Can birth control cause acne?

In this article:

• How can birth control cause acne?
• What birth control treats acne?
• What to do if your birth control causes acne
• The bottom line: It depends on the birth control type

In this article

• How can birth control cause acne?
• What birth control treats acne?
• What to do if your birth control causes acne
• The bottom line: It depends on the birth control type

According to the Centers for Disease Control and Prevention (CDC), 65% of women of childbearing age (15-49) use some form of birth control to prevent pregnancy. One popular choice, the birth control pill, is 99% effective when taken at the same time every day, but common side effects include mood changes, weight gain, abnormal bleeding, breast tenderness, and increased risk of blood clots.

Another potential side effect of hormonal birth control is acne, but there’s a catch. Hormonal birth control can also be used to treat acne. Here’s what you need to know about the best birth control to improve your skin (and which types to avoid if you’re acne-prone).

RELATED: What is the best birth control pill for you?

How can birth control cause acne?

Acne lesions form when the pores and sebaceous glands near the hair follicles become clogged with excess sebum (oil produced by sebaceous glands), dead skin cells, debris, and bacteria, says Michele Green, MD, a board-certified cosmetic dermatologist in New York, New York. She explains that the skin naturally produces sebum to keep it soft and moisturized, but when too much oil is created, it can become trapped in your hair follicles and pores.

Acne breakouts typically appear on the face but can also occur on the back, shoulders, and chest. According to Dr. Green, anyone can develop a pimple, but some factors increase the likelihood of experiencing an acne flare, including:

• Age: Skin problems like acne often appear in the teenage years and can last into early adulthood. You can also develop acne for the first time in adulthood, which is more common in women than in men.
• Genetics: Acne tends to run in families, with excess sebum production making some people more prone to flare-ups, says Dr. Green.
• Lifestyle factors: Diet, stress, lack of sleep, and poor hygiene can lead to acne breakouts, says Dr. Green. Heavy sweating and humidity can also contribute to acne.
• Hormonal changes: Hormonal fluctuations caused by puberty,  menstruation, pregnancy, and hormonal birth control (such as birth control pills) can cause acne.
• Androgens: Male sex hormones, like testosterone, have been linked to acne. Follicles are sensitive to androgens, so higher levels of androgens lead to increased sebum production and an increased presence of acne-causing bacteria.
• Certain drugs: Steroids, testosterone, estrogen, phenytoin, and hormonal IUDs can contribute to or worsen acne.
• Excess skin contact: Rubbing and touching the skin too much can cause and worsen acne.

Types of birth control that can lead to acne

While some hormonal birth control methods help with acne, others can lead to skin breakouts, says Dr. Green. Research suggests that, on average, the following birth control methods can worsen acne compared with combination contraceptive pills:

• Birth control injections, like Depo-Provera
• Subdermal implants like Nexplanon
• Hormonal intrauterine devices  (IUDs), like Mirena and Skyla
• Progestin-only pills, such as Camila, Errin, Heather, Incassia, Jencycla, and Nora-Be

That’s because they lack estrogen, which helps control androgen levels. The skin’s oil glands have hormone receptors, and excess androgens can result in the secretion of extra sebum, leading to acne, explains Cameron Rokhsar, MD, a double board-certified dermatologist and medical director of the New York Cosmetic, Skin, and Laser Surgery Center.

RELATED: Could progestin-only birth control be right for you?

Hormonal acne caused by these types of birth control tends to be cystic, presenting as painful cysts that are inflamed, irritated, and tender, most often along the jawline and lower face, says Dr. Green. As the bacteria flourish under the skin and in the pores, the cystic lesion will increase in size and become more inflamed, she says, adding that cystic acne, a type of inflammatory acne, often causes permanent scarring.

Hormonal acne can be inflammatory or noninflammatory:

• Blackheads, a form of noninflammatory acne, are caused by oil and dead skin that blocks follicles.
• Whiteheads, a form of noninflammatory acne, are caused by clogged follicles or sebaceous glands.
• Pustules, a form of inflammatory acne, are pus-filled bumps on the skin’s surface.
• Nodules, a form of inflammatory acne, are large, hard bumps deep beneath the skin.
• Cysts are similar to nodules, but the bumps buried under the skin are soft.

