Good & Bad Birth Control Pills And Implants For Acne

[Green Gables 515]

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.

Edited September 5, 2013 by Green Gables

[BlueMoon3 15]

Very helpful, thank you!

I've heard that Belara is a good BCP for acne, but I can't seem to find many reviews online about it (only medical information and claims from the company about its positivity, which is never good enough as it always helps to read reviews from actual patients). I broke out terribly on Yasmin, which is apparently supposed to be one of the "best" birth control pills for acne. I'm worried that my skin will get worse if I choose to go on another pill, which would just result in a mess because once I come off it, I'll be getting post-pill acne again.

Have you heard anything about Belara? Do they even prescribe it in the UK?

Very helpful, thank you!

I've heard that Belara is a good BCP for acne, but I can't seem to find many reviews online about it (only medical information and claims from the company about its positivity, which is never good enough as it always helps to read reviews from actual patients). I broke out terribly on Yasmin, which is apparently supposed to be one of the "best" birth control pills for acne. I'm worried that my skin will get worse if I choose to go on another pill, which would just result in a mess because once I come off it, I'll be getting post-pill acne again.

Have you heard anything about Belara? Do they even prescribe it in the UK?

This is the information that is been in my signature for years. I am moving it to a post.

Those of you who use birth control pills for acne, please realize that not all pills are created equal. For acne you want a pill that is LOW in androgenic activity. There are other factors but that is the first place to start.

Neutral (won't affect acne either way)
No hormones. Copper Paraguard IUD

Good (can reduce acne)
Drospirenone. Anti-androgenic. Used in Yaz, Yasmin, BeYaz.
Norgestimate. Low androgenic. Ortho Tri Cyclen, Tri Sprintec, TriNessa, Ortho Cyclen, MonoNessa, Sprintec.
Cyproterone. Low androgenic. Diane-35.
Cyproterone acetate. Low androgenic. Dianette.

Chlormadinone. Low-medium androgenic. Belara. (Jury is still out on this one, but results look promising.)

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.

Very helpful, thank you!

I've heard that Belara is a good BCP for acne, but I can't seem to find many reviews online about it (only medical information and claims from the company about its positivity, which is never good enough as it always helps to read reviews from actual patients). I broke out terribly on Yasmin, which is apparently supposed to be one of the "best" birth control pills for acne. I'm worried that my skin will get worse if I choose to go on another pill, which would just result in a mess because once I come off it, I'll be getting post-pill acne again.

Have you heard anything about Belara? Do they even prescribe it in the UK?

[JennaBean 8]

What about ortho tri cyclen LO?

[Green Gables 515]

What about ortho tri cyclen LO?

"Lo" pills are just versions with less estrogen. Because of the relationship between estrogen, testosterone, progesterone, and acne, these pills do not a have great track record with acne sufferers. In GENERAL you want an anti or low androgenic progesterone pill with moderate to high estrogen.

[JennaBean 8]

Ugh. Why the heck did my old derm give me that then?! Geez.

I started seeing a new derm last month and I started sprionolactone as well.

[Green Gables 515]

Ugh. Why the heck did my old derm give me that then?! Geez.

I started seeing a new derm last month and I started sprionolactone as well.

The medical community is very slow to accept new ideas, and right now the idea that small differences in hormones in a birth control pill can cause acne is not widely accepted.

[JennaBean 8]

Do you think along with the sprionolactone it will be ok as far as keeping the acne away? I really don't want to switch BC pills again

[Green Gables 515]

Do you think along with the sprionolactone it will be ok as far as keeping the acne away? I really don't want to switch BC pills again

In my personal opinion, I don't think it will be okay.

[JennaBean 8]

Green gables: I'm not sure i agree with you. There's plenty of people that are clear on the spironolactone alone. I think the birth control will help it, or not even make a difference.

[Green Gables 515]

Green gables: I'm not sure i agree with you. There's plenty of people that are clear on the spironolactone alone. I think the birth control will help it, or not even make a difference.

Do what you want, nobody's stopping ya

[JennaBean 8]

I think everyone is different, and responds differently to BCPs. If there was one that worked for everyone to clear acne, then that would be the only pill that acne suffers would take. Too bad it's not that simple.

[Green Gables 515]

I think everyone is different, and responds differently to BCPs. If there was one that worked for everyone to clear acne, then that would be the only pill that acne suffers would take. Too bad it's not that simple.

Oh sure. It's just the general principle, if your acne is hormonal, revolves around lowering androgenic activity. First you look at progestin in the birth control pill. The progestin can't be too high, and the source of progestin can't be inherently androgenic. The next step is estrogen levels. Estrogens themselves reduce the effects of androgens in the body. As soon as you lower estrogen, you basically give the androgens in your body more power to operate. Since a "Lo" pill has the same amount of progestin and just cuts down the estrogen, you're often asking for trouble.

Just read another post today where yet another woman's acne became WORSE on OTC Lo than it ever had been.

