Oral Contraception and Acne
Acne affects more than 42 million people in the U.S. This includes teenagers, as well as men and women older than 25 years. The worst form can result in long lasting scars on the face, chest, and back. Four factors are involved in getting acne.
- Clogged pores and plugged follicles.
- Excess sebum produced by oil glands.
- Increase in a bacteria (P. acnes) in the follicles.
- Pus that breaks out of the follicle and into the skin layer around it.
As a result, treatments for acne are most often combined treatments that target each of these factors but depend on the state of the disease.
Hormone treatment has been known to improve acne in some women. Estrogens given in high doses suppress the amount of sebum produced. But, such high doses are no longer found in oral contraceptives (OCs).
The FDA has approved three OCs for the treatment of moderate acne in females who are at least 14 or 15 years old and have begun having menstrual periods. These low-dose estrogen products include Estrostep®, Ortho TriCyclen®, and Yaz®. Although only three OCs are prescribed for acne, many others have also been studied and shown to be useful (i.e. Aleese®, Yasmin®, Microgynon®, Nordette®, Levlen®, Ortho-Cept®, and Femodene®).
Who can use this treatment?
- Teenage girls (over 14 years old) with severe acne who have failed early treatments, such as creams and antibiotic pills.
- Healthy, nonsmoking women with stubborn lower face, jaw line, and neck acne
- Women who produce too much androgen from their adrenal glands.
- increased facial hair
- irregular menses
- deep voice
- presence of acanthosis nigricans (velvety, light-brown-to-black, markings on the neck, under the arms or in the groin)
- male pattern hair loss
- Women with polycystic ovary syndrome (PCOS) (less than 9 periods per year or cycles greater than 40 days apart plus other signs listed above)
- Women who have acne and severe PMS.
Who cannot use the treatment?
- Women who have had any type of blood clot disease, such as deep venous thrombosis, pulmonary embolism, heart attack, or stroke.
- Women with severe or uncontrolled high blood pressure.
- Women who have migraines with auras and other warning signs. Women who have migraines around the time of their periods are candidates for OC treatment.
- Women who have had cancer.
- Pregnant women or women who intend to get pregnant.
- Women who are breastfeeding less than 6 weeks after giving birth.
- Women who are heavy smokers (more than 15 cigarettes per day) and older than 35 years.
- Women with other health problems that rule out the use of hormone treatment include atherosclerosis, bile disease, and breast cancer (current), diabetes with end-organ disease, liver disease, and prolonged bed rest.
Which medicines may decrease the effects of contraceptives?
- Anticonvulsants, for instance, phenytoin, carbamazepine, phenobarbital, and others
- Antibiotics and antifungals
- Rifampin
- Topiramate combined use with OCs may result in breakthrough bleeding. This does not include Ortho-TriCyclen®.
What side effects might there be?
- Irregular menstrual bleeding may occur. The bleeding pattern may change during the first few months of the treatment as part of the normal course. It is vital that you adhere to your treatment plan!
- Spotting may occur, but does not warrant changing the treatment plan during the first three months.
- Weight gain was not proven to be an issue in clinic trials.
- Other side effects may include: headache, nausea, bloating, and breast tenderness.
How long does it take for the hormone treatment to work?
It takes at least three months (or 3 cycles) for an OC to improve acne. OC treatment combined with creams or prescribed medicine may improve your results more quickly.
When should you start your hormone treatment?
- On the Sunday of your next period.
- Within 24 hours of your next period.
- On the day of the first visit (Day 1 starter - only if your pregnancy test is negative). If you are not within 7 days of the start of your period, a back up method of birth control is advised for 1 week.
What should you do if you miss any pills?
- If you miss one active pill
- Take it as soon as you remember. Take the next pill at the normal time. This means you take 2 pills in one day.
- You do not have to use a back-up method of birth control if you are sexually active.
- If you miss two active pills
- Take 2 pills on the day you remember. Take 2 pills the next day.
- Then take 1 pill a day until you finish the pack.
- You may become pregnant if you have sex in the 7 days after you miss pills.
- You must use a back-up method of birth control for those 7 days.
- If you miss 2 active pills in a row in week 3 or if you miss 3 or more active pills in a row during the first 3 weeks
- If you are a Day 1 starter, throw out the rest of the pill pack. Start a new pack that same day.
- If you are a Sunday starter, keep taking 1 pill every day until Sunday. On Sunday, throw out the rest of the pack. Start a new pack of pills that same day.
- You may not have a period this month but this is normal. But, if you miss your period 2 months in a row, call your doctor or healthcare provider because you might be pregnant.
- You may become pregnant if you have sex in the 7 days after you miss your pills. You must use a back-up method of birth control for those 7 days.
Other Concerns
- If bleeding does not begin while you are on inactive pills, you should think about having a pregnancy test.
- Please note: OCs do not prevent sexually transmitted diseases.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 07/06/2011
Copyright © 07/06/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6708
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