These are just some of the top search terms Google throws up about the oral contraceptive Pill. Clearly, we have a lot of unanswered questions, and none more so than the connection between the Pill and our skin.
Can I take The Pill continuosly to skip my period, and is it safe?
The right doctor and the right contraception. Harder than you think
What should I know about taking The Pill as someone under 18
Whether we breakout right before our period or are battle painful cystic acne into adulthood, finding the right acne treatment for our skin can be a challenge. Although hormonal treatments (such as using certain types of the Pill) can work wonders for some women, for others it can even make our acne worse.
So, what role does the Pill play in treating acne? What different types of acne exist? And, most importantly, why doesn’t the Pill cure acne for everyone?
Most of us will experience acne at some point in our lives, making it one of the most common skin conditions. In fact, it’s estimated 85% of Australians aged 15-24 years old will experience acne.
The occasional pimple or breakout can be frustrating, but consistent and painful acne is more disruptive than that. So, what causes this condition to occur?
Typically, acne is caused by blockages in sebaceous glands close to the surface of our skin. These tiny glands are near our hair follicles and work to lubricate the hair through 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. 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.
● Our weight
● Our lifestyle and activity levels
● Being pregnant
● Having an underlying condition, such as polycystic ovarian syndrome
Acne is most common during adolescence (when our hormones are going haywire). Although teenage boys experience bouts of acne due to higher levels of male androgens, women and teenage girls often experience acne in sync with their cycle. This comes back to changes in our hormone levels, with varying levels of estrogen shown to increase the chance of blockages and inflamed pores.
Despite all being caused by blocked pores, not all breakouts are the same. In fact, acne fits into two 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 dermatologist is often necessary to find the right oral prescription to suit your situation.
Another key type of acne is hormonal acne: breakouts 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. In many cases, 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 hormonal breakouts.
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.
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. But there is a range of factors that can cause adult acne including stress, anxiety, lack of sleep, lifestyle factors, and even some medications (including 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). However, some adult acne presents as milder forms of blackheads, whiteheads or papules.
The hormones contained in the Pill can play a role in reducing acne. Particularly for those suffering from hormonal acne, the Pill can lower the circulation of androgens which also decreases the production of sebum (a.k.a. oil production on the skin). Less oil can mean less acne for some women.
However, effective acne reduction is only seen with types of contraception that contain a combination of both estrogen and progestin. That means the minipill (which contains only progestin) won’t have an impact on improving acne.
For those of us who experience breakouts in sync with our cycle, the Pill can be an effective acne 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 stabilises the hormone levels in the body). In most cases, it will take a few months to see the full impacts so it’s important to be patient.
When it comes to combined oral contraceptive pills, the research suggests there aren’t big differences in effectiveness between different types of the Pill. 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.
After comparing the results across 12,579 participants, the review found 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.
And that brings us to the important conundrum: why doesn’t the Pill work 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 GP to understand the root cause of the acne. In some cases, the Pill can actually cause acne (as certain formulas can contain acne-causing strains of the hormone progestin).
It’s important to speak with your GP to 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.
Although the Pill might be an effective acne treatment for some, it isn’t a cure-all for every woman. It might be a process of trial-and-error for a number of different treatment methods before finding the solution. So, make sure to speak with your doctor to find the right treatment plan to suit your skin.