The best treatment for women with adult and hormonal acne

How common is hormonal acne?

If you're dealing with hormonal acne, you are not alone! Hormonal acne is very common, particularly for women in their 20s and 30s. Data show that up to 50% of women in their 20s and 30s suffering from adult acne have some hormonal factor influencing their breakouts.

How to determine if acne is hormonal

There are two typical signs that help determine if your acne is hormonal in nature. The first is by the areas it appears on your face, and second is the timing of breakouts. Read below to learn more!

Where is hormonal acne typically located on the face?

Woman with cystic hormonal acne on chin and jawline due to hormonal imbalance

While typical teenage acne appears most of the forehead and cheeks, the most common areas for hormonal acne to pop up are on the lower sections of the face, including around the mouth, on the jawline, and on the neck.

When are hormonal acne breakouts expected?

The most typical sign of hormonal acne is its connection to the monthly hormonal cycle. Some women experience breakouts during ovulation (mid-cycle), while others have pimples pop up before or during menstruation—2 times in the month when there are significant hormonal changes. During ovulation, higher levels of progesterone stimulate oil glands and rev up the production of sebum, which can cause pores to get clogged. During pre-menstruation, estrogen and progesterone levels drop, causing even higher levels of the production of sebum, often causing more inflamed breakouts.

For women with a hormonal imbalance, these normal hormonal fluctuations are often exaggerated, causing more significant changes in skin's behavior and, ultimately, more numerous, severe, and inflamed breakouts.

How do birth control pills work?

Certain types of birth control can help some women improve their acne by helping to regulate preexisting hormone imbalances. Others, however, can have the opposite effect and make acne worse! Below is your guide to choosing the right birth control to help with acne. Birth control pills work by temporarily changing the hormonal balance in your body. These pills contain a different combination of estrogen and progesterone. Some birth control pills only contain progestin, the synthetic form of progesterone.

What are the best birth control options for women with hormonal acne?

Birth control pills, IUDs, implants can all potentially benefit some women with acne. Unfortunately, they do not have the same effect across the board, and some birth controls that work well for certain women can be the worst nightmare for others.

There are certain birth control pills that tend to affect the hormonal balance in a way that typically reduces breakouts, while other pills or IUDs tend to have the opposite and make acne worse. This effect typically depends on the dose of progesterone in the pills or IUD. As a rule of thumb, birth control that contains a higher level of progesterone will have a stronger androgenic effect and have a higher risk of promoting acne breakouts.

The best birth control pills for women with Acne are pills that contain drospirenone and ethinyl estradiol. Examples for these types of pills are Yasmin, Yaz, Beyaz, Ocella, Safyral, Syeda, Gianvi, Loryna, Nikki, Vestura, Zarah.

What are the risks of taking birth control pills?

While birth control pills may seem like an easy go-to option for treating hormonal acne, there are some risks associated with hormonal birth control pills including increased risk of blood clots, weight gain, nausea, mood changes, and breast tenderness. These are potentially serious side effects that need to be considered before starting or inserting birth control and monitored over time. If significant side effects occur, it may be a good idea to consult your physician about a different birth control option,

What are the best birth control pills for hormonal acne?

The best birth control pills for women with acne typically contain at least 35 mcg (.035 mg) of Ethinyl Estradiol and progestin with a low androgenic effect.
A study recently published in the Journal of Drugs in Dermatology categorized the different types of contraceptives by their efficiency in clearing acne. We found the study super interesting, so we just had to share the findings with you!

In addition to the contraceptive element, birth control pills can provide additional benefits such as reduction of acne breakouts, lighter and more regular periods, fewer menstrual cramps, and a reduced risk of certain cancers, including ovarian, uterine, and colon cancers.

The U.S. Food and Drug Administration (FDA) has formally approved a handful of brands of birth control for the treatment of acne:

  1. Beyaz: a combination of drospirenone, ethinyl estradiol, and levomefolate calcium
  2. Estrostep Fe: a combination of which s norethindrone acetate, ethinyl estradiol, and ferrous fumarate
  3. Ortho Tri-Cyclen: norgestimate and ethinyl estradiol
  4. Yaz: drospirenone and ethinyl estradiol

Having said that, many other birth control pills could help with adult acne including, Ocella, Yasmin, Trinessat, MonoNessa, Apri, and Reclipse. As mentioned above, some of these medications come with additional risks and side effects that should be considered before starting.

Birth control pills and IUDs that usually have little or no effect on acne

The paraguard, a vaginal implant used for contraception has little to no effect on acne

For some women, a preferred form of contraceptive birth control may be one that has little or no effect on hormones and acne. Some options in that category include the Nuvaring (a vaginal plastic ring that releases smaller amounts of estrogen and progesterone after being placed near the cervix), Microgestin (pill), and Orthoevra (patch). Paragard/Copper IUD does not contain any hormones and will usually not make acne better or worse.

Birth control pills and IUDs that can cause acne

There are several contraceptive options that are known to exacerbate or trigger acne in some women as they are higher in progestin (i.e. they increase testosterone-like activity) and low in estrogen. These include Depo-Provera (a shot), Skyla, Lylema, Implanon, and Nexplanon (a subdermal implant).

Is there a way to balance hormones without birth control?

There are several medications besides birth control that can help balance hormones and effectively treat acne. One of the most effective is called, Spironolactone (Aldactone), an oral medication that was originally used for the treatment of high blood pressure that was found to help with hormonal acne. Interestingly, Spironolactone does not contain hormones or synthetic hormones. It's actually a diuretic that also works as an androgen blocker, which means it blocks the effects of male hormones in the body like testosterone, which contribute to oil production and, ultimately, acne.

DIM - Best natural supplements to balance your hormones and help with adult acne

The DIM + cruciferous supplement is an excellent addition to the treatment of women that feel that their breakouts are influenced by the monthly cycle and women that have pimples on the lower parts of the face (chin and jawline). They contain a natural extract of cruciferous vegetables (kale, broccoli, alfalfa, and spinach) specially formulated to help balance hormones and reduce signs of acne in adult women. Check this link for more detailed info on the MDacne DIM supplements.

So, what birth control should you use if you have acne?

Though there are certain guidelines you can follow above when considering birth control and acne. If you struggle with acne, it's recommended that you choose an option known to help balance acne-producing hormones or at least, one that is known to have little or no effect on acne. This category includes a variety of options from hormonal pills to vaginal implants, to patches and others. Before consulting with your OB/GYN read through the above and create a list of questions and concerns to help you both identify the best birth control choice for you! As always, monitor any symptoms or side effects and discuss them with your provider. Sometimes it takes trying a couple (or few...) different birth control options to find a good fit.

More info:

DIM - Best natural supplements to balance your hormones and help with adult acne
Effect of birth control pills on acne in women
Spironolactone for Acne – read this first!

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