I'm not over 40, I was on Livial as add-back when in a chemically induce menopause for my endometriosis. My skin at the end of the treatment was absolutely horrific. My acne is extremely resistant (accutane 2.5 times, even though it is moderate). So what I'm saying is that Livial may or may not have been a contributory factor in that flare but I'm fairly sure it was as when I withdrew it and went onto Yasmin my acne calmed within 2 weeks, didn't go away but it was like taking the oxygen from the fire.

Livial decreases SHBG (sex hormone binding globulin) which acts like a mop to mop up free testosterone. I believe that is a contributing factor as when you take birth control for acne SHBG increases as does the ratio between estrogen and testosterone. The presence of testosterone is a double edged sword though because it's what gives you the 'get up and go', zest and libido that Livial gives.