The best birth control pill for acne treatment

There are several pill types your dermatologist might prescribe, but one kind is ideal

By Amy Wilkinson | Updated on Aug. 17, 2022 Medically reviewed by Marissa Walsh, Pharm.D., BCPS-AQ ID

Pimples. Blemishes. Spots. Whatever term you use to describe those painful, persistent bumps on your face or body, one fact remains: Acne is a common problem for many people—up to 50 million Americans—way beyond their teenage years. According to a study published in the Journal of the American Academy of Dermatology, adult acne affects a wide range of age groups: 50.9% of women in their 20s, 35.2% of women in their 30s, 26.3% of women in their 40s, and 15.3% of women 50 years of age and older.

Acne is a skin condition that occurs when a hair follicle becomes clogged with dead skin cells or sebum (oil), leading to whiteheads, blackheads, and pimples. For adult women, fluctuating hormone levels (specifically increased levels of androgens, such as testosterone) are often to blame for these breakouts, which are also known as hormonal acne. Women typically experience acne-causing hormonal shifts during puberty, menstruation, menopause, and due to conditions like polycystic ovarian syndrome (PCOS).

Types of birth control that treat acne

There are currently four birth control pills that are FDA-approved for acne treatment. They include:

Ortho Tri-Cyclen
Estrostep
Yaz
Beyaz

Yaz or its generics, including Jasmiel and Loryna (estradiol/drospirenone), is particularly effective among acne patients, says Morgana Colombo, MD, FAAD, a board-certified dermatologist and co-founder of Skintap, a virtual dermatology practice. That’s because the anti-androgenic properties of its progesterone element are beneficial in controlling acne–adult female hormonal acne in particular, Dr. Colombo says.

Other birth control pills can be helpful to treat acne too, says Cybele Fishman, MD, a dermatologist with Advanced Dermatology PC in New York, New York.. “There are four generations of progestins in combination birth control pills. The third- and fourth-generation pills are better for acne,” she says. Good options are combination pills that include the third-generation progestins desogestrel and norgestimate, or the fourth-generation drospirenone.

If you’re wondering if it’s okay to be on a hormonal IUD and still take a birth control pill to treat acne, it’s not a good idea, Dr. Fishman says. That’s because by combining the two contraceptives, you could be getting too much progesterone, leading to unpleasant side effects. What’s more, it could actually exacerbate your acne. If you are on a hormonal IUD, a better choice may be spironolactone for acne, Dr. Fishman advises. Your healthcare provider can help you choose the best birth control for acne.

Benefits of birth control for acne

According to Dr. Colombo, estrogen/progesterone birth control pills work best for adult females between the ages of 18-35 years old who have adult hormonal acne. It’s characterized by cystic outbreaks on the lower face, chin, jaw, neck and chest areas, and it tends to flare a couple days before the woman’s menstrual period, she says.

Birth control can also be beneficial in pre-menopausal women whose acne flares at certain times during the menstrual cycle, Dr. Fishman adds. “During ovulation, there is a testosterone spike. The week before your period, there is a progesterone spike. These tend to be the times that acne flares if it is correlated with one’s menstrual cycle,” she explains. Hormonal birth control pills can help to regulate such hormonal fluctuations to keep acne at bay.

Risks of birth control for acne

There are a handful of common side effects associated with birth control pills. Headaches, nausea, menstrual irregularities (such as spotting in between periods), weight gain, and breast tenderness are the most common. Although rare, a more serious side effect is the risk of deep vein thrombosis—in which a blood clot forms in your vein, often in the thigh or lower leg. But the estrogen in birth control will not cause acne, Dr. Colombo says.

According to Dr. Fishman, the following groups should not take birth control for acne treatment:

Cigarette smokers, because they are at increased risk of blood clots
Women with a personal or family history of blood clots or a medical condition that increases the risk of blood clots
Women who experience migraines with aura because combination birth control pills can increase their risk for stroke
Women with a personal or family history of breast or uterus cancer.

