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Oral contraceptives (OCs) have been available since 1960, and have been modified since then to reduce their risk of side effects. They are the favoured method of contraception by most young couples. Oral contraceptives prevent ovulation and make conditions difficult for a fertilized egg to implant on the uterus wall.

Oral contraceptives can either be made up of progestin alone (called the minipill), or of a combination of synthetic estrogen and progestin. The combination pill has estrogen, which is usually in the form of ethinyl estradiol, or mestranol (only occasionally).

The vast majority of contraceptive pills use ethinyl etradiol as the estrogen, which acts to lower levels of luteinizing hormone (LH) and increase the sex hormone binding globulin (SHBG). This in turn lowers testosterone, thus reducing the drive of the oil glands that are responsible for acne to produce excess oil.

The level of testosterone in women with acne is within the normal range, but the level is lowered in those on OC’s. Some experts believe that the normal range of testosterone for women that is set by laboratories is higher than it should be. If this is true, it could mask the results for some people whose level, although considered to be within the normal range, is actually high for them individually. In such women, their acne improves when their testosterone is lowered by taking the OC pill.

A number of different forms of progestins are used depending on the brand. The progestins can be used at a constant dose throughout the cycle (monophasic), or the daily dose can vary (biphasic or triphasic). Progestins are hormones that have a differing influence on your body, depending on their molecular structure.

Some progestins have effects that can be androgenic (acting like male hormones), while others are anti-androgenic (blocking the production of androgens or blocking androgen receptors, which allow your body to absorb and use the androgen), and some are even estrogenic (estrogen-like). These different actions certainly can influence the side effects as well as the effect on your skin and acne. For treating acne, those pills that produce little or no androgens, or even those that block androgen production (anti-androgens) are best.

By reducing the effect of the androgen hormones on the sebaceous glands, OC's can reduce the amount of oil your glands produce, which means that your pores are less likely to get blocked. Recent studies have shown that some contraceptives are also effective for treating acne.

Many women who have minimal to mild acne and who are also looking to use some form of contraception would find this very useful. As well, women who have moderate to severe acne can consider this as the primary treatment along with topical therapy. It is also considered to be one of two preferred methods of contraception for women, using oral isotretinoin (Accutane®) for treating severe acne. Mini pills may not offer adequate protection for this purpose.


Has anyone found a pill that doesn't cause an initial breakout nor cause heavy emotional responses? I tried Ortho-Tricyclen a while ago and it was awful! Terrible breakouts, awful mood swings, everything bad. I guess cause it has three different hormone levels. Are there any with a steady flow of hormones that regulate androgens?

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