Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 2/9/2021
Have you ever noticed a friend’s skin clearing up after starting birth control? Combined oral contraceptive pills (COCP, or more commonly, just “birth control pills”) can be used for more than just preventing pregnancy.
Oral birth control is widely used to treat and control acne. Healthcare providers have prescribed the pill to women with problematic hormonal acne for decades, and the FDA even recommends three specific birth control pills for women suffering from acne.
On the other hand, there’s also a persistent belief that birth control pills can cause acne -- a belief that’s backed up by some anecdotal cases.
The relationship between birth control pills and acne can be confusing. After all, hormones are highly complicated. Luckily, with a bit of explanation, it’s easy to understand the role oral birth control plays in controlling, treating and managing acne.
Below, we’ve explained how birth control can work as an acne treatment, as well as whether or not birth control can cause acne.
We’ve also looked at the types of birth control most commonly used for acne, as well as the difference between oral birth control and other acne treatments.
Generally speaking, no. Acne is usually caused by high levels of androgens -- male hormones that can stimulate sebum production and clog hair follicles. Higher levels of androgens (more specifically, testosterone) mean more sebum, which in turn usually leads to more pimples.
Most birth control pills contain estrogen and progesterone -- two female hormones that are not directly responsible for acne.
In fact, these hormones can work together to reduce your risk of developing acne on a regular basis by balancing the effects of excess androgens.
In short, not only do birth control pills not cause acne -- over the long term, they’re very effective at preventing it.
So, where does the belief that birth control pills cause acne come from? Part of this belief is due to the natural changes in hormones that can occur over the course of your menstrual cycle, with another part coming from the sudden change in hormones that can occur with birth control.
First, let’s cover the menstrual cycle and its effect on hormones. Over the course of the month, the amount of androgens (male sexual hormones) and estrogens (female sex hormones) that are produced by your body will fluctuate.
Generally, you’ll reach your highest androgen levels in the week before your period, as well as during your period. During your period, your estrogen will also increase, while your body’s level of progesterone will reach its lowest point.
In short, your period, and the days leading up to it, is when you’ll have the highest concentration of androgens circulating throughout your body. This can lead to a sudden increase in acne that’s usually referred to as a hormonal acne outbreak.
If you’ve just switched to an oral contraceptive, it’s easy to assume this outbreak is caused by your birth control pill. This is very unlikely. Instead, it’s far more likely to be caused by regular hormone fluctuations that your new birth control hasn’t yet been able to prevent.
However, there’s one caveat to this rule. Progestin-only birth control pills, which are commonly known as “mini-pills,” don’t contain estrogen. Although it’s uncommon, these birth control pills can cause your androgen levels to fluctuate, resulting in an increase in hormonal acne.
Healthcare providers have been prescribing birth control pills as an acne treatment for several decades, with the FDA even recommending several oral contraceptives as acne treatments as well as for birth control purposes.
The way birth control works as an acne treatment is simple. As a woman, your body produces a small quantity of androgenic hormones such as testosterone. These hormones are essential for optimal wellbeing and health.
Testosterone, for example, plays a role in everything from your muscle and bone health to your sex drive.
Testosterone also regulates the amount of sebum produced by your skin. When your adrenal glands and ovaries produce too much testosterone, your skin can become overly oily, resulting in more severe and frequent acne outbreaks.
Our guide to hormonal acne explains this process in more detail. Simply put, the higher your levels of testosterone and other androgens, the more likely it is that you’ll experience acne in the days leading up to your period.
The estrogen and progesterone in oral contraceptives lower the amount of androgens in your body. Lower levels of testosterone mean less sebum production, which means a lower risk of experiencing hormonal acne.
Although there are numerous different birth control pills, the FDA has currently only approved three different pills for treating acne.
All of the FDA-approved birth control pills are combined oral contraceptives, meaning they contain a mix of estrogen and progestin.
Right now, the three FDA-approved birth control pills for treating acne area:
Estrostep, which contains ethinyl estradiol (an estrogen) and norethindrone (a progestin). Estrostep reduces acne breakouts by increasing sex hormone-binding globulin (SHBG), which decreases free testosterone levels in your body.
Ortho Tri-Cyclen, which contains estrogen and norgestimate. Like other progestins, norgestimate is shown to lower the levels of androgens like testosterone in the body, helping it to treat, prevent and control hormonal acne.
Currently, the FDA hasn’t approved any progestin-only oral contraceptives for treating acne.
If you have persistent hormonal acne, using a birth control pill as an acne treatment can be a safe, effective way to keep it under control. As with anything contraception-related, the best approach is to talk to your healthcare provider about using an oral contraceptive for acne.
Your healthcare provider will be able to recommend the best birth control pill for you based on your needs, the severity of your acne and your health history. Because each birth control pill uses a different progestin, it’s far from uncommon to experience a slight difference in results between birth control pills.
It’s also normal for acne to persiste for a few months after you start using birth control -- normally, it takes about three months to clear. If you have severe acne, or your acne doesn’t respond to birth control, your healthcare provider might also recommend the use of a retinoid or antibiotic.
These medications stop acne through different mechanisms than birth control and can often produce better results when used together. Over the course of several months, you and your healthcare provider will be able to “dial in” your usage of birth control, as well as other medications, helping you to bring your acne under control.Birth Control vs. Other Acne Treatments
There are several other classes of medication that treat acne. The most common are retinoids and antibiotics.
As mentioned above, dermatologists will often prescribe these medications at the same time to target acne from multiple angles:
Birth control pills treat acne from a hormonal perspective. By reducing the amount of androgens produced by your body, combined oral contraceptives keep your sebum production low and reduce your risk of dealing with a blocked pore.
Retinoids, such as tretinoin and isotretinoin, work by speeding up your body’s skin cell turnover process. This means that there’s less time for dead skin and oil to build up in your hair follicles and cause an acne breakout.
Antibiotics prevent infection, meaning that any pimples that do form are less likely to become infected and inflamed. This is particularly important if you’re prone to painful cystic acne.
Finally, some healthcare providers will treat acne using spironolactone. Spironolactone works by blocking the effects of androgens, reducing sebum production and preventing acne breakouts.
Because acne can vary in severity and persistence, there’s no “best” acne treatment for every situation. Your healthcare provider will prescribe the best acne treatment for you based on your symptoms, needs and history, meaning that what works for you might not be ideal for someone else.
Used effectively, birth control can help you get your acne under control and enjoy clearer, better looking skin.
In general, birth control does not cause acne, although in certain situations it could temporarily worsen your skin before making it better.
If you have acne and think birth control could be a good treatment, talk to your healthcare provider. They’ll be able to assess your acne and recommend the best treatment for your needs, whether it’s an oral contraceptive, a topical retinoid or an antibiotic.