Hormonal Contraceptives and Acne

By:  Dr. Lilit Garibyan and Dr. Deborah Cummins

For decades female acne has been known to be a condition affected by hormones.  Treatment options have included hormonally active agents such as oral contraceptive pills (OCPs) and spironolactone. However, many questions have remained regarding the effects of different hormonal contraceptives on female acne.  A recent study in the Journal of Drugs in Dermatology (June 2016) sheds some light on these questions.  The study retrospectively analyzed 2147 women on hormonal contraceptives who presented for acne consultation.

On average, patients in the study believed that their acne had worsened with initiation of depot injections (including Depo-Provera), subdermal implants (including Implanon), and hormonal intrauterine devices (including Mirena).  Of interest, hormonal intrauterine devices (IUDs) exert their effect primarily by local effects on the uterus as opposed to depot injections and subdermal implants which work by systemic hormonal regulation.   Based on this mechanism of action, one might expect that the systemic hormonal effects of a hormonal IUD would not be significant enough to induce or aggravate acne, but the data from this study indicate otherwise.   The current study indicates that patients on average felt that hormonal IUDs did worsen their acne, suggesting that for patients concerned about their acne a non-hormonal copper IUD or other contraceptive method may be favored over a hormonal IUD.

In contrast, on average patients felt that oral contraceptive pills (OCPs)and hormonal vaginal rings each decreased acne severity.  Moreover, there appeared to be differences in efficacy among the agents based on the progestin component.  The results indicate that patients on drospirenone containing OCPs were more likely to see acne improve than patients with OCPs containing norgestimate or desogestrol.  The study suggested that levonorgestrel and norethindrone may be less effective still.  Unfortunately, drospirenone containing contraceptives have been associated with a variety of side effects including increased thrombosis (blood clots) making other OCPs such as those containing norgestimate or desogesterol preferable for most patients.