I don't recommend Lo pills unless you have a documented problem with estrogen. There are a few acne sufferers I've seen who really do have an estrogen metabolism problem and need a pill with lower levels.

Now to answer your question, maybe by taking a high dose of spiro you will be able to offset your natural androgens plus any estrogen/progestin proportion problems introduced by the OTC Lo. Maybe you'll be totally fine. The way I deal with acne, though, I'd rather go through the inconvenience of switching birth controls just to be on one with a better track record.

And yeah, I did clear on spiro alone, I use a copper IUD for birth control, which has no hormones. If at all possible, I prefer to treat my natural set of hormones only...instead of altering them with birth control and then fixing whatever is left over from that.

Edited September 2, 2013 by Green Gables

[JennaBean 8]

Thanks green gables. I'm going to see my derm on Tuesday and ask her about all this. I'm also going to show her my blood work I had done months ago (my previous derm ordered the lab work).

[stephzoars 11]

So helpful! I go to the gyno every six months and I always ask about ones that would help with my acne and he always pushes the topic aside and gave me a prescription for Mircette. After reading the horror stories on consumer reports I decided I'm just not even going there.

Do you have any suggestions on how to persuade them to give me something like Ortho Tri Cyclen?

Also.. can I be tested for hormone levels? And where would I go to do that?

[Green Gables 515]

So helpful! I go to the gyno every six months and I always ask about ones that would help with my acne and he always pushes the topic aside and gave me a prescription for Mircette. After reading the horror stories on consumer reports I decided I'm just not even going there.

Do you have any suggestions on how to persuade them to give me something like Ortho Tri Cyclen?

Also.. can I be tested for hormone levels? And where would I go to do that?

It shouldn't really be hard if they have your best interests at heart, you can always just say that a family member had success on it, and you'd like to stick with that. Though for acne, I personally recommend Ortho Cyclen, which keeps your estrogen levels stable (Ortho Tri Cyclen changes the estrogen level periodically...hence the "Tri"...some acne sufferers have problems with the fluctuations).

[brenmc 52]

Great insight Green Gables! In my experience Diane temporarily helped my acne but in the long term made it worse. When I quit it a few years ago before knowing about/trying spiro my face exploded is painful nodules and cysts. Ten-twenty times worse than pre-Dianne. Always wean off bc ladies!

[Green Gables 515]

Updated the original post.

[mirili 3]

Hi Green

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.

Hi Green Gables,

firstly thanks a lot for this post it is very helpful and secondly I wanted to ask you where have you read that chlormadinone acetate (hormone in Belara) is low-medium androgenic. The manufacturer claims it has anti-androgenic properties. I am currently taking this pill and it helped my acne a lot, even more than Yasmin or another bcp pill I used which contaied dienogest and these both are supposed to be anti androgenic. It is possible that pill that is low-medium androgenic works better for me? I also lost a lot of weight on Belara which I couldnt loose any while using the other two pills,.

[Green Gables 515]

Unfortunately there isn't much research or information available about Belara in U.S. clinical trials or research libraries, so I don't have much to go on.

[maria199 80]

Hi Green

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.

Hi Green Gables,

firstly thanks a lot for this post it is very helpful and secondly I wanted to ask you where have you read that chlormadinone acetate (hormone in Belara) is low-medium androgenic. The manufacturer claims it has anti-androgenic properties. I am currently taking this pill and it helped my acne a lot, even more than Yasmin or another bcp pill I used which contaied dienogest and these both are supposed to be anti androgenic. It is possible that pill that is low-medium androgenic works better for me? I also lost a lot of weight on Belara which I couldnt loose any while using the other two pills,.

I am no expert in women hormones (i hate them..) and not familiar with this pill but i will try to help. The research i found combines CMA( the hormone in belara) and ethinylestradiol. The conclusion is "In addition to its contraceptive efficacy described elsewhere, EE/CMA is an effective treatment for moderate papulopustular acne and other androgen-related skin disorders.". If you see improvement, congratulations! I don't know about CMA alone (i didn't find a research with this alone) but with this EE it's definitely effective.

Edited October 9, 2013 by maria199

[mirili 3]

Hi Green

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.

Hi Green Gables,

firstly thanks a lot for this post it is very helpful and secondly I wanted to ask you where have you read that chlormadinone acetate (hormone in Belara) is low-medium androgenic. The manufacturer claims it has anti-androgenic properties. I am currently taking this pill and it helped my acne a lot, even more than Yasmin or another bcp pill I used which contaied dienogest and these both are supposed to be anti androgenic. It is possible that pill that is low-medium androgenic works better for me? I also lost a lot of weight on Belara which I couldnt loose any while using the other two pills,.

