What causes acne?
Acne is caused by sebum secretion, an oily substance that covers the skin. Sebum production is not fully understood but we know that it plays part in protecting the skin. It’s also heavily related to hormone levels in the body. High progesterone levels are seen alongside high levels of sebum production, manifesting as acne.
Although having acne does not carry a large risk to individuals’ overall health, it can have profound psychological implications, particularly for those suffering long into their adult years or with especially severe forms of the condition. For patients whose self-confidence and mental health has been significantly affected by this condition, the benefits of acne treatment can outweigh even an extensive list of potential side-effects.
Can contraceptives cause acne?
Combined oral contraceptives do not directly cause acne and can actually help keep skin look clearer for longer. However, hormones and their relationship with one another are complicated; administering hormonal treatments has a knock-on effect for other hormone levels in the body.
Combined oral contraceptives contain both estradiol and progestin (synthetic forms of oestrogen and progesterone). The former causes a reduction in androgen levels (thereby reducing sebum production) but the latter can have the opposite effect. At times when progesterone is at its highest (right before and during menstruation), acne is often at its most noticeable. Pills with higher progestin to estradiol ratios are thereby most likely to create cyclical breakouts.
Oral contraceptives as acne treatments?
Whilst research has yielded evidence that pills with anti-androgens can help to treat acne, there is little in-depth comparison of how different combination pills weigh up against each other on this front. Most treatments come with a similar list of side effects and similar effectiveness.
If your doctor prescribes you an oral contraceptive specifically to treat your acne, there’s a good chance it’s co-cyprindiol. This drug helps to stop the production of sebum as it contains oestrogen and an anti-androgen; seeing as androgens stimulate sebum production, this combination can thereby reduce the appearance of acne whilst also working as a contraceptive.
Co-cyprindiol comes with the usual combined oral contraceptive side effect warnings, including headaches, sore breasts, weight gain or loss and headaches. It’s also associated with an incrementally increased risk of developing breast cancer in later life. Instances of venous thromboembolism are also around twice as high in women taking co-cyprindiol compared to those using other pills. The associated risks increase according to other health factors, such as for women with high blood pressure, smokers, diabetes or a family history of cardiovascular illness. Unfortunately, low mood is another side-effect emergent with Diane/Diane-35 treatments, although it is only reported at a ≥ 1% rate.
Another pill popularly used to treat acne is Drospirenone, known commercially as Yasmin. This drug is often administered for mild acne and is said to “have characteristics closer to those of natural progesterone than most synthetic progestogens”. Side effects are similar, with nausea, headaches and mood changes especially common, although Yasmin also carries risk of fluid retention. Both this treatment and cyprindiol lie carry higher risk of deep vein thrombosis than the more commonly administered Levonorgestrel contraceptive pill. However, this pill is the least effective in treating acne. It is mostly prescribed as an emergency contraceptive.
For those suffering with mild, moderate and severe forms of acne, both drospirenone and co-cyprindiol (as well as their comparable alternatives) can make a large and lasting difference within around 3 months of treatment, although the full effects may take up to 6 months. Whilst they could help to tackle depression by reducing the adverse psychological factors concurrent with acne, individuals suffering with depression may also experience a downturn in their mood due to the pill itself. As such, the decision of whether to begin taking combined oral contraceptives in order to treat acne can seem like something of a catch-22.
For anyone considering this treatment, the pros and cons pertain specifically to the severity of one’s acne and its effect on their quality of life, alongside their singular experiences of depression/low mood. When using contraceptives to treat acne, one must employ the same approach as selecting a contraception method merely for the purpose of birth control; consider your health holistically and make a highly personalised decision. Everyone is different and everyone has different practical, health, emotional and financial priorities to consider.