Hormonal Acne and Birth Control

Hormonal acne can be frustrating to deal with, both emotionally and economically. Many become less inclined to socialise and experience low self-esteem as they struggle with skincare issues. Investing in various skincare products can be an economic burden as well. While many different lotions and creams can help treat different kinds of acne, birth control pills can help regulate hormonal acne as they stabilise sebum production by regulating hormone fluctuations. Here is a guide on what hormonal acne is, and how the pill might help improve it.

What causes acne?

The simple answer is clogged pores.

The more detailed answer is that the pore serves as an opening to a follicle, which consists of a hair and a sebaceous gland. Sebaceous glands are responsible for secreting sebum, an oily substance with the primary function of lubricating our hair and skin and protecting them from moisture loss. Excessive sebum production combined with dead skin cells, however, can block the pore. This blockage prevents the excess sebum from escaping, eventually forming a pimple.

Worse still, these sebum-filled pores are exactly what acne-causing bacteria, P. acnes, look for in an ideal habitat. The bacteria's colonisation of the pore can exacerbate the acne and lead to inflammatory acne.

While sebum is essential for the protection of your skin, excessive sebum production can cause lots of problems. Sex hormones are one of the key players in regulating sebum production, which is why imbalances in these hormones can lead to conditions like hormonal acne.

What is hormonal acne?

Acne linked to hormonal fluctuations is typically associated with puberty, but it can happen to adults of any age. Menstruation and menopause are also factors that contribute to hormonal acne, and will be covered in the next section.

Puberty-related hormonal acne usually appears in the forehead, nose and chin, whereas hormonal adult acne often shows up in the lower part of the face, including the bottom of the cheeks and around the jawline. Hormonal acne can also present as blackheads, whiteheads, small pimples that come to a head, and cysts for some people.

How do the different sex hormones affect sebum production?

Different sex hormones work together to regulate sebum production. In women, these sex hormones are estrogen, progesterone, and testosterone.

Testosterone is an androgen, which means it is a steroid hormone responsible for reproductive development. Androgens bind to receptors in the sebaceous glands to increase the production of sebum, so essentially, more testosterone, more sebum production.

Estrogen, on the other hand, is known to have "anti-sebum" effects when present in sufficient amounts. Researchers believe it directly opposes the effects of testosterone and suppresses sebum production. Furthermore, estrogen is generally thought to be crucial in overall skin health, from increasing skin thickness and elasticity to improving skin moisture and reducing wrinkles, which is why on days 12 to 16 of their menstrual cycle (when estrogen levels are at their peak) women often find their skin to be in the best condition. It is also why postmenopausal women, whose estrogen levels are markedly lower after hitting menopause, sometimes notice increased skin sensitivity.

The role of progesterone is still unclear, but researchers have found that when progesterone levels spike, sebum production also goes up. This comes as a surprise because progesterone reduces the activity of an enzyme that activates sebum production, which theoretically should mean that progesterone reduces sebum production. Based on observational research, that does not seem to be the case.

How do hormonal fluctuations during the menstrual cycle lead to acne?

Testosterone and estrogen levels are usually balanced in the body. However, during the menstrual cycle, estrogen levels peak at around ovulation, and then plummet for the rest of the cycle. The imbalance caused by this decrease in estrogen means testosterone's effects become more pronounced. In other words, there is an increase in sebum production, making the skin oilier, and increasing the likelihood of acne. This explains why women often break out 7 to 10 days before their menstruation.

How does birth control help with hormonal acne?

Birth control pills help regulate hormone fluctuations. The synthetic estrogen found in combination contraceptive pills are present in doses which suppress ovulation. Thus, estrogen levels remain high and stable in the body, which prevents overproduction of sebum, thereby preventing acne.

Some women, however, may experience increased acne for the first three to four months of using birth control pills. This is a response to the changing hormone levels, but should subside as the body adjusts.


The birth control pill is multifaceted - it operates as a way to prevent pregnancy, regulate menstrual cycles, and as a form of acne treatment, to name a few. However, it is best to speak to your physician in order to find out what works best for you.

If you intend to get on the pill to treat acne, and are wondering which variation would be best for you, you can arrange a consultation with one of our licensed physicians to get advice and discuss these topics in further detail.