What birth control treats acne?

While some birth control causes acne or worsens flare-ups, other forms of birth control help to treat acne. Combination oral contraceptives containing both estrogen and progestin (the synthetic form of progesterone) are often a treatment option for acne because they help decrease levels of the androgen testosterone, Dr. Green explains.

Combination birth control pills that are FDA-approved for acne include:

• Ortho Tri-Cyclen (norgestimate/ethinyl estradiol)
• Estrostep (norethindrone acetate/ethinyl estradiol)
• Yaz (drospirenone/ethinyl estradiol)
• Beyaz (drospirenone, ethinyl estradiol, and levomefolate calcium)

While research is limited, hormonal birth control options like the patch and Nuvaring, which contain estrogen and progestin, may also improve acne. But after starting birth control, acne may worsen before getting better, says Anna H. Chacon, MD, a board-certified dermatologist based in Miami, Florida. That’s because your hormones are still in flux when you first begin a hormonal contraceptive. Although some notice improvement in just a few weeks, acne may take up to six months to improve, adds Dr. Green.

What’s more, birth control’s effects on acne can vary due to individual hormone levels, sensitivity to specific progestins, and other factors influencing acne development, says Dr. Rokhsar. Because of this, it’s hard to predict the effect of various birth control formulations on each individual’s acne.

What to do if your birth control causes acne

If acne develops after starting a new birth control regimen, it is advisable to consult a dermatologist or healthcare provider, says Dr. Rokhsar. They can assess the situation, determine potential causes, and suggest appropriate skincare or treatment options.

Prescription treatment

Your dermatologist may suggest switching to another type of birth control that is better for acne. A prescription medication, spironolactone, can help block the effect of hormones on the oil glands in the skin. There are also newly FDA-approved lasers, like ACCURE or AviClear, which target the oil glands to shrink them permanently. Laser treatments promise to cure acne long-term.

RELATED: Should I take spironolactone for acne?

Skincare

Incorporating acne-fighting ingredients into your skincare routine is also a good idea if you experience breakouts after starting a new birth control, says Dr. Green.

• Salicylic acid is a common ingredient in acne cleansers because it removes dead skin cells and penetrates deep into the skin to unclog pores, Dr. Green says.
• Benzoyl peroxide is also commonly used in cleansers and spot treatments because it has antibacterial and anti-inflammatory properties, says Dr. Green. Recent information has come out warning that benzoyl peroxide products may contain high levels of benzene, a cancer-causing agent. On March 8, 2024, the American Academy of Dermatology announced that it is reviewing the issue and recommends using other topicals if there is a concern about benzoyl peroxide
• Prescription retinoids like Retin-A (tretinoin) can help clear acne, reduce redness, and provide anti-aging benefits, suggests Dr. Green.
• Topical probiotics have been shown to reduce inflammation and improve the skin microbiome.

RELATED: Cystic acne treatments and medications

Lifestyle changes

Lifestyle changes can help too. For example, your body produces androgens in response to stress, which activates the oil glands in the skin, says Dr. Chacon. She suggests practicing stress-reduction strategies such as:

• Exercising regularly
• Practicing mindfulness and meditation
• Trying breathing exercises
• Getting enough sleep
• Avoiding excessive caffeine intake

Although there is little evidence that consuming foods like chocolate, milk, sweets, or high-fat foods results in acne, you may wish to avoid them if you discover that eating these or any other foods results in breakouts, suggests Dr. Chacon.

A low-glycemic diet, which contains vegetables, fruits, beans, and oats, has been shown to aid with acne reduction because it lessens blood sugar spikes, which can lead to inflammation in the body. Dr. Chacon recommends following a diet that’s low in fried foods and high in fruits, vegetables, and omega-3 fatty acids.

The bottom line: It depends on the birth control type

The varying effects of birth control on acne boil down to the hormones it contains. Whereas birth control containing estrogen and progestin will improve acne due to lowered androgen activity, birth control containing only progestin can worsen acne. Finally, if combination hormonal birth control is not improving acne, underlying issues like polycystic ovary syndrome (PCOS) may be contributing to the breakouts, says Dr. Green.