Which birth control pills can help reduce acne?

Photo of young woman looking into a mirror (ron summers / iStock / Thinkstock) Using birth control pills as a form of contraception can improve the complexion of girls and women who have acne. Certain types of pills might be somewhat more effective in treating acne than others. But the differences are small.

Acne is the most common skin condition in teenagers. Most boys and girls will have acne to some degree during puberty. Clearly visible, persistent acne can be very distressing for teenagers, affecting their self-esteem. As a result, many boys and girls try out all sorts of things to get rid of their pimples. 

The contraceptive pill and acne 

The main reason acne develops is because the male sex hormone androgen is made in larger amounts during puberty – in girls too. Inflammatory and non-inflammatory acne can improve in girls and women who use contraceptive pills as birth control. The pills that help against acne have the hormones estrogen and progestin in them. But most contraceptive pills have not been specifically approved for the treatment of acne. There are also non-hormonal therapies which can help against acne, some of which have fewer side effects.

The frequency and severity of side effects are influenced by the dose of hormones in the birth control pills. But the possible side effects might still play an important role when deciding which pill to use. So knowing whether some contraceptive pills are more likely than others to improve your complexion, and which side effects they might have, is helpful.

Research has only found small differences in the effect on acne

Researchers from the Cochrane Collaboration – an international research network – took a look at the effectiveness of contraceptive pills in the treatment of acne. They did a search for studies comparing the pill with a fake drug (placebo) or a non-hormonal acne medication. The researchers analyzed 31 studies involving a total of about 12,500 participants. Most of the studies compared different contraceptive pills with each other or with a placebo. Hardly any of the studies compared the pill with other acne medications.

All of the contraceptive pills used in the studies reduced both inflammatory and non-inflammatory acne. They often had to be taken for several weeks or months before the participants’ skin got better. The pills that reduced acne had ethinyl estradiol in them, combined with one of the following drugs: levonorgestrel, norethindrone, norgestimate, drospirenone, cyproterone acetate, chlormadinone acetate, dienogest or desogestrel.

The studies showed that most of the pills had a similar positive effect on acne. But some types of pills seem to be somewhat more effective than others: In one study, pills that had cyproterone acetate in them were found to help reduce acne somewhat better than pills that had levonorgestrel in them. Cyproterone acetate has not been approved for contraceptive use in Germany, but it can be prescribed for the treatment of acne. None of the other studies found any of the pills to be better or worse than others. So any claims that a certain pill will lead to much better skin than other pills should be treated with caution.

Risk of deep vein thrombosis depends on the type of pill

Contraceptive pills can have side effects such as headaches, breast tenderness and nausea. Some women stop taking the pill because of these effects. There has not been enough research to say whether side effects like these are more common with certain pills than with others.

Hormonal contraceptives also increase the risk of blood clots in the legs (deep vein thrombosis), even if the overall risk is low. Third and fourth-generation birth control pills such as desogestrel, gestodene and drospirenone seem to increase the risk of deep vein thrombosis more than the "older" hormones used in first and second-generation pills such as levonorgestrel and norgestimate. It is estimated that deep vein thrombosis will occur within one year in about

  • 9 to 12 out of 10,000 women who regularly take desogestrel, gestodene or drospirenone, and in about
  • 5 to 7 out of 10,000 women who regularly take levonorgestrel or norgestimate.

For comparison: Deep vein thrombosis occurs in about 2 out of 10,000 women who are not taking a contraceptive pill.

Deep vein thrombosis can cause tenderness, swelling, an aching pain in the legs, and sometimes even skin problems. In very rare cases it may lead to a life-threatening blockage of the artery that transports blood to the lungs (pulmonary embolism).