The contraceptive pill and acne

The main reason acne develops is because the male sex hormone androgen is made in larger amounts during puberty – in girls too. Inflammatory and non-inflammatory acne can improve in girls and women who use contraceptive pills as birth control. The pills that help against acne have the female sex hormones estrogen and progestin in them. But most contraceptive pills haven't been specifically approved for the treatment of acne. There are also non-hormonal treatments which can help against acne, some of which have fewer side effects.

The frequency and severity of side effects are influenced by the dose of hormones in the birth control pills. But possible side effects might still play an important role when deciding which pill to use. So it's good to know whether certain pills reduce acne more effectively than others and what side effects they have.

Research has only found small differences in the effect on acne

Researchers from the Cochrane Collaboration – an international research network – took a look at the effectiveness of birth control pills in the treatment of acne. They did a search for studies comparing the pill with a fake drug (placebo) or a non-hormonal acne medication. The researchers analyzed 31 studies involving a total of about 12,500 participants. Most of the studies compared different contraceptive pills with each other or with a placebo. Hardly any of the studies compared the pill with other acne medications.

All of the birth control pills tested were able to improve acne. They reduced both inflammatory and non-inflammatory acne. The pills often had to be taken for several weeks or months before the participants’ skin got better. The birth control pills that reduced acne had ethinyl estradiol in them, combined with one of the following drugs: levonorgestrel, norethindrone, norgestimate, drospirenone, cyproterone acetate, chlormadinone acetate, dienogest or desogestrel.

The studies showed that most of the pills had a similar positive effect on acne. Some medications did a little better than others in individual studies. But further studies are needed in order to be able to say whether they are actually more effective. In one study, pills that had cyproterone acetate in them were found to help reduce acne somewhat better than pills that had levonorgestrel in them. Another study found pills that contained chlormadinone acetate to be more effective than those with levonorgestrel. Cyproterone acetate isn't approved for contraception in Germany, but it can be prescribed for the treatment of acne. None of the other studies found any of the pills to be better or worse than others. So any claims that a certain pill will lead to much better skin than others pills should be taken with caution.

Risk of deep vein thrombosis depends on the type of pill

Contraceptive pills can have side effects such as headaches, breast tenderness and nausea. Some women stop taking the pill because of these problems. There hasn't been enough research to say whether side effects like these are more common with certain pills than with others.

Hormonal contraceptives also increase the risk of blood clots in the legs (deep vein thrombosis), even if the overall risk is low. Third- and fourth-generation birth control pills (such as those containing desogestrel, dienogest, gestodene and drospirenone) appear to increase the risk of thrombosis more than older first- and second-generation pills do (such as those containing levonorgestrel or norgestimate). It is estimated that thrombosis occurs within one year in

• about 9 to 12 out of 10,000 women who regularly take a birth control pill containing desogestrel, gestodene or drospirenone.
• about 5 to 7 out of 10,000 women who regularly take a birth control pill containing levonorgestrel or norgestimate.

For comparison, thrombosis occurs in about 2 out of 10,000 women who aren’t on the pill.

Deep vein thrombosis can cause tenderness, swelling, an aching pain in the legs, and sometimes even skin problems. In very rare cases it may lead to a life-threatening blockage of the pulmonary artery (pulmonary embolism).

Sources

• Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2012; (7): CD004425. [PubMed: 22786490]
• Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Rote-Hand-Brief zu kombinierten hormonalen Kontrazeptiva, einschließlich Informationsmaterialien: Risiko von venösen Thromboembolien. February 3, 2014.
• European Medicines Agency (EMA). Dienogest / ethinylestradiol-containing medicinal products indicated in acne. March 24, 2017.
• European Medicines Agency (EMA). Ethinylestradiol + drospirenone-containing oral contraceptives (YASMIN, YASMINELLE and other products) – Risk of venous thromboembolism. May 26, 2011.
• Lawrie TA, Helmerhorst FM, Maitra NK, Kulier R, Bloemenkamp K, Gülmezoglu AM. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev 2011; (5): CD004861. [PubMed: 21563141]

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