Birth control for acne: Does it work?

Does the pill make you moody? Does it make you put on weight? Or help with acne?

These are just some of the most commonly googled queries about the oral contraceptive pill, and one thing is clear: we have a lot of unanswered questions, and none more so than the connection between the pill and our skin.

Whether we break out right before our period or battle painful cystic acne into adulthood, finding the right acne treatment for our skin can be a challenge. And although hormonal treatments — like using certain types of birth control pills — can work wonders for some women, for others it can have the complete opposite effect.

So, what role does the pill play in treating acne and why doesn't it work for everyone? Let us explain.

What causes acne?

Most of us will get acne at some point in our lives, making it one of the most common skincare conditions. In fact, it’s estimated that 85% of Australians aged 15-24 years old will experience acne [1].

While the occasional pimple or breakout can be frustrating, consistent and painful acne is more disruptive than that — so, what causes it?

Typically, acne is caused by blockages in sebaceous glands close to the surface of our skin [2]. These tiny glands are near our hair follicles and work to lubricate the hair by producing an oily substance called sebum. If these tiny holes become blocked, they can cause whiteheads, blackheads, or even cysts if infected by bacteria on the skin.

Blockages are typically caused by dead skin cells and sebum and can build up in our pores to create plugs [1]. Our hormones have a big role to play in the skin’s production of oil, which has caused many sufferers to turn to hormonal birth control as an acne solution — and we'll expand on that shortly.

Common causes of acne include:

• Genetics
• Stress
• Diet
• Weight
• Lifestyle and activity levels
• Pregnancy
• Having an underlying condition, such as polycystic ovarian syndrome (PCOS)

Are all types of acne the same?

Despite all being caused by blocked pores, not all breakouts are the same [3]. In fact, acne fits into 2 broad categories: non-inflammatory and inflammatory.

As the name would suggest, inflamed acne causes red, swollen, and deeply-clogged pores that are infected by bacteria, often painful and hard to get rid of. In contrast, non-inflammatory acne is closer to the skin’s surface, doesn’t cause swelling, and isn’t infected by bacteria (usually presenting as whiteheads or blackheads).

Identifying which type of acne you have is the first step towards finding a successful treatment.

In the case of mild non-inflammatory acne, over-the-counter topical treatments are often effective, such as products containing salicylic acid or benzoyl peroxide. For more severe cases of inflamed acne, speaking with a practitioner is often necessary to find a suitable prescription treatment.

Additionally, acne can also be hormonal, meaning the breakouts are tied to changes in our hormones.

This type of acne usually presents on the bottom of the face around the lower cheeks or jawline and takes a variety of forms depending on severity. Often, hormonal acne causes cystic bumps under the skin that can’t be reached by over-the-counter topical medications.

In these cases, hormonal treatments (such as the oral contraceptive pill) are commonly recommended to rebalance the body’s hormones and reduce breakouts.

What’s the deal with adult acne?

Acne might be most common during our teenage years, but many of us still battle pimples well into our 20s and beyond. For those of us navigating adult acne (acne that continues after the age of 25), the condition can cause a major hit to our mood and self-confidence [4][5].

Women are more likely to encounter adult acne than men, which leads researchers to believe that hormonal changes linked with our menstrual cycle have an important role to play in causing adult acne [2]. But there is a range of other factors that can cause it as well, including stress, anxiety, lack of sleep, lifestyle factors, and even some medications (such as certain corticosteroids, antidepressants, and epilepsy treatments).

In more severe cases, adult acne presents as a type of inflammatory acne that causes redness, swelling, irritation, and deep cysts that can lead to scarring of the skin over time. In other cases, it can present as milder forms of blackheads, whiteheads or papules.

Why does the pill reduce acne for some women?

The hormones contained in the birth control pill can play a role in reducing acne.

Particularly for those suffering from hormonal acne, the pill can lower the circulation of androgens and decrease the production of sebum, which for some women, can mean fewer breakouts.

However, effective acne reduction is only seen with types of birth control that contain a combination of both oestrogen and progestin, also known as combined oral contraceptives. That means the mini pill — which contains only progestin — doesn't improve acne.

For those of us who experience breakouts in sync with our cycle, the pill can be a particularly effective treatment.

When looking for acne-fighting pill prescriptions, your doctor should recommend a pill variation that contains progestin with a low androgenic possibility, which helps to stabilise the hormone levels in the body [6]. Bear in mind that in most cases, it takes a few months to see the full impacts so it’s important to be patient.

If you're keen to start using the pill as an acne treatment, you'll love how convenient Kin's pill subscription is. It includes free and fast delivery of your contraception to your door 2 weeks before you run out (or earlier if you prefer).

Signing up is easy: simply complete a digital consult with our Aussie practitioners and you'll have your pill in no time — no trips to the doctor's office or chemist needed.

What type of pill is most effective in treating acne?

When it comes to combined oral contraceptive pills, the research suggests there aren’t big differences in effectiveness between different types. Some of the most comprehensive research on hand is a 2012 review by Cochrane Review, which looked at 31 trials of birth control as a means of acne treatment [7].

After comparing the results among 12,579 participants, the review found that there were no significant differences in acne reduction across various types of the combined pill.

Although there is some evidence suggesting pills containing drospirenone were more effective in acne reduction, the impacts weren’t significant enough to cause doctors to favour one type over another [8].

Why doesn’t the pill work as an acne treatment for everyone?

It all comes down to the type of acne you have and the factors causing these breakouts to occur.

For those who haven’t noticed an improvement in their skin after 3 months of using the oral contraceptive pill, it’s important to speak with your practitioner to understand what's triggering the acne. In some cases, the pill can actually be the trigger, as certain formulas can contain acne-causing strains of progestin.

Speaking with your healthcare provider will also help you rule out any underlying conditions that may be causing breakouts to still occur while on the pill, such as polycystic ovarian syndrome (PCOS). If there is another condition at play, topical products and even hormonal treatments often won’t work effectively in resolving acne.

While the pill might work to clear acne for some people, it's not a one-size-fits-all treatment. It might be a process of trial and error before you find the right solution for you, but trust the process and you'll get there.

How to treat acne without the pill

If you're looking for a reliable way to combat acne that doesn't involve the contraceptive pill, Software's personalised acne treatment is worth exploring.

Software is a prescription skincare company that creates formulas based on your skin needs and goals. Simply upload selfies and share your skin concerns and an Australian practitioner will create a prescription for you based on this information. A Software pharmacist will then create your custom bottle and ship it straight to your home.

While the ingredients used within each formula vary depending on your individual needs, you can expect to see medical-grade ingredients like prescription retinoids to clear acne, reduce redness, and increase skin firmness, as well as niacinamide to strengthen the skin barrier, and hyaluronic acid to hydrate and plump the skin.