Birth control for acne: which pills help and how
Some combined birth control pills are FDA approved for acne. How they work, how long they take, who should not take them, and which methods can worsen acne.
By Nick, Founder of Skinli. Not a doctor. General education only.
Part of the Hormonal and adult acne, which puts every step in order.
Birth control pills are one of the two hormone treatments dermatologists use for acne in women. The American Academy of Dermatology (AAD) says the pill has been found to treat blackheads, whiteheads, pimples, and deep acne nodules and cysts, and that the FDA has approved some pills to treat acne. This guide covers which pills are approved, how they help, how long they take, who should not take them, and which birth control methods can make acne worse. For the full plan, see the hormonal acne treatment guide.
Skinli gives general education and is not a doctor. Birth control pills are prescription medicines. A prescriber decides whether a pill is safe for you after checking your health.
Which pills are approved for acne
The pills used for acne are combined pills, which contain two hormones: an estrogen and a progestin. The AAD names four brands that the FDA has approved for acne. Their FDA labels show three different progestins paired with the estrogen ethinyl estradiol:
| Progestin in the pill | Who the label approves it for, for acne |
|---|---|
| Drospirenone | Moderate acne in females at least 14 who have started periods (two approved brands, one with an added B vitamin) |
| Norgestimate | Moderate acne in females at least 15 who have started periods |
| Norethindrone acetate | Named by the AAD as FDA approved for acne |
Each label adds a condition: the pill should be used for acne only if the person also wants birth control. That means a pill is chosen as birth control that also treats acne, and a prescriber weighs both.
The AAD does not rank one approved pill above another. It says your dermatologist can tell you whether a combined pill might be right for you, and if so, which one is recommended. NICHD, the NIH's institute for women's and children's health, says there is no single pill that works best for PCOS, and that pills whose progestin has low male-hormone effects are more effective for PCOS symptoms.
How the pill helps acne
The pill lowers the effect of androgens, the male-type hormones that drive oil production. NICHD says pills with an estrogen and a progestin reduce androgen levels in women with PCOS. The FDA labels say the combined pill raises a protein called sex hormone binding globulin and lowers free testosterone, the active form. The labels add that the link between these changes and less acne has not been proven.
MedlinePlus puts it simply: some birth control pills treat acne by decreasing the amounts of certain natural substances that can cause acne.
How well it works
The FDA labels report trials that lasted six monthly cycles:
| Pill | What the trials found after 6 cycles |
|---|---|
| Drospirenone pill | Inflamed spots fell 48% and 51% in two trials, against 32% and 34% on a dummy pill. Clear or almost clear skin: 15% and 21%, against 4% and 9% |
| Norgestimate pill | Total spots fell 42%, against 27% on a dummy pill |
The AAD's 2024 acne guideline gives combined pills a conditional recommendation, a weaker grade than it gives benzoyl peroxide or retinoids on the skin. The AAD says a dermatologist may prescribe other acne medicine along with the pill to get acne under control.
How long it takes
The AAD says women notice improvement on the pill in 2 to 3 months on average. When hormonal therapy clears acne, it says patients may stay on it for a long time, and that long-term hormonal therapy appears to be safe.
One more finding matters for the monthly flare. In a 2001 study of 400 women, those taking birth control pills had flares before their periods as often as those who were not. A pill does not always stop period acne by itself. See period acne.
Who should not take the pill
The three combined pill labels Skinli read each carry a boxed warning, the strongest warning on a drug label: cigarette smoking raises the risk of serious heart and blood vessel events, and women over 35 who smoke should not use combined pills. The labels also list other conditions that rule them out, including:
- A blood clot in the legs or lungs, now or in the past
- Stroke or heart disease
- High blood pressure that is not controlled
- Headaches with nerve symptoms, or any migraine after age 35
- Breast cancer, now or in the past
- Liver tumors or liver disease
- Unexplained vaginal bleeding
The drospirenone pill's label also rules it out for people with kidney problems or adrenal problems, because this progestin can raise potassium.
