Raise your hand if you’ve tried EVERYTHING in your skincare routine and STILL get breakouts! Yep that would be me. It can be discouraging to have a vigorous skincare routine and still wake up with acne – that’s why I wanted to educate you on a topic that most people use to define acne they “just can’t control” – hormonal acne.

My main goal in this post is to show you that there are options. Sometimes we fail to seek-out medical help because we feel like it’s just something we just have to deal with. This article is not meant to be used as medical advice but as information and a resource for you to know there are options. You just need to talk to your healthcare provider and know which questions to ask.

WHAT IS HORMONAL ACNE?

All acne after puberty is in a sense hormonal. Androgens (most commonly known as male hormones but still present in females) increase oil production on the skin. Increased oil leads to obstruction of the pore which leads to breakouts. Just to be clear, androgen levels are usually NORMAL in most women with acne. 

Androgens -> Oil production -> Pore obstruction -> Breakouts

Side note: An increased level of androgens can be seen in PCOS (polycystic ovarian syndrome) and other disorders which are treated differently. This is a topic for a different day.

Today, we are talking about acne in women with NORMAL androgen levels which is the majority of the population. First, we will talk about a few different options and the very basics on how they work, and then I’ll tell you about my experience with them.

ORAL CONTRACEPTIVE PILLS

Birth control pills have long been used to decrease acne breakouts by stabilizing hormones but not all are the same. To decrease acne, you must have a combination of estrogen and progesterone (the mini-pill won’t work).

Estrogen is a hormone that works to inhibit acne breakouts. It is NOT androgenic. However, different side effects come along with higher estrogen. Blood clots are one of the major risk factors of taking estrogen. Your healthcare provider will determine if you are at a high risk.

Progestins are the synthetic form of progesterone in birth control. This is the hormone required to prevent pregnancy. Most progestins have ANDROGENIC properties (they can increase breakouts). However, there are a few that are known to be “anti-androgenic.” This is why the progesterone component of a birth control pill is the most important factor in determining whether it will increase or decrease your acne breakouts. 

The most common progestin in the US used to decrease acne is Drospiernone which is found in Yaz and Yasmin.

Overall, oral contraceptive pills are a great addition to prevent acne. However, everyone reacts differently to different medications. You may have to try a few before you find the right one. Here a few of the pros and cons:

Pros:

• Easy to stop if you don’t see the desired effect
• Prevents pregnancy
• Can decrease menstrual cramps and PMS symptoms

Cons:

• Must remember to take it everyday
• Increased risk of blood clots (your healthcare provider will evaluate your risk for this) 
• Can’t use if you are trying to get pregnant

IMPLANTABLE CONTRACEPTIVE DEVICES (IUDs)

I have had several people ask if they can get an IUD with the same effect since they can’t remember to take a pill everyday. Not quite.

IUDs are implanted in the uterus in an outpatient setting to prevent pregnancy. The two most common IUDs are Implanon and Mirena.

These are likely to increase your acne breakouts because they only contain progestins, and there is no estrogen component to protect you from breakouts. 

Make sure to discuss this with your healthcare provider BEFORE having it put in. Most insurances will not cover the cost to have it removed early. 

Overall, IUDs work fantastic for preventing pregnancy but I would not recommend them to treat acne. Here are the pros and cons:

Pros:

• You don’t have to take a pill everyday
• Great for people at risk for blood clots since there is no estrogen

Cons:

• You can’t easily have it removed
• Can increase acne

As another side note, Paraguard is an IUD that contains copper only and does not contain any hormones. This might be an option to discuss if you are worried about breakouts want an IUD.

SPIRONOLACTONE

This is an oral medication that was originally used to lower blood pressure and acts as a diuretic (removes fluid). 

It can be used by itself to treat acne or with an oral contraceptive pill and should NOT be used if you are trying to get pregnant. It can cause significant fetal harm. 

For acne it works as an anti-androgen. It must be taken everyday to be beneficial and like birth control pills when you stop taking it you stop seeing the benefits.

This medication also comes along with some other side effects your healthcare provider will want to evaluate you for.

MY EXPERIENCE

I’ve been taking oral contraceptive pills since I was 15 years old. I have been on multiple different ones over the years. Let me tell you, just because one doesn’t work does NOT mean they all don’t. 

There are many different types I have been on but recently I decided to change and it was a huge mistake.

I was so shocked at how quickly I noticed a difference. The effect was night and day – and the only difference was the amount of estrogen in the pill.  It felt like my breakouts increased overnight when the rest of my skincare routine stayed the same. I tried it for three months and saw no improvement so I switched back.

My point in this is that if you try one and you don’t see improvement, don’t give up. Keep trying because everyone reacts differently to medications. 

Many people I have talked with have a hard time remembering to take the medication. I am super type A and have to take thyroid medication as well so remembering to take a pill daily isn’t a challenge for me. I just put them all in a weekly pill box and every morning when my alarm goes off that’s the first thing I do. 

When I have patients in the ER that mention having a hard time remembering to take their medication,  I recommend they attach it to something they do every single day to create a habit. For example: you brush your teeth every morning (hopefully) so put the pill by your toothbrush so that you take it every day at the same time. 

I know this was alot of information, but don’t feel like you need to know all the things. My main goal was to let you know that there are options and that just because one thing doesn’t work doesn’t mean something else wont. The more educated people are about their health and options, the better decisions they can make.

RECAP

• Almost all acne is “hormonal” that occurs after puberty.
• Birth control pills can be a great way to decrease breakouts. 
• Estrogen decreases acne
• Progesterone (can) increase acne. However, some are less likely than others. 
• Just because one pill doesn’t work doesn’t mean they all don’t. 
• Spironolactone can be a great add on to birth control pills
• IUDs can increase acne. Make sure you have a serious discussion with your provider before having one placed. 

As always, I’m here to help if you have any questions. Use the contact form here so I can assist you in looking your best self! Thanks for stopping by!