Acne and the Birth Control Pill: How Do Oral Contraceptives Work?

Walking through a pharmacy, there are all sorts of topical creams and products designed to get rid of the inflammation, irritation and redness characteristic of acne. Treatments for acne symptoms can often be very effective; however, many fail to deal with the source of the problem. Acne is often referred to as a hormonal disorder, one that can appear during puberty with the initial release of certain hormones and remain present even many years into adulthood. While it may seem that hormones would be even harder to control than acne symptoms, this is no longer the case, and hormonal acne treatment can now be a very effective way to minimize acne in women. So how does all this work?Hormones are chemicals that are created in one part of the body and travel in the bloodstream to another, where they trigger specific processes or functions. While ultimately helpful, some hormones can affect us in ways that are less than desirable. A prime example of this is the role that androgen hormones have on creating acne in women. Androgens stimulate the sebaceous glands, causing the production of sebum. In healthy skin, sebum travels up hair follicles and pores to the skin’s surface, lubricating the skin and protecting it from environmental damage. An over-production of sebum, it has been suggested, can actually clog these pores and follicles. This is not a problem in itself; the problem occurs when natural skin bacteria are caught in the pores and follicles with the sebum. These bacteria are thought to break down sebum and reproduce rapidly, irritating the pore walls, causing inflammation and acne.In healthy skin, androgens are kept in balance, and sebum production is optimal. Experts suggest that acne problems in women occur either with an overproduction of androgens, an under-production in estrogen to counteract those androgens, or when a woman has a genetically predetermined sensitivity to androgens. This last option is thought to be the most common reason for acne, and oral contraceptives containing estrogen and progestin can be very helpful in limiting the effects of androgen, thus negating the sensitivity.Progestin is a synthetic hormone that can is taken orally to mimic the effects of the hormone progesterone. Progesterone is reported to be both harmful as well as helpful when it comes to acne. It is thought to mask the effect of androgens through bonding with it to maintain normal sebum production, but it can also encourage fluid retention in the skin, causing pinched-off, blocked pores. When progestin is combined with estrogen in birth control pills (BCPs), ovulation is prevented…but there are also three key anti-acne effects that have been reported. The pill prevents formation of androgens, reduces the amount of androgens in the bloodstream, and blocks androgens from reaching the receptors that allow them to initiate an action.With varying estrogen and progesterone levels in each pill, choosing one is as personal as choosing a pair of shoes; what works for one woman may not work at all for another. Often, women may use a certain oral contraceptive for a while and then find that it is no longer compatible with their own natural hormone levels, precipitating a change to a new pill. There are some concerns associated with oral contraceptives, and before going on the pill or any acne medication, women should have a serious discussion about these concerns with their doctor. For many women, however, oral contraceptives are an effective acne medication recommended by many doctors and dermatologists.

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