that I switch. I have now been on cilest ( which I think is the UK version of ortho cyclen or ortho tri cyclen) for about four months with no problems. I have tried mercelon or marvelon in the past ( can't remember which, but it worked well also. I always steer away from progestin based pills and go for a combined pill.

I was just wondering how long does it take skin to go back to normal after coming off the pill? I was on a generic form of alesse for two years after my derm told me it was good for acne. Then after my breakouts persisted I went to a new derm, who told me that this birth control was ok for acne, but prescribed me spironalactone. 10 months later and the Spiro hasn't helped much, I really think it's my bcp causing my breakouts.

i was on beyaz for a year and like 5 months and it kept my face really clear then out of nowhere i started getting pimples everywhere do you know why this could have happen ?

WHAT you are so awesome. Everyone here should be thanking you profusely! How did you come by all of this research just out of curiosity? I have been battling acne and trying every birth control pill to control it! Sadly, for me, yaz gave me perfect skin BUT made me have terrible side effects and I am allergic to the main ingredient (which is also the basis for Spironolactone). I was also on orthocept which made me have no libido and currently I am taking orthotricyclen lo which has done nothing. I will have to try another pill now with this info-- do you happen to know where I might find info about emotional fluctuations and HBC? Because yaz made me crazy literately. I just want a pill that makes my skin clear without being a psycho witch. THank you SO SO SO SO SO SO SO SO SO much for this post.

Is Estarylla the same as Ortho Cyclen?

I know GreenGables mentioned MonoNessa and Sprintec were the same, but this pill contains the same amounts of norgestimate and ethinyl estradiol.

I have a question for anyone who has an answer! How long does it take before you start seeing results when taking birth control? I'm about to complete my first month of Ocella. I don't think I have hormonal acne (i.e. the chin acne); I have overactive oil production that may or may not be due to hormones... I'm giving Ocella a shot to see if it does anything. So far, the only difference I see is that my skin is a little drier. However, I'm also using tretinoin cream and I think that's the true culprit. I'm still treating my current clogged pores with PC's BHA 2% once a day and the 4% weekly. I apply tretinoin usually once every two nights. I'm not crazy with it.

hey thank you so much for this post ! I'm on a pill qlaira ffor hormonal acne from pcos .. where would qlaira or natazia come on this list ? It's new & I feel like I the only one in the world on it
It cleared my acne before in about 2 months I had to come off it in July & by September I was back in full swing with my acne
I'm bacback on qlaiqlaira nnow & am in week 2 1/2 I'm hoping it will clear me again but I'm so scared it won't !

Hi @Green Gables,

I am on Loestrin/Minastrin and it has been fine for me. I will occasionally break out a little bit the week before my period but otherwise my acne has been fine. I took Accutane maybe five or so years ago for extremely severe acne. Thankfully it has cleared, but I would still consider myself "prone" to acne. I am interested in getting the Mirena IUD but am worried about my acne flaring up again (as well as gaining weight, but that doesn't seem to be your specialty). My skin ranges from oily to dry depending on the season and location I am living, and I used to have a tendency toward cystic acne but now only get smaller red surface level pimples that don't usually have a white head or blackhead (but aren't cystic) and don't last for very long. I also take Benzaclin/clindamycin for my skin. What do you think about Mirena for my skin, especially since I take a pill that you have classified as "not-so-good" for hormonal acne? I believe that my acne earlier in my life was not so much hormonal as it was a problem with my oil glands (whatever Accutane fixes, etc), and my hormonal acne has gotten significantly better on Loestrin rather than Yaz which is what I used to take a while ago.

Thanks!!

I was put on Alesse, didn't help my periods at all however my skin wasnt TOO terrible. Then I was switched to Triquilar and it MESSED up my skin. Like I literally have acne everywhere. I'm on my third month but I REALLY just want to stop taking it right now and ask for Ortho Tri-Cyclen as I know many people that have taken it and their skin has improved drastically. I never had bad acne in the first place and now its just terrible.

I would like to say that everyone's body is different and some pills that are high in estrogen can actually cause someone to break out. Lo dose does not mean at all that it wouldn't fix hormonal acne. I had a really good doctor explain to me how the pill works to clear the skin. in fact having too much estrogen or progesterone in the body can cause hormonal acne. Also not all acne is hormonal in which case the pill might not work to clear someone's skin. I have friends who were on ortho cylen and yasmin and it caused their acne to get worse. When they swithed to lower dose pills it made their skin so much more clear. Tri cyclen lo made my best friend skin so clear and she never broke out at all on this pill. The higher dose one ortho cylen cause her to break out all over her face. I had mild to moderate hormonal acne and Alesse was the pill I was on and it worked wonders on my skin! I never got any pimples and my face was clear the whole time I took it. Yaz didn't work well with me and I got break outs on it. Mircette helped one of my friends with cystic acne and she hardly ever got acne on it. I think it's trail and error I noticed some of the pills on the bad list are ones that have worked for my friends and some of the pills on the good list made people i knew break out badly. I think its important that there is no one pill that works for everyone.

Hi, thanks a lot for this post its exactly what I was looking for!
Now can i have your opinuon Green Gables: i did well on yaz but i stupidly went of because i wanted to stop using fake hormones. 6 months later after slowly breaking out i have a few cysts and ive decided, screw it im gonna go back on. Whrn i go to the specialist im thinking of trying yaz+spirp 25mg. What do you think?

A bit about me, i have PCOS symptoms but no blood sugar issues or actual ovarian ccysts. I don't give a damn how meds affect my period, in fact on yaz I stopped getting it at all which was fine by me. I cannot get pregnant so I'm open to Spiro also.
Awesome that youre so well informef! But sadly as most doctors are so little help, we have to be informed on our own.
snarkygirl

Your number 1 (Zarah) gave me horrible acne when I never had acne before. Hopefully, one day I'll find the right BC.

On May 16, 2016 at 2:26 AM, ElizabethSara14 said:

Your number 1 (Zarah) gave me horrible acne when I never had acne before. Hopefully, one day I'll find the right BC.

orthocyclen may be better for you.

I'm on week 2 of Ortho Cyclen and it is still wreaking havoc on my skin. Reading this post encouraged me to switch to Ortho from Lo Loestrin, which also wreaked havoc on my skin... lol. Can't wait for my body to adjust.

Something interesting my dermatologist told me about OTC vs Ortho Cyclen - OTC is considered better for acne because the progestin dose is lower for most of the pack. That is probably something to consider for people debating monophasic vs triphasic - there can be some benefits to the triphasic dosing schedules.

I've heard the best for acne are either monophasic like orthocyclen or ones with drospirone like Yaz or Yasmine.
I did well on orthocyclen and now I'm on Yaz but its only been one month.

Okay so I wanted to help my housemate who is on the pill. I looked up stuff for her, but I am not a skin expert so I thought someone on here could help me. She is on tri cyclen lo and was prescribed it for acne. Now I think she thinks her acne is not as bad as she thinks it is, cause I looked at it last night, it didn't seem bad at all, in face I don't think I would have noticed it if she hadn't pointed it out. Anyways she was telling me that like she has good skin on the pill most of the time, except every once in a while she gets spots under chin, jaw line and side of face. She hardly gets spots on forehead, nose and upper checks. I mean there was once when she got like some spots near mouth. She wanted to switch pills but doesn't know what brand what help to decrease spots in those areas. She said forehead is clear a lot, and nose. What are some other brands of pills that could help? and is monophasic pill better? I don't think she can be on high dose though cause of her blood pressure is a bit high on tri cyclen lo. What are her options?