I've been struggling with acne for a while now. I've had it since I was probably 13-14 (I'm 20 now), but it keeps getting worse and worse. When I was younger, it was relatively mild- normal teenage acne. I'm almost certain now that it is related to my birth control.
I started birth control when I was 17. I started on Nuvaring, and while my acne did worsen while on it, it certainly wasn't severe. I was on Nuvaring for about a year, and decided to change birth control simply because the ring was fairly expensive. I did not use birth control for about 6 months, and I honestly can't remember how my acne was at that time. About a year and a half ago, I decided to get the Skyla IUD (same thing as Mirena, just smaller). I really enjoy the freedom that the IUD gives, but I can't say that my body has taken well to it. Insertion was VERY, VERY painful for me and the thought of having it removed makes me cringe. That is partly why I've tried my best to cope with the side effects, namely cramping and spotting for the first 3 months following insertion, severe acne, some moodiness, and a lower sex drive.
I'm at my wit's end with the acne. I keep my face as clean as I possibly can- using gentle cleansers, salicyclic acid, Cetaphil moisturizer, gentle makeup with sunscreen (which I remove ASAP after getting home), etc. Despite all that, I've had borderline pizza face roughly since I started Skyla. Currently, I'm dealing with rosacea-like redness, papules, pustules, cystic acne, and a few nodules at a time just to make things even more fun. The acne is concentrated on my cheekbones, jawline, chin, and between my eyebrows. I will likely have a fair amount of scarring after it's all cleared.
I've been to two nurse practioners in dermatology who only want to prescribe topical antibiotics. The first prescribed a 30-day round of oral doxycycline and topical Tretinoin, which I've been on for the past 6 months and is not very effective. The second, after me telling her that the antibiotics weren't working, simply wanted to switch me over to clindamycin (another topical antibiotic) and get me back on doxycycline. I haven't filled that script. I told the second NP that I'm convinced this is hormonal, since the Skyla is progesterone-only, high in androgenic activity, and that I tend to run high on testosterone anyways. She didn't want to hear it, told me she didn't have any solutions for me in that aspect, and told me that I'd be better off seeing a gynecologist and switching birth control. I suppose this is my fault for not seeing an MD, but in my area the wait time to see a dermatologist is upwards of 3 months. Maybe that's typical, but I'm desperate for ANYTHING to help control it.
I have a few family members who are really into natural supplements (re: I'm a skeptic). They sent me some Flax Seed, Spearmint Tea, and DIM-Plus, all of which supposedly lower androgen levels. I've been taking the flax seed because, hey, worse case scenario I just get some extra fiber in my diet. The DIM-Plus scares me- there's little to no research on it (all anecdotal) and there's conflicting evidence (some say it blocks androgens, some day it blocks estrogen ie. Estroblock which I'm pretty sure is the OPPOSITE of what I need).
If anyone has found a way to keep the IUD and counteract the acne, I'm open to suggestions. However, at this point I'm fairly convinced that I need to switch birth control to something with estrogen. From what I understand, birth control pills are the way to go for most people. I've heard Yaz, Yasmin, Ortho Cyclen, Diane-35 are all optimal for getting rid of acne. The reason I've never done BCPs are because I have a sensitive stomach, so nausea would likely be a pretty nasty side effect for me. I don't know if they still do the Patch in the US- is that an option? I would love to get some recommendations for dealing with this- skin care regiments, BCP advice, side effect management, etc. Thanks!
TL;DR hormonal IUD probably gave me pizza face, derms won't give anything other than topical antibiotics. considering switching BC method
THIS post saved my life: http://www.acne.org/messageboard/topic/330166-good-bad-birth-control-pills-and-implants-for-acne/
It helped me get off a terrible BCP for acne called Lo Loestrin Fe 1.5/30 that ruined my skin and has caused me issues to this day. I completely empathize with you as doctors completely misled me and were not honest about how certain BCPs affect acne, it's disgraceful that they hand out pills like candy and don't even take the time to investigate if their patients are acne-prone and what pill they should give to them accordingly. LLF RUINED my life! It probably didn't help that I had to take plan B right before I began the drug, as that's androgenic too.
Mirena/Skyla and NuvaRing are, sadly, both the same. NuvaRing is medium-high androgenic and unfortunately Mirena is high androgenic. I've seen countless posts here about how perfectly clear women or women with mild acne got pizza faces on Mirena/Skyla and it's heartbreaking to me, having been through something similar with LLF. The problem is, LLF was low estrogenic and things like NuvaRing and Mirena/Skyla are mainly Progestin, and that upsets the delicate balance between Estrogen and Progestin. Estrogen is good for clear, plump and glowing skin, so too much Progestin, especially androgenic Progestin = acne. 
I think I have always been prone to androgentricity...because I was a hairy kid, Italian, very thick eyebrows, and PMS zits every month. So even being a little acne prone can make these options a nightmare.
Honestly your best bet is just get rid of the Skyla ASAP. DO NOT TAKE DIM. Your Estrogen levels are already suffering from Skyla, since the Progestin in it is already suppressing/outweighing your Estrogen and DIM will quickly make your acne worse...if you're not Estrogen dominant [and you're not, trust me], DIM adds to the acne problem because it lowers estrogen even more. You're right that drugs like Yaz, Yasmin, ortho Cyclen and Spiro can all help acne. My experience with Spiro was weird...it seemed to help at first, but then it made my eyebrows and lashes shed rapidly as the days went by, and it stopped the day I quit the drug. I feel this is because I am sensitive to the anti-androgen effect of the medication, as some women simply are. No one really understands why, as Spiro is supposed to make your hair grow, but I think my T levels weren't elevated enough for me to really benefit from the drug...and according to GreenGables, Spiro can actually do the opposite and act as a mild androgen if the dose is wrong or your body chem isn't right for it. There are a lot of women who have their scalp hair fall out from the drug too, for that reason. So that means for me, Yaz and Yasmin are also off the table, since they are basically Spiro in a BCP.
