Oral contraceptives for Acne

Oral contraceptives estrogen and progesterone are often used in the treatment of acne.   Oral contraceptives for acne are usually prescribed to women who suffer from adult acne. These pills can be used for long-term treatment and they help suppress overactive sebaceous glands  as they decrease testosterone levels. In fact studies have shown a dramatic 30%-60% decrease in acne lesions in women on oral contraceptives.

How should oral contraceptives be used?

Oral contraceptives contain estrogen and progesterone – both of which are female sex hormones. They usually come in tablet form that has to be swallowed every day. Sometimes they cause nausea, so doctors may recommend that you take them with milk or food. Oral contraceptives must be taken at the same time each day and instructions given by the doctor or mentioned on the label must be carefully followed. There are different brands of these pills available. Your dermatologist will give you the right oral contraceptives for acne.

Benefits of oral contraceptives for acne

Hormonal therapies offer very effective acne treatment for adult women. Many adult women over the age of 20 (50%) suffer from acne. There is no cure for acne but there are certain hormonal therapies that can fight this condition. In this age group of women, the male hormone testosterone can increase due to menopause, during and after their periods and such. These increase acne outbreaks due to the increase in oil production by the sebaceous glands. Oral contraceptives like other hormonal therapies check the production of testosterone therefore controlling acne outbreaks. A combination of three oral contraceptives maybe given to treat acne. Doctors will carefully screen women before recommending the actual combination

All oral contraceptives for acne must contain estrogen and progesterone. Since there is a direct correlation between hormones and acne, taking oral contraceptives can help healthy women follow birth control and fight acne at the same time. Hence oral contraceptives for acne serve a dual purpose. The three approved oral contraceptives for acne are Estrostep, Yaz and Ortho Tri-Cyclen. All three contain the same type of estrogen and each uses a different type of progesterone.

Oral contraceptives are used to treat mid to severe acne outbreaks. They reduce acne flare-ups, decrease the number of pimples and reduce inflammatory conditions.

Limitations and Side Effects

Progesterone alone can worsen acne outbreaks and it must always be combined with estrogen. Only 3 types of oral contraceptives have been approved for acne treatment by the USFDA. Oral contraceptives for acne can only be prescribed to women over the age of 15, have already begun to menstruate and need to use contraception. These pills must be taken for a few months before skin begins to clear. They work only on one cause of acne outbreaks – sebum production. Hence, they cannot be used as stand alone treatment but in combination with oral antibiotics and topical medications if the outbreaks are severe. Birth control pills can produce many side effects and hence they must be taken with caution and only given by a certified dermatologist. 

Side effects

Oral contraceptives can cause many different side effects and these must be carefully monitored and reported to the doctor at once. Some of these are:

  • Possible Minor side effects (these must be reported if they become severe and do not go away)Oral Contraceptives for acne

    • Nausea and vomiting
    • Diarrhea
    • Bloating and cramps in the stomach
    • Gingivitis
    • Constipation
    • Weight loss or gain
    • Loss of appetite
    • Abnormal hair growth
    • Increased acne outbreaks
    • Changes in menstrual flow, spotting or bleeding between cycles
    • Missed periods
    • Painful periods
    • Tenderness, discharge or unusual enlargement of breasts
    • Vaginal itching, burning, redness or swelling
    • White discharge from the vagina
  • Possible Serious side effects

    • Heart attack
    • Stroke
    • Blood clots in the lungs or legs
    • Hypertension
    • Gallbladder or liver disease
    • Migraine headaches
    • Mood swings
    • Depression
    • Impaired speech
    • Dizziness
    • Fainting spells
    • Coughing blood
    • Leg pain
    • Loss of vision (partial or complete)
    • Severe chest pain that feels crushing
    • Chest heaviness
    • Numb feeling in the legs or arms

When initial side effects become serious and persist – e.g. excessive tiredness or nausea etc., these symptoms must be reported at once. Oral contraceptives also increase the risk of developing liver tumors, liver or breast cancer, strokes or heart attacks.

Precautions

A very critical precaution to follow is that women who take oral contraceptives must not smoke. If they do, it can cause serious consequences like blood clots, strokes and heart attacks. The risk is higher in women over 35 who are heavy smokers. Do not share your medication with anyone else without a prescription.

Women who suffer from V Leiden deficiency that is a blood clotting disorder, have a history of hypertension, heart disease or breast, liver or uterine cancer, diabetes, liver disease and migraines must not take oral contraceptives. Those who are presently pregnant or nursing babies or are physically impaired or severely obese are also not candidates for oral contraceptives.

If you are allergic to progestin or estrogen you must inform your doctor. Your doctor must be made aware of all medical conditions you suffer from – e.g. blood clots, coronary artery disease, strokes, irregular heart beat, cancers, tumors, diabetes, chest pain, depression, seizures etc. All breast problems you have suffered from – lumps, cancer, abnormal mammogram, fibrocystic breast disease must all be reported. Patients, who experience changes in vision, miss periods while on contraceptives or need any surgery must inform the concerned doctors that they are on oral contraceptives.

No special diet needs to be followed when taking oral contraceptives. If you miss a dose of these pills when they are being taken for acne treatment, then take the next dose without fail. The levels of folate in the body could decrease when taking oral contraceptives. In this case, your doctor could recommend a supplement. 

Drug interaction

Give a list of all medications, vitamins, supplements, herbal medications etc. that you maybe taking. Your doctor must know this for some medications (E.g. acetaminophen, antibiotics) can react adversely with oral contraceptives for acne. 

Storage

Oral contraceptives must be kept in their original packaging and out of children’s reach. It must be kept away from moisture and heat and at room temperature. All medication that is not being used or is past the expiry date must be disposed off.

Summary

Oral contraceptives for acne are effective treatment options when used with other acne medications. Follow all instructions carefully and report side effects to your doctor immediately.