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Where do I even begin. I took birth control (portia 28 I believe) for the first time because I was sexually active at the time. I had clear skin prior to this, I don't think I ever got huge breakouts since high school- anyway, fast forward to a few months after stopping birth control I had comedonal acne. It's gotten progressively worse, and it's been 7 months now and my skin is the worst it has ever been. I have horrible (sore and painful) white heads and just really bad acne. I went to my GP and he prescribed me Alesse 28 about a little over a month ago but 5 days in I stopped taking it because I felt like it was breaking me out even more and I had terrible mood swings. It was awful. I went back to my GP and now will be starting a very low dosage of Accutane Roche, however I just noticed that he prescribed me Alesse 28 AGAIN! 
I sat my butt down for a good amount of time doing extensive research and found that Alesse was horrible for acne and that it may actually aggravate hormonal acne even more. I'm going back to my GP on tuesday to discuss this with him and also give him a list of all the other BCP's that have more anti-androgen properties (i.e Diane 35, Ocella, Zarah, Yasmin etc). I guess I have two questions:
1) What is the best BCP to take while on Accutane? I've done extensive research and I haven't really found a solid answer. I'm just tired of my skin suffering so much- it's taken such a toll on my confidence. I have hormonal acne and in the past have taken: Portia 28, Aleese 28. I've done diet changed, drank (still do) buckets of water. I've tried taking Omega-3's, Probiotics, Vitamin B. I've tried topical medicine (Dapsone gel 5%).
2) Will I break out if I discontinue taking BCPs after Accutane? And is it possible to take Accutane without BCP? I will be taking a low dosage of Accutane (10mg) for the course of 2 months, just to see if it works with me, but I'm so frightened to take BCPs after my past two horrible experiences with BCP that led me to take Accutane. I also live in Canada, so no iPledge here. I am single, and have been abstinent for 7 months now and do not at all intend to be with anyone for the next year. Will not taking BCP while on accutane effect the way it works on my skin? Do I need to take it for my hormonal acne to disappear, or will Accutane be enough on its own?
I would immensely appreciate any sincere advice given. I'm sick of waking up to my aching face and new pimples all over. I'm tired and fed up. I want to start my journey with accutane as soon as I possibly can (and yes I do know about the side effects of taking accutane; I watched a lot of videos and read many things but I've solidified my decision to take accutane)
Wishing everyone the best,
x K
I feel your pain! Long time lurker here, the similarity in our experiences compelled me to make an account for the first time. I've been on Accutane (2 rounds, about 6 months each) and BC (Gianvi/Ocella/Yaz, 6 years total). These are my thoughts about your questions:
1. As you know, theway BC will affect your acne depends on your hormones. Personally, my hormonal tests showed high levels of testosterone. I respond really well to drospirenone/ethinyl estradiol combinations like the three listed above. I was on each for different years and they worked beautifully - my skin was pretty much blemish free on them. If you are looking for BCs that have been shown to clear up acne, you'll want these on your list.
2. Having taken Accutane and BC, I can say for sure that my acne came back after stopping BC. Some of it could have been in reaction to my body adjusting itself, or perhaps it was just a return to my baseline. After so many years on BC, it's hard to tell. Anecdotally, I've heard that this is pretty common for women who have been on Accutane. I even have one friend who essentially lied to her dermatologist about being on BC during her course of Accutane in order to avoid dealing with a flare after discontinuing BC. The result seems to be that her course of Accutane was longer, but she's avoided any surprises associated with coming off BC. My sense is that, sure, BC contributes to Accutane's success, but that's not why they prescribe/mandate it - your doctor just really, really doesn't want you to get pregnant on Accutane. It's a major headache for them if you do, not to mention what would happen to thefetus!Honestly, if I had to go back on Accutane, I would do what my friend did and lie (while being 100% abstinent during the treatment of course).
I'm about 6 months off of BC right now - in the past, I've run back to it because the acne becomes unbearable by the 4 month mark and I don't want to go back on Accutane for health reasons. I don't want to jinx myself, but my skin is actually pretty healthy and clear right now. The acne seemed to peak at the 4 month mark.My testosterone is lower too, which is a good data point to use for reference. I don't know if this helpful, and you certainly didn't ask for it, but here's what's working for me:
- Supporting my body in balancing hormones naturally: WomanCode by Alisa Vitti, The Hormone Cure by Sara Gottfried, and Sarahsday vlogs (search for the ones on acne) really informed how I think about this subject. Nutritionally,this has meant eating gluten free as much as possible (I don't have a diagnosed allergy, but I believe it's not good for my gut), eating TONS of greens, no dairy, minimizing meat to about once a week, and making sure I'm getting plenty of micronutrients, eg magnesium, selenium. I am also taking herbal supplements recommended by a traditional Chinese medicine doctor who also treats me with acupuncture. The supplements I am taking are available on Ying Therapeutics. I take the Adrenal Support and Calcium Blend. (I have no connection to this company, I just think their blends work.) Unfortunately you can only get these supplements via a registered practitioner, but I truly believe they are worth finding a practitioner who can provide them.
- The acne.org Regimen: This has been great for me, and I was skeptical given how under-the-surface my acne can be. I've used Dan's method since stopping BC and I think it's been a big part of my success. I use the BP, moisturizer, and AHA+. The acne that I do get is less inflamed and heals much faster. It's also decreased my oiliness.I have fewer spots, and the ones I do have are much more predictable. I know women with androgen issues don't always have success on the Regimen but it's hugely effective for me.
- Stress reduction: I won't bore you with the obvious. Stress is bad, relax, cut out negative influences, etc etc. For me, the real game changer has been changing how I relax. I noticed that a lot of my "healthy" habits were stressful on a physiological level - 5 mile runs, HIIT/Crossfit style workouts, dragging myself to the gym when I wanted to sleep. I started do more low-impact exercises and activities: walking those 5 miles, yoga/pilates, letting myself be okay with doing nothing. Sure enough, my post-workout acne decreased (yet my weight and overall fitness seems the same if not better).
This is a lot of unsolicited advice. I'm so sorry! I just relate to your situation and want you to know what has worked for this former Accutane and BC addict. There's hope! Right now my face has maybe one active pimple. Things could change, but I feel like it will only get better. The same is possible for you!Hope this response has been helpful!