I would recommend Ortho Cyclen out of them all, since according to the post I linked, it's the stablest one [monophasic] and helps raise estrogen without being an aggressive anti-androgen like Yaz and Yasmin. The generic like MonoNessa seems pretty safe, as does Sprintec, which I'm trying. Ortho Cyclen also seems to be a good option for people with mood disturbances [like myself] since tri-phasics can make mood wings far worse. As for the antibiotics and such, going on Doxy actually made my acne way worse and more aggressive since it seemed to disrupt my gut flora. I developed more nodules from it in places I'd never gotten them before and it was a nightmare...they stung and hurt so badly. It was a big blow because antibiotics tend to help people but I just haven't had luck with them.
We can take control back and beat the acne. You can't see yourself at its mercy. There are way better options out there for us versus androgenic pills and options like these. I'm here to talk. Hugs
I actually found that post just prior to writing this- it's a lifesaver for sure! To be fair, I'm pretty sure the gyn who inserted the IUD warned me about the chance my of acne worsening. I just never expected it to get to the point where it's unmanageable. I haven't been to that gyn since I went off to college, but I guess I'll be making an appointment soon enough. I'm fairly certain he would be willing to switch me over to BCPs. Ortho Cyclen is covered by my insurance, so that will probably be my go to.
I did take a few DIM-Plus pills when I first received them, but I quit after I continued researching them and got worried. I never noticed a difference, but I'm sure I would if I continued taking them.
I'll certainly keep that in mind about Yaz and Yasmin. I've never tried Spiro, and I have no clue if the symptoms you had would also happen to me. Again, my main concern with any BCP is nausea. I know I will have it- all the women in my family did when they were on BCPs. Hopefully my body can adjust to it over time, or maybe the gyn will be kind enough to prescribe some anti-nausea meds.
Being a woman is tough, but at this point I'd do anything to not have to wear makeup just to go out, or to not want to hide my face from my own SO.
Thank you for understanding. Hugs.
UPDATE: I had my Skyla IUD removed on January 5th. My GYN did tell me that while there was no research he had seen indicating a causative link between cystic acne and hormonal IUDs, there may well be one and my reason for getting it removed was justified. He prescribed me Tri-Sprintec, a generic form of Ortho Tri-Cyclen, which I started taking in late February.
Immediately following getting the IUD taken out, I saw a drastic reduction in the amount of cystic acne. In fact, since starting Tri-Sprintec, I haven't had a single cystic spot or nodule. No more giant, painful, pus-filled blemishes! However, the transition to being acne-free has not occurred as quickly as I would have hoped. I suppose that is to be expected, considering I've dealt with it for years. Four months isn't nearly enough time for it to fully heal..
I do have a fair amount of scarring- thankfully none of it is too deep. My scars appear as prominent red marks on my cheekbones, jawline, chin, and between my eyebrows. Some of these scars are slightly raised, some are smooth. I believe this is post-inflammatory erythema and is due to broken capillaries in the skin. I'm currently waiting for these to eventually fade, and that takes time. I also have general redness spread across my cheekbones and nose. The birth control switch does not appear to have improved that.
Scarring aside, my skin is fairly smooth, although I do deal with dryness and scabbing near the scar sites. Currently, I'm experiencing my worst breakout in a month or two- consisting of a few papules near my chin and on my left cheekbone, and an unfortunate pustule on the tip of my nose.
In conclusion, while switching birth control will not miraculously improve your acne overnight, it will certainly be the first (huge) step to recovery. And for anyone who is acne-prone and considering getting a hormonal IUD... please consider other options.
Just wanted to let everyone know i had HORRIBLE cystic acne caused by my Mirena. I™m 32 and I™ve always had some mild acne but I got my Mirena In May 2017 and by July I had horrible acne. By December, I was unrecognizable!!! I got to the point I couldn™t leave my house. I cried every day and make up did nothing for me. I broke out all around my jawline, neck and around my mouth. Even after going to the dermatologist and on 100 mg a day of spironolatone for a few months it was so horrendous I just couldn™t take it anymore. I thought it might have been my diet, stress levels, and tried everything!!!! I was in antibiotics but they only worked for a month then stopped. I felt hopeless. After looking back I realized it got this bad after I put in my Mirena. I started researching and found I was not the only one. I decided to take my Mirena out and within just days my skin cleared up. It™s 5 weeks out from removal and I don™t even have one! I can™t tell you how happy Iam I took it out. My face was so bad with huge nodules and cysts that popped up every few hours. I was so depressed and I isolated my self from everyone and eneything. This was all due to that stupid Mirena!! I even asked the nurse if it would make me break out and her exact words were, œIt won™t make it any better or any worse. Well here what it did to my face: (picture below) and my face 4 weeks after (2nd picture). Yeah, I think it™s safe to say it was the Mirena. I know not everyone has this reaction but if you™re on you™re on your phone, hiding on your house trying to find if your Mirena caused your acne, then I™m speaking to you. Don™t wait. Get it out! I still get one or two around my period but I™m so happy with that compared to what it was! Im till working on some dark spots and a few scars but very much easy to work with makeup my confidence is back and I want to share my experience because I know how hard it is! I hope this helps! 