I am no expert in women hormones (i hate them..) and not familiar with this pill but i will try to help. The research i found combines CMA( the hormone in belara) and ethinylestradiol. The conclusion is "In addition to its contraceptive efficacy described elsewhere, EE/CMA is an effective treatment for moderate papulopustular acne and other androgen-related skin disorders.". If you see improvement, congratulations! I don't know about CMA alone (i didn't find a research with this alone) but with this EE it's definitely effective.

Thank you

[Ann B. 3]

Nice post. I've been on Spiro for going on 5 months with excellent, life changing results. My periods, however, have been CRAZY....I mean anywhere from one to 4+ week intervals. Just started Yasmin 3 days ago, so we shall see!

[smichelle 3]

Hi Green Gables,

Your post is amazing and I want to thank you for sharing. I've been searching up and down for an explanation to my birth control situation. ANY advice you could offer would be amazing. I was on Alesse for about 5 years- always had sort of oily skin, and a few clogged areas. January 2013 my doctor switched me to Seasonale and thats where everything changed. About 3 months in, I started getting extreme oily skin- with clogged pores as a result. I use a strict skin care routine so most of them weren't inflamed- just closed comedones. I also got breakouts on my scalp, back and little red pimples on my chest too. I never ever had these issues before! I went through everything I could and last resort thought I'd research my birth control. Alesse and Seasonale are both on the list for high androgens- which causes oily skin and breakouts, but why was it so much worse with Seasonale? The hormone levels are;

Seasonale- progesterone 0.15, estrogen 0.3

Alesse- progesterone 0.1 and estrogen 0.2

Could it be possible even that much more of a hormone could affect my skin? Also which hormone relates to the high androgens in this birth control?

Hi Green

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.

Hi Green Gables,

firstly thanks a lot for this post it is very helpful and secondly I wanted to ask you where have you read that chlormadinone acetate (hormone in Belara) is low-medium androgenic. The manufacturer claims it has anti-androgenic properties. I am currently taking this pill and it helped my acne a lot, even more than Yasmin or another bcp pill I used which contaied dienogest and these both are supposed to be anti androgenic. It is possible that pill that is low-medium androgenic works better for me? I also lost a lot of weight on Belara which I couldnt loose any while using the other two pills,.

Hi Green Gables,

Your post is amazing and I want to thank you for sharing. I've been searching up and down for an explanation to my birth control situation. ANY advice you could offer would be amazing. I was on Alesse for about 5 years- always had sort of oily skin, and a few clogged areas. January 2013 my doctor switched me to Seasonale and thats where everything changed. About 3 months in, I started getting extreme oily skin- with clogged pores as a result. I use a strict skin care routine so most of them weren't inflamed- just closed comedones. I also got breakouts on my scalp, back and little red pimples on my chest too. I never ever had these issues before! I went through everything I could and last resort thought I'd research my birth control. Alesse and Seasonale are both on the list for high androgens- which causes oily skin and breakouts, but why was it so much worse with Seasonale? The hormone levels are;

Seasonale- progesterone 0.15, estrogen 0.3

Alesse- progesterone 0.1 and estrogen 0.2

Could it be possible even that much more of a hormone could affect my skin? Also which hormone relates to the high androgens in this birth control?

[Green Gables 515]

Yes, in terms of birth control pills, 0.05 or 0.1 is a big number.

Generally androgens create the acne. However, as you can see, none of the birth controls have androgens in them. But the synthetic progestins have an androgenic component. This is why both Seasonale and Alesse are listed as bad, because they both use a progestin that has a highly androgenic progestin.

I would suggest that it is the increased amount of a highly androgenic progestin that is giving you trouble. 0.05 difference doesn't seem like a lot, but think of it this way...if 0.1 of progestin is enough to prevent pregnancy, then a 0.05 increase is still a pretty big deal.

Edited December 9, 2013 by Green Gables

[smichelle 3]

Yes, in terms of birth control pills, 0.05 or 0.1 is a big number.

Generally androgens create the acne. However, as you can see, none of the birth controls have androgens in them. But the synthetic progestins have an androgenic component. This is why both Seasonale and Alesse are listed as bad, because they both use a progestin that has a highly androgenic progestin.

I would suggest that it is the increased amount of a highly androgenic progestin that is giving you trouble. 0.05 difference doesn't seem like a lot, but think of it this way...if 0.1 of progestin is enough to prevent pregnancy, then a 0.05 increase is still a pretty big deal.

Thanks for the response!! That makes sense for sure as to why I did have clogging before even from the Alesse- it just wasn't AS bad, and no body breakouts. I've been back on Alesse for 2 weeks- but I am still experiencing bad clogging on my face- how long until you think this stops? I'm also seeing a doctor this week, to get some hormone tests done and hopefully this will help. Could you recommend which birth control would be best so I don't get this skin issue anymore? I've read so many reviews on how yaz and diane 35 makes people break out even more! Scares me so much. I do want to say I really don't have acne(inflamed) at all..and clogging is just my issue which I can't help but think is because of the birth control and the oil it makes my skin produce. Which hormone does that?