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Hormonal agents

Most females will only think about the pill as a contraceptive but it can also help some women to control their acne. In those with an irregular cycle, just regulating their periods with a combined oral contraceptive pill can be useful for helping acne.

The pill can treat acne by blocking the stimulatory effect that androgens (male hormones) have on the sebaceous glands of the skin. It works by decreasing oil or sebum production and can be used in women whose acne doesn't respond to topical treatments or recurs after completing a course of oral antibiotics.

In women over 25 years old or those experiencing premenstrual flare-ups of acne, the pill may be particularly useful.
Taken daily, the hormones in the pill prevent the ovaries from ovulating (releasing eggs). Pregnancy is prevented because there are no eggs to fertilise. The pill also causes changes in the lining of the uterus and the mucus of the cervix, which also reduces the chances of pregnancy.

The progestogen component of a combined oral contraceptive pill is most important in determining whether an oral contraceptive pill is likely to improve or worsen your acne. 

Very low dose pills

The pills with proven benefits in acne include 'very' low oestrogen dose pills containing 20mcg ethinyloestradiol along with the following progesterones:

  • Low dose (100mcg) levonorgestrel, such as Loette and Microgynon 20. Pills containing higher doses of levonorgestrel (eg 150mcg) can worsen acne;
  • Drospirenone (3mg). An example is Yaz.

There are some safety benefits (fewer side effects) with low dose pills and for good contraceptive protection (i.e. not getting pregnant), it is important to take this pill around the same time every day.

Breakthrough bleeding is a more common problem for females taking a low dose pill. When used alone, low dose pills are usually only indicated for mild to moderate acne, but could be used in combination with other treatment options for more severe forms of acne.

Low dose pills

  • Dienogest (2mg). This type of pill (Valette) has a particular benefit for women with hormonal problems including oily skin, acne, PCOS and menstrual irregularities.

Other oral contraceptive pills

Combined oral contraceptive pills containing 35mcg ethyloestradiol 2mg and cyproterone acetate (an anti-androgen) have also proven useful in managing acne. They include Brenda-35 ED, Estelle-35 ED, Diane-35 ED, Juliette-35 ED.

These pills are also more likely to be associated with mood changes; depression; weight gain; changes in libido; fluid retention and carry the greatest risk of increasing the risk of deep vein thrombosis. This risk is increased if you are a smoker and have a BMI >30 (obese, not just overweight).

Other contraceptive pills that have been shown to generally improve acne include those containing the progestogens desorgestrel (eg, Marvelon), gestodene (eg, Minulet) and drosperinone (eg, Yasmin). 

Minipill and contraceptive implants

The minipill and contraceptive implants are more likely to worsen rather than help acne due to their effects on the menstrual cycle. These are progestogen only pills or implants (eg. Depo-Provera; Depo-Ralovera; Microlut; Mirena and Implanon). 

Spironolactone: a non-contraceptive

Spironolactone (eg, Aldactone, Spiractin) is a non-contraceptive anti-androgen which also has proven benefit for acne on its own or in combination with the pill. It is particularly useful for females with excessive body hair (hirsutism) or androgenetic alopecia (male pattern hair loss in a female). After starting spironolactone, a reduction in skin oils will typically be observed in the first 4-6 weeks. The full benefits for reducing acne lesions are usually noticed in the second and third months of use. 

Some points to consider:

  • If you are using the pill as an acne treatment, it will need to be taken for at least six months. It is often prescribed for prolonged periods to control acne. The pill can suppress acne until its natural resolution, given in 8-12 per cent of females, acne can continue into the late 20s and even 30s;
  • Common side effects of the oral contraceptive pill include nausea, vomiting, abdominal pain, headaches including migraines, breast tenderness/enlargement and vaginitis, including thrush;
  • You should still continue to cleanse, treat and moisturise your skin whilst on the pill;
  • You should expect to see an improvement in your acne after being on the pill for 8 to 12 weeks. Your skin should be less greasy, with fewer spots;
  • Your pimples should continue to improve from 3 to 12 months;
  • The pill can be taken for as long as acne and/or contraceptive treatment is needed. If you stop treatment, you may find that your acne returns, although not as severely as before. As you get older, the chance of acne returning is reduced;
  • If you are diabetic, suffer from migraine, are an epileptic, are overweight, a heavy smoker or suffer from high blood pressure, your doctor may wish to discuss whether to put you on the pill;
  • You will also need to discuss if there is a family history for breast cancer as the pill may not be appropriate in these cases; and
  • The pill can reduce incidence of ovarian and uterine cancer, pelvic inflammation, some diseases of the breast, iron deficiency anaemia and rheumatoid arthritis. 

Taking the oral contraceptive pill

Having chosen a convenient dose time, for example after breakfast or after dinner, try and stick to it. During the first 14 days of the first cycle only, additional non-hormonal methods of contraception must be used;

Starting instructions

Step 1

Start on the first day of menstrual bleeding.

Step 2

Take your first pill from the highlighted section.

Step 3

Press out the pill marked with the appropriate day of the week.

Step 4

Take a pill each day always following the direction of the arrows.

Pill facts

  • Frank Colton, an American chemist, invented the first commercially available oral contraceptive in 1960;
  • Today, 70 million women across the world take the oral contraceptive pill;
  • Current contraceptive pills have much lower hormonal content than years ago; and
  • See your doctor if you smoke, have a family history of blood clots or breast cancer.





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