Which type of birth control is best for hormonal acne?

“Birth control pills containing estrogen/ progesterone stabilize hormonal fluctuations and indirectly decrease testosterone,” Dr. Colombo says. “That leads to decreased stimulation of the oil glands and less inflammation, making the skin less oily.”

The bottom line? Fewer acne flare-ups. To treat your hormonal acne, a dermatologist may recommend the use of oral contraceptives. But it’s important to note that only combination birth pills are effective. There are several hormonal contraceptives on the market:

Two types of oral contraceptive pills: combination pills (which contain both hormones estrogen and progestin) and minipills (which contain only progestin)
Implants (aka Nexplanon)
IUDs (including Mirena, Kyleena, Liletta, and Skyla; plus copper versions that don’t contain hormones)
The ring (aka NuvaRing)
The patch (including Xulane and Zafemy)
The Depo-Provera shot

The hormonal IUD, minipill, or Depo-Provera shot are not helpful to treat acne, says Dr. Colombo; in fact, they may actually trigger or worsen the condition. The birth control implant is neutral, Dr. Colombo adds. They don’t contain enough estrogen to be beneficial, but at the same time don’t contain unopposed progesterone to aggravate acne, she explains. And because the copper IUD doesn’t have any hormones, it won’t have any effect on acne.

How does birth control help with acne?

Combination birth control pills help with acne by preventing androgen levels from spiking, which, in turn, keep sebaceous glands from producing too much oil and clogging pores. The estrogen component here is key—progestin on its own won’t work, which is why minipills aren’t approved for the treatment of acne.

What is the best birth control pill for acne?

The best birth control pill for acne is a combination pill—one that contains both estrogen and progestin. The Food & Drug Administration (FDA) has approved four brand birth control pills for the treatment of acne: Ortho Tri-Cyclen, Estrostep Fe, Beyaz, and Yaz. Generic formulations of these branded birth control pills would also be effective.

The type of progestin the pill contains can also affect a birth control pill’s efficacy, per a study in the Journal of Drugs in Dermatology. According to their findings, drospirenone (the progestin found in Yaz) was the most helpful in preventing acne, while levonorgestrel and norethindrone (the progestins found in Levora and Lo Minastrin Fe, respectively) were the least helpful.

In fact, one combination birth control pill that contains norethindrone acetate, Lo Loestrin (Lo Loestrin coupons | What is Lo Loestrin?), can actually cause breakouts (acne is listed as one of its side effects), so it should probably not be taken if you are looking to clear up skin problems. Bottom line: Not all birth control pills treat acne or treat it with the same level of effectiveness.

When it comes to birth control for acne and weight loss, Dr. Colombo says Yaz works best. The progesterone element in the pill, drospirenone, has anti-androgen and mildly diuretic properties, she explains. “It basically blocks testosterone, which helps acne and decreases water retention which leads to water weight loss.”

How long does it take the pill to clear acne?

Once you begin taking birth control pills, it could take several weeks to months to see a difference in your skin. Many studies show some improvement at three months with the greatest improvement evident at six months. This is because the pill needs some time to recalibrate the hormone levels in the body that contribute to acne.

Other treatments for acne

If birth control medications do not clear up your acne, your doctor may prescribe another kind of medicine to clear up your skin. Effective treatment options may include:

Topical treatment options such as benzoyl peroxide and retinoids, particularly used in conjunction, have been shown to be effective in fighting pimples.
Salicylic acid, a β-hydroxy acid can be helpful as an exfoliating agent to unclog pores.
The high blood pressure medicine spironolactone, though not FDA-approved to treat acne, has been shown to be effective, especially among women. But spironolactone should generally not be used in conjunction with oral birth control products containing the progestin, drospirenone, due to increased risk of adverse effects.
In some severe cases, your dermatologist may consider isotretinoin, a vitamin A derivative most commonly known under its former brand name of Accutane.