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
Two typical signs help determine if your acne is hormonal in nature. The first is by the areas it appears on your face, and the second is the timing of breakouts. Read below to learn more!
Where is hormonal acne typically located on the face?
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, jawline, and 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 acne flare-ups 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. Higher progesterone levels stimulate oil glands during ovulation and rev up sebum production, causing pores to get clogged. Estrogen and progesterone hormone levels drop during pre-menstruation, causing even higher sebum production levels, often causing more inflamed breakouts.
These normal hormonal fluctuations are often exaggerated for women with a hormonal imbalance, causing more significant skin behavior changes and, ultimately, more numerous, severe, and inflamed breakouts.
What is the best treatment for women with hormonal acne?
The best treatment for women with hormonal and adult acne would be a combination of effective medical-grade topical anti-acne medications and oral therapy. The topical over-the-counter treatment options will usually be benzoyl peroxide, salicylic acid, retinol or niacinamide, oral treatment, birth control pills, spironolactone, or non-hormonal supplements (DIM). The topical medications will help unclog skin pores, reduce inflammation, and kill the acne bacteria, while the oral treatment will help balance the hormones.
How do birth control pills work?
Certain birth control types can help some women improve their acne by regulating 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.
Certain birth control pills 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.
What is the effect of combined oral contraceptives (combination pills) on acne?
Combined oral contraceptives (COCs) are birth control pills that include both estrogen and a type of progesterone(progestin). Combinations of both estrogen and progestins can help with hormonal acne through inhibition of androgen production. The reduction of androgen production will reduce the blackheads, whiteheads, and inflamed red pimples typical to acne.
The estrogen that is used in birth control pills is almost always Ethinyl estradiol and rarely mestranol. The usual amount is 20–50 µg.
Estrogen effect provides some anti-androgenic effect through 3 mechanisms:
1. Suppress secretion of pituitary gonadotropins, inhibit ovulation, and thus inhibit androgen production by the ovaries.
2. Block the Androgen receptors
3. Increase the liver production of SHBG and reducing circulating testosterone.
The choice of progestin in birth control pills is essential for women with acne-prone skin. Women with acne need to avoid taking progestins with potent androgenic (acne-causing) effects, i.e., levonorgestrel and norgestrel. A better choice of progestins for women with acne would be drospirenone, norgestimate, gestodene, and desogestrel with a weaker androgenic effect.
The best birth control pills for women with Acne are pills that contain drospirenone and Ethinylestradiol. Examples of these pills are Yasmin, Yaz, Beyaz, Ocella, Safyral, Syeda, Gianvi, Loryna, Nikki, Vestura, and 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 recent study in the Journal of Drugs in Dermatology categorized the different contraceptive types by their efficiency in clearing acne. We found the study super interesting, so we just had to share the findings with you!
According to this study, drospirenone (the progestin found in Yaz) was the most helpful in preventing acne, while levonorgestrel and norethindrone (the progestins found in Levora and Lo Minastrin Fe, respectively) were the least helpful.
The U.S. Food and Drug Administration (FDA) has formally approved a handful of brands of birth control for the treatment of acne:
- Beyaz: a combination of drospirenone, Ethinyl estradiol, and levomefolate calcium
- Estrostep Fe: a combination of which s norethindrone acetate, Ethinylestradiol, and ferrous fumarate
- Ortho Tri-Cyclen: norgestimate and Ethinyl estradiol
- 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
A preferred form of contraceptive birth control may have little or no effect on hormones and acne for some women. 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
Lo Loestrin was found to cause more acne breakouts. Several other contraceptive options 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).
Should I use mini-pills for my acne?
There are 2 types of oral contraceptives: combination pills (which contain estrogen and progestin) and mini-pills (which include only progestin). As the estrogen part of the pill is essential to reduce the androgen effects, mini pills are not FDA approved for acne treatment and should be used by women with acne-prone skin.
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 used to treat high blood pressure found to help with hormonal acne. Interestingly, Spironolactone does not contain hormones or synthetic hormones. It's actually a diuretic that works as an androgen blocker, which means it blocks the effects of male hormones in the body like testosterone, contributing 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 who feel that their breakouts are influenced by the monthly cycle and women with 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 acne signs 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 the 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 various options, from hormonal pills to vaginal implants, 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 a few...) different birth control options to find a good fit.
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