Dermatologists Say This Is the Best Birth Control for Acne

For some people, acne isn't just a pesky skin issue that appears every so often; it's a chronic condition. Instead of dealing with the occasional breakout or two, the skin is consistently red, inflamed, and sometimes even painful to the touch. It's at this point that many look to birth control as a way to treat and control flare-ups.

But just like taking any other prescribed medication, you need to do your research and talk to a doctor before using birth control for acneic skin. That's because not all birth control works the same or provides the same skin-clearing results. A 2016 Journal of Drugs in Dermatology study found that combination birth control pills, or those that contain versions of both estrogen and progesterone, are generally best at clearing skin, while hormonal injections, implants, and intrauterine devices (IUD's) tend to worsen acne.

Below, six experts explain how certain birth control methods may improve acne.

How Birth Control Works

Combination hormonal birth control, or the main type of oral contraceptive prescribed for acne, contains two hormones: estrogen and progesterone. Together, these hormones suppress ovulation. A typical menstrual cycle includes menstruation (a period), a follicular phase, ovulation, and a luteal phase, which are all driven by fluctuations in hormones from the brain and ovaries. The pill stops these fluctuations and in turn, stops ovulation.

How Birth Control Can Improve Acne

Birth control works by affecting your body's hormone levels, which is how, along with preventing unwanted pregnancy, it can also impact other hormonal-related issues like acne.

"When women's hormone levels shift from a more female profile, for example, with estrogen and progesterone, to a more male profile, for example, testosterone, during our cycles, this has an effect on oil production and acne," says Melissa Kanchanapoomi Levin, MD, a board-certified dermatologist and the founder of Entière Dermatology in NYC.

"When the hormone profile is more male dominant, a couple of skin changes occur: The sebaceous glands (the glands that make oil) become more active, there is an increase in dead skin cells, and the skin cells become stickier. This environment is perfect for acne flares. Some women are more sensitive to circulating testosterone and develop hormonal acne," says Levin. Taking birth control pills can stabilize these hormones and decrease the amount of testosterone in your body.

The Best Types of Birth Control for Acne

Levin, who also works as a faculty member at NYU Langone, says Ortho Tri-Cyclen, a popular brand of birth control, has been cleared by the Food and Drug Administration (FDA) for the treatment of acneic skin. Along with Ortho Tri-Cyclen, Estrostep, and Yaz are two other brands of birth control cleared by the FDA for acne treatment. Yaz contains the hormone progestin drospirenone that is known to be especially effective in the reduction of hormonal acne.

While certain brands of birth control carry the FDA's approval as an acne treatment, others are still prescribed off-label with some success. Other times, people who are prescribed oral contraceptives for other indications may find that a bonus "side effect" is an overall reduction in their acne symptoms. OB/GYN Sara Twogood, MD, notes that all oral contraceptive pills can have the effect of being anti-androgenic, meaning that they can lower the level of androgens like testosterone in the body. Androgens are one factor that leads to the development of hormonal acne, so blocking them can help to improve acne over time.

"There are no set requirements or parameters for starting birth control pills for acne. The decision about when or if starting the pill to help control acne should be individualized," says Twogood.

Nava Greenfield, MD, of Schweiger Dermatology Group, agrees: "Each person may respond differently to different forms of oral contraception, so finding the one that works for you is important."

Types of Acne That Birth Control Can Treat

Acne can take the form of a blackhead, whitehead, a small mark, or even a cyst, but it's the underlying cause of your acne that determines whether birth control might be an effective treatment. According to Levin, teenage or inflammatory acne can be treated with oral antibiotics, but hormonal acne is not usually successfully treated by antibiotics.

That's where hormonal medication, such as birth control, can come into play. If home treatment doesn't help your breakouts, or if you're finding yourself with large, hard, or pus-filled bumps, you may want to consult your doctor to learn if you're experiencing hormonal or cystic acne—both of which may be treated with birth control. Other signs that you're dealing with hormonal acne rather than good old-fashioned inflammatory acne include breakouts that follow a cyclical pattern with your menstrual cycle and acne that pops up mainly along your jawline or chin.

How Long It Takes to See Results

While it can take as little as a month to notice an improvement, says Twogood, "in most studies, it took three to six months to show a reduction of acne due to birth control use." Of course, oral contraceptives are considered long-term treatment, and acne may flare back up with discontinued use of the medication.

Potential Side Effects of Taking Birth Control for Acne

Side effects of taking birth control pills for acne are the same as those of someone who takes the pill for contraception or any other indication. The most common short-term side effects of birth control are nausea, breast tenderness, and bloating. You may also experience longer-term mood changes and changes in libido. You should speak with your doctor about whether you're a good candidate for this medication given your medical history and to get more information about other possible side effects.

"If a person has a history of a blood clotting disorder, is a smoker, or suffers from migraine headaches, they are not good candidates for a birth control pill," warns Birmingham-based dermatologist Julie C. Harper, MD.

Who Can Prescribe Birth Control for Acne

While any physician can write the script, "dermatologists, OB/GYNs, and primary care doctors are the usual prescribers," Twogood says.

When to Talk to Your Doctor About Birth Control

If your acne is getting especially bad and isn't responding to other treatments, consider speaking with a specialist or your primary care physician. Your doctor can help identify the underlying cause of your breakouts and suggest a treatment plan.

While there is no harm in asking your doctor about taking birth control for your acne, particularly if you believe your breakouts are hormone-related, be prepared to follow a suggested treatment plan, even if it doesn't include the pill. While birth control may be incredibly effective against certain types of acne, it's important to note that it's not usually intended to be the first line of defense.

Usually, dermatologists will first recommend a topical retinoid. "Topically, my feeling is everyone and their mother should be on a retinoid," says board-certified dermatologist Adam Friedman, MD, FAAD. "This first-line medication can be difficult to get covered in our current healthcare climate, so fortunately, there is an over-the-counter form available called Differin Gel ($15)."

Levin agrees: "In addition to clearing existing acne, Differin Gel will also help to prevent future breakouts from forming by increasing skin cell turnover to minimize clogging of pores."

And while being on birth control can help manage hormonal acne, you still need a solid skincare routine and diet. "As acne is an inflammatory disorder, foods that cause inflammation may also contribute to acne," board-certified dermatologic surgeon Dendy Engelman, MD, FACMS, FAAD, says. According to Engelman, high-glycemic index foods and dairy have been linked to acne.

As for your skincare routine, Friedman says it should take on a "less-is-more approach" as opposed to loading up on anti-acne products. "Many believe overwashing, exfoliating, [and] scrubbing will improve acne, but, in fact, it will only make it worse. The inflammation that causes the visible pimple disrupts the skin barrier, impacting its ability to keep water in and harmful things out. Overwashing or using harsh cleansers can further disrupt the skin barrier, which can, in turn, create more inflammation and even more acne."

Friedman recommends a gentle wash, like Cerave Foaming Facial Cleanser ($14).

The Takeaway

While birth control can be an effective treatment for certain types of acne, it's not appropriate for all acneic skin types nor is it typically the first recommendation for treating acne. If you're struggling with acne, talk to your doctor about various treatment options, and ask if birth control could be your route to clear skin.