The AAD says the pill is generally considered safe for women, and that the risk of blood clots is greater during pregnancy and just after having a baby than when taking the pill. It lists the possible serious risks as blood clots, heart attack and high blood pressure. It says you can lower the risk of clots by staying active, drinking plenty of water and not smoking. The American College of Obstetricians and Gynecologists (ACOG) says the risk is higher in people over 35 who smoke more than 15 cigarettes a day, and in people with several heart disease risk factors.
If you are 35 or older, the AAD says the pill may not be an option, and spironolactone alone may be prescribed instead. See spironolactone for acne.
Side effects
The drospirenone pill's label lists the most frequent side effects in its trials as headache or migraine, irregular bleeding, nausea or vomiting, breast pain and mood changes. The AAD adds two:
- Dark patches on the face. Some women develop melasma. The AAD says protecting your face from the sun can help. See melasma.
- Breakthrough bleeding. The AAD says taking the pill at the same time each day often prevents it.
ACOG says most side effects are minor and often go away after a few months.
Birth control methods that can worsen acne
Hormones in birth control can work in either direction:
- MedlinePlus says some medicine-containing IUDs can make acne worse.
- ACOG lists acne among the possible side effects of the birth control implant in the arm.
- MedlinePlus lists acne among possible side effects of one combined pill, and its acne page says pills may make acne worse in some women.
- NICHD says some progestins have male-hormone effects, such as oily skin, acne and extra hair growth.
- NICE, the UK guideline body, advises the combined pill in preference to the progestin-only pill for people with acne who want hormonal birth control.
If acne started or got worse after a new method, tell your prescriber before you stop it, and use other birth control if you do stop.
The pill with other acne treatments
The pill is often one part of a larger plan:
- With a product on the skin. Adapalene, benzoyl peroxide, azelaic acid or salicylic acid keep working on clogged pores and bacteria while the pill works on hormones. The hormonal acne treatment guide explains how to choose.
- With spironolactone. The AAD says taking both can increase how well they work, and the pill gives the birth control that spironolactone requires. It adds that side effects such as irregular periods and breast tenderness may lessen when the two are taken together.
- With isotretinoin. Isotretinoin requires two forms of birth control used together. The rules, including which methods count, are in Accutane and pregnancy.
- For PMOS. NICE advises standard acne treatment first for people with PMOS, the condition once called PCOS, and then adding a combined pill if that does not work. See PCOS acne.
Tell every prescriber that you take the pill, including for short courses of other medicines, and ask whether anything new could affect it.
Starting and stopping the pill
The AAD lists starting or stopping birth control pills among the hormone changes that can bring breakouts in adult women. Some people notice acne come back after stopping, often called post birth control acne. If that happens, standard acne treatment is the first step. The adult acne guide covers the products that fit adult skin.
Getting a prescription
The AAD says a dermatologist can prescribe the pill for acne, and you do not need a Pap smear or pelvic exam first. Your blood pressure will be taken. Before the visit, list your medical conditions, including high blood pressure, heart disease, blood clots, migraines and cancer, plus your medicines, supplements and conditions in close relatives.
Skinli's free acne plan gives you a routine for your skin to use alongside the pill, since the pill works best as part of a plan.
Frequently asked questions
Does birth control help with acne?
Combined birth control pills, which contain an estrogen and a progestin, help acne in many women. The American Academy of Dermatology says the pill has been found to treat blackheads, whiteheads, pimples and deep acne, and that the FDA has approved some pills for acne. In the FDA label trials, the approved pills cut inflamed spots more than a dummy pill over six months.
Which birth control is best for acne?
The birth control pills with the strongest case for acne are the combined pills the FDA has approved for it. The American Academy of Dermatology names four brands, which contain an estrogen with one of three progestins: drospirenone, norgestimate or norethindrone acetate. It does not rank one above the others. NICHD, part of the NIH, says pills whose progestin has low male-hormone effects work better for PCOS symptoms.
How fast does birth control work for acne?
Birth control pills take 2 to 3 months to improve acne on average, according to the American Academy of Dermatology. The FDA label trials measured results after six monthly cycles. For one drospirenone pill, 15% and 21% of women in two trials reached clear or almost clear skin, compared with 4% and 9% on a dummy pill. Keep using your skin treatment meanwhile.
