Hi everyone.
I've had acne ever since I hit puberty (about 11 years old). I had horrible periods and was put on birth control pills when I was about 17 (I'm 20 now). My acne was never terrible, but it was stubborn. I had been on numerous antibiotics, used tons of prescription topical treatments, etc. Finally, my derm decided I should try accutane (which is brutal, by the way). It did work. My skin never became "perfect," but the acne mostly went away for about a year. At the end of December 2015, I had Mirena inserted because the birth control pills had begun to cause spotting and cramps again. About two months after Mirena was inserted, my acne got BAD. Worse than it had ever been. Large pimples on my lower cheeks and chin only but they're painful and leave hyperpigmentation and often little scars. My derm prescribed me spironolactone 100 mg once a day, plus tretinoin topical cream and clindamycin topical gel twice a day. It's been about two months since I started this regimen and I've seen little, if any improvement. I'm so frustrated. I'm trying to stick with spiro because I don't want to go back on accutane because it was so harsh, and I don't want the Mirena removed because in terms of my periods (which are now nonexistent) I have been doing better than i ever remember and it's the only thing that has worked (I've been on multiple different BC pills). Does anyone have a similar experience they can share, or any sort of advice? I'm so frustrated and desperate for a solution 
Hiya
just wanted to say I'm in a similar boat. I was on Yasmin for a couple years for my acne which completely cleared it up but I decided to get the Mirena coil as I don't want to be on bc my whole life.
Now omg acne is back with a vengence!!! I've started taking Vitex and I swear it's just getting worse. Sorry I have no advice, I'm hoping someone else will!!
You may have to change your bc to one that is known to help with hormonal acne such as ortha tri. I have been on spiro for over a year and helped my acne a lot but it's not consistent, it just makes it not as bad. It took many months to even begin to see improvement - like 8+ months. Give it time as hormones are slow and it takes time for your body to adjust.
Just throwing it out there in case you did not know this, but Mirena is one of the worst contraceptives for sensitive/acne-prone skin. More specifically if you're androgen/progestin sensitive. It's progestin-only which means it is more likely to cause breakouts vs. an estrogenic pill like Yaz. I've known several people who had terrible acne flare-ups on Mirena, and the flare-ups died off when they removed it.
Honestly, if you can hack it, I would ditch the Mirena, keep up the Spiro if you're in good health [normal potassium/no major side effects] and seek other contraception if you want to lighten your periods. I don't mean to scare you, but yes, Mirena is probably going to keep breaking you out, if not for a while until your body adjusts...but who wants that for 6+ months? I know, it's hell and I'm sorry it's this hard. It's so frustrating, I have been in your shoes so many times.