How contraception affects our skin and hair

19 April, 2022

Birth Control Pills - Acne Treatment And Hair Loss Treatment?

Have you ever noticed that a friend’s skin cleared after using contraception? Combined oral contraceptive pills (COCP, or more commonly, just “birth control pills”) can be used for more than just preventing pregnancy. Oral contraception is widely used to treat and control acne. Doctors have been prescribing pills to women with problematic hormonal acne for decades, and the FDA even recommends three specific birth control pills for women suffering from acne.

On the other hand, there is also a persistent belief that birth control pills can cause acne - a belief supported by some anecdotal cases. The relationship between birth control pills and acne can be confusing. After all, hormones are very complicated. Fortunately, with little explanation, it is easy to understand the role that oral birth control plays in the control, treatment, and management of acne.

Below we have explained how birth control pills can function as an acne treatment, as well as whether contraception can cause acne. We also reviewed the types of contraception most commonly used for acne, as well as the difference between oral contraceptives and other acne treatments.

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So, do birth control pills cause acne?

Generally speaking, no. Acne is usually caused by high levels of androgens - male hormones that can stimulate sebum production and clog hair follicles. Higher androgen levels (more precisely, testosterone) mean more sebum, which in turn usually leads to more acne.

Most birth control pills contain estrogen and progesterone - two female hormones that are not directly responsible for acne. In fact, these hormones can work together to reduce the risk of regular acne by balancing the effects of excess androgens. In short, not only do birth control pills not cause acne - they are very effective in prevention in the long run.

So where does the belief that birth control pills cause acne come from? Part of this belief is due to the natural changes in hormones that can occur during your menstrual cycle, and the other part comes from the sudden changes in hormones that can occur with birth control pills.

First, let’s start the menstrual cycle and its effect on hormones. During the month, the amount of androgens (male sex hormones) and estrogen (female sex hormones) produced by your body will vary. You will generally reach your highest androgen levels in the week before your period as well as during your period. During your period, your estrogen will also increase, while the level of progesterone in your body will reach its lowest point. In short, your period and the days that precede it are when you will have the highest concentration of androgens circulating in your body. This can lead to a sudden increase in acne, which is usually called hormonal acne breakouts. Guides for hormonal acne and the androgens that cause acne explain the hormonal side of acne over time, as well as what you can do to control them.

If you have just switched to oral contraception, it is easy to assume that this outbreak is caused by your birth control pill. This is very unlikely. Instead, they are much more likely to be caused by regular fluctuations in hormones that your new contraceptive has not yet been able to prevent.

However, there is one caveat to this rule. Progestin-only birth control pills, commonly known as "mini-pills," do not contain estrogen. Although rare, these birth control pills can cause androgen levels to fluctuate, resulting in an increase in hormonal acne.

How do birth control pills work to treat acne?

Doctors have been prescribing birth control pills as an anti-acne medication for decades, and the FDA even recommends several oral contraceptives as anti-acne medications, as well as for the purpose of preventing pregnancy.

The way the birth control pill works as an acne medication is simple. As a woman, your body produces a small amount of androgenic hormones like testosterone. These hormones are essential for optimal well-being and health. For example, testosterone plays a role in everything from muscle and bone health, to sex drive.

The pill contains the same hormones that your body makes, called estrogen and progestin, only in different amounts, so it can override your body’s signals to release an egg (or ovulation). Consequently, it also lowers testosterone levels in your body, which in turn can reduce acne. Testosterone is a male hormone that, as we already know, increases our oil production. Oils give birth to bacteria, and bacteria lead to breakthroughs. So, the theory is that if testosterone drops, so does acne. Testosterone regulates the amount of sebum produced by your skin. When your adrenal glands and ovaries produce too much testosterone, your skin can become overly oily, resulting in a more serious and frequent outbreak of acne.

Simply put, the higher your levels of testosterone and other androgens, the more likely you are to have acne in the days leading up to your period. Estrogen and progesterone in oral contraceptives reduce the amount of androgens in your body. Lower testosterone levels mean less sebum production, which means less risk of hormonal acne.

It would be said that 90% of girls ’skin problems dramatically improve or completely resolve within six months of starting taking the pill. But it's not exactly a momentary pleasure. The handy part is that sometimes a flare-up occurs before suppression occurs, which can temporarily worsen acne before it improves. Sometimes the onset occurs because the progestin of some pills can have a pseudo-testosterone effect, which can cause a sudden breakout.

A good rule? Wait a few months before deciding if your birth control pill is bad news. Then, if your skin is still irritated, talk to your doctor about trying another. Girls may react differently to the same pill, 90 days is a good general measure of hormonal normalization.

Finally, just remember: it’s science, not magic. So while birth control pills will help reduce acne, this is not your golden card for abandoning facial and stain treatment. It usually breaks occur during or just before menstruation, or when hormone levels change due to dropping or taking a pill. It is important to be especially careful in your routine at that time.

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Using birth control pills as an acne treatment

If you have persistent hormonal acne, using a birth control pill as an acne medication can be a safe, effective way to keep it under control. As with anything related to contraception, the best approach is to talk to your doctor about using oral contraceptives for acne. Your doctor will be able to recommend the best birth control pill for you based on your needs, the severity of your acne, and your medical history.