Which birth control causes acne?
Some birth control methods can make acne worse. MedlinePlus says some medicine-containing IUDs can worsen acne, and that birth control pills may make acne worse in some women. The American College of Obstetricians and Gynecologists lists acne among possible side effects of the birth control implant. NICHD says some progestins have male-hormone effects such as oily skin and acne. Ask your prescriber before switching.
What is post birth control acne?
Post birth control acne is acne that appears or returns after stopping birth control pills. The American Academy of Dermatology lists stopping, or starting, birth control pills among the hormone changes that can lead to breakouts in adult women. If you stop the pill and acne returns, a standard acne product or another treatment from a dermatologist can help. Use other birth control if needed.
Does the progestin-only pill help acne?
The progestin-only pill is absent from the list of pills the American Academy of Dermatology names as FDA approved for acne. The UK's NICE guideline says that when someone with acne wants hormonal birth control, doctors should consider the combined pill in preference to the progestin-only pill. The pills the FDA has approved for acne are all combined pills, which contain both an estrogen and a progestin.
Should I take birth control for acne?
Birth control for acne suits women who also want birth control and have no health reason to avoid it, as the FDA labels require. The boxed warning says women over 35 who smoke should not use combined pills. Labels also rule them out after blood clots, stroke, heart disease, uncontrolled high blood pressure, some migraines, breast cancer or liver disease. A prescriber decides.
Can you take birth control and acne medication together?
Birth control pills are often used together with other acne medicines. The American Academy of Dermatology says a dermatologist may prescribe other medicine along with the pill, and that taking both spironolactone and the pill can work better than either alone. The UK's NICE guideline suggests adding a combined pill to standard acne treatment for people with PMOS, the condition once called PCOS.
Does birth control work for chest and back acne?
Birth control pills can help acne on the chest and back as well as the face. The American Academy of Dermatology lists struggling to clear acne on the chest or back among the signs that a woman may want to consider hormonal therapy. Washes and gels used on the body also help, and a dermatologist can combine them with the pill.
Do you need a pelvic exam to get birth control for acne?
A pelvic exam is not needed before a dermatologist prescribes birth control pills for acne, according to the American Academy of Dermatology. It says you do not need a Pap smear or pelvic exam, and that your blood pressure will be taken to check for high blood pressure. You will be asked about your health, medicines, smoking and family history of blood clots or cancer.
Sources
- Stubborn acne? Hormonal therapy may help (American Academy of Dermatology)
- Acne: Diagnosis and treatment (American Academy of Dermatology)
- Adult acne (American Academy of Dermatology)
- Guidelines of care for the management of acne vulgaris (Journal of the American Academy of Dermatology (PubMed))
- Drospirenone and ethinyl estradiol tablets, prescribing information (DailyMed, U.S. National Library of Medicine)
- Drospirenone, ethinyl estradiol and levomefolate calcium tablets, prescribing information (DailyMed, U.S. National Library of Medicine)
- Norgestimate and ethinyl estradiol tablets, prescribing information (DailyMed, U.S. National Library of Medicine)
- Ethinyl estradiol and norethindrone (oral contraceptives) (MedlinePlus, U.S. National Library of Medicine)
- Acne (medical encyclopedia) (MedlinePlus, U.S. National Library of Medicine)
- Combined hormonal birth control: pill, patch, and ring (American College of Obstetricians and Gynecologists)
- Long-acting reversible contraception (LARC): intrauterine device (IUD) and implant (American College of Obstetricians and Gynecologists)
- Acne vulgaris: management (NG198), Recommendations (National Institute for Health and Care Excellence (NICE))
- What are the treatments for PCOS? (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH)
- The effect of the menstrual cycle on acne (Journal of the American Academy of Dermatology (PubMed))
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Analyze my skinSkinli gives simple tips for skin with pimples. It is not a doctor. It cannot tell you what is wrong the way a doctor can. If your pimples hurt, are deep under the skin, are getting worse, or will not go away, see a doctor.