Because each birth control pill uses a different progestin, far from rare cases there is a small difference in results between birth control pills. It is also normal for acne to start disappearing a few months after you start using contraception - it usually takes about three months to clear up.

If you have severe acne or do not respond to contraception, your doctor may also recommend the use of retinoids or antibiotics. These medications stop acne by different mechanisms than contraception and can often achieve better results when used together. Over the course of a few months, you and your doctor will be able to “call” your contraceptive use, as well as other medications, helping you to control your acne.

What research says about different types of contraception and skin / hair

Progestin-only contraceptives

Implant (eg Nexplanon, Jadelle):

The Nexplanon implant contains a progestin called etonogestrel. An analysis of 942 people who used the etonogestrel implant for an average of two years found that 12% reported acne, but only about 1% stopped using the implant because of this side effect. In a study conducted in Chile where etonogestrel implant users were asked about acne before starting implants and then during their use, 13% reported new or worsened acne during the first two years of use, but the same number of people reported that acne improved during use of implants.

The Jadelle implant uses the progestin levonorgestrel. In a study of 594 people who used this implant over five years, five people stopped using it because of acne, four because of hair loss, two because of other hair problems like hirsutism or coarse hair, and four were removed because of “other skin problems". This study did not report the number of participants who had a side effect, but continued with the implant.

Hormone spiral with a higher dose (eg Mirena, Liletta):

The hormone spiral contains the progestin levonorgestrel. In a study of more than 17,000 people using a hormone spiral in Finland, 35% of respondents reported acne, 16% said they were losing hair from their scalp, and 17% reported “excessive hairiness” on their body. All of these side effects were most common in people under the age of 33 and decreased with age.

One study found that people who used a hormonal IUD had more pustules than acne after using contraception for a year compared to people who used a non-hormonal, copper IUD. The difference between these groups was small, so it is unknown whether the participants felt the impact.

Hormonal IUDs with lower doses (e.g. Kyleena, Jaydess, Skyla):

IUDs also contain the progestin levonorgestrel, but in lower doses than Mirena and Liletta.

During a three-year study conducted in North America, South America, and Europe, acne that was likely associated with hormonal IUD use was found in 10% of people who used any of the lower-dose hormonal IUDs.

In another study of a population of mostly Asian participants who used Jaydess for three years, acne was noted in only about 3% of participants, but about half of those who reported acne had the implant removed because of it.

Injection (e.g. Depo-Provera):

In a study of 536 people who used Depo injection, side effects affecting the skin and hair were common. For people who first started using the injection, 8% reported acne or other skin problems after 3 months, and that number increased to 14% after 9 months. In the same group, up to 11% of Depo users reported hair loss during the first 9 months of use, and up to 3% said facial hair was a side effect.

In another study, 6% of people developed facial hair growth after using an injection for six months, compared with 1% of people who used non-hormonal birth control methods.

Combined hormonal contraceptives (estrogen and progestin)

Tablets (various brands):

An analysis of 31 different studies has shown that the pill is effective in treating acne, but less is known about how specific pills compare in their ability to improve acne.

Ten studies compared birth control pills with placebo. Nine out of ten found that the pill was effective in improving acne, and one in ten did not have enough data to include them in the analysis. Tablets containing antiandrogenic progestins can improve acne more than tablets with androgenic progestins.

Combined oral contraceptive pills are recommended as an initial treatment for people who have hirsutism (excess, unwanted body hair) and who are not trying to get pregnant. The tablet is effective in treating mild hirsutism, but may take six to 12 months to show improvement and may need to be combined with other medications or treatments. Tablets containing antiandrogens, progestins, drospirenone and cyproterone acetate may be better than other forms of progestins in improving hirsutism, but the Endocrine Society does not recommend certain tablets.

In a small study, 31 people with oily hair received birth control pills containing the progestin chlormadinone for one year. Participants reported that their hair was less greasy and in better condition after three months, and this improvement continued throughout the year. The researchers also rated participants ’hair thicker with less dandruff and irritation after a year. This contraceptive pill formulation is available throughout Europe.

People who used contraceptive pills containing the progestin desogestrel were less likely to develop hair loss than people who used non-hormonal methods of contraception such as abstinence, condoms, or surgery in a two-year study. Birth control pills - often in combination with other medications - can be prescribed to stop progressive hair loss in people who have androgen-related hair loss.

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Who should avoid birth control pills

The decision to take birth control pills must take into account your medical history. Certain health conditions can get worse if you use oral contraceptives. Birth control pills are not usually recommended if you have any of the following conditions:

History of heart disease, hypertension, blood clots in the legs or lungs
Blood clotting disorder
History of cancer, especially breast, uterine or liver cancer
Liver disease, diabetes or migraine headaches

You should also not take oral contraceptives if:

You have been a smoker for over 30 years
You are currently pregnant or breastfeeding
You are severely obese or physically immobilized

Method selection

It is important to talk to your doctor to determine the safest and best for you. Before you start using the method of contraception, ask your doctor questions and share your concerns about possible side effects so you can decide together what is best for you. If you experience side effects with the contraceptive method, you may need to advocate for yourself to make sure your healthcare provider takes your concerns seriously.