Contraceptives

Is my brand of low dose birth control pill causing my acne? I have been asked this several times so here is an oversimplified answer and explanation which I hope will shed light on this issue and help those of you for whom this is a real problem.

All birth control pills are not equal even though 98% of pills prescribed today are low dose ones. As you know, there are low dose birth control pills that contain a combination of 2 types of synthetic hormones, estrogen and progestin and pills that contain only PROGESTIN (often called the mini pill)

The synthetic estrogen in all birth control pills is of the same type (ethinyl estradiol) so it’s easy to compare doses across brands of BC pills. UPDATE to this post 2011  On May 6, 2010 the Food and Drug Administration approved Natazia as the first ever birth control pill to use estradiol valerate in the United States.

The TYPE and strength (potency) of synthetic progestin varies across brands of birth control pills.

There are 8 types of progestin which vary in strength so 2 diffent brands of pill can appear to contain the same dosage of progestin but if they contain different TYPES of progestin, the strength of the dose will vary and so may the effect it has on your body. Stay with me here because this is where acne enters the picture.

Progestin in a birth control pill helps to prevent ovulation but it can also increase ‘androgenic activity’ which in turn can encourage the devlopment of acne and other side effects reflective of male characteristics.

What is androgenic activity?

Androgenic ( ‘andros’ meaning man + genein meaning to produce). Androgenic activity begins in puberty, when androgen (male hormone) is produced by the testes (between 12 and 14 yrs in men) and the adrenal glands. Both men and women produce androgens and androgenic activity can be higher in some women than others, resulting in side effects such as excessive body hair and other male characteristics, including acne.

So depending on the type of progestin in my birth control pill, my acne could get worse? This is a possibility if your adrenal glands are producing a higher than normal level of androgen. Combine this tendency with a low dose birth control pill high in androgenicity and you can see the consideration needed as to which brand of birth control pill will suit you best. If your low dose birth control pill is one that contains a type of progestin with high androgenic activity and a low estrogen content you may wish to ask your doctor about switching to a pill with a lower androgenic activity and a higher estrogen content. I bet that will impress! Talk to a health care professional if you think your type of acne is hormonal, since a change of birth control pill may only be part of a combined treatment type of treatment for you. You may be prescribed anti -androgen drugs to reduce oil production so it’s vital that if you also prefer to use oral contraceptives as your birth control that you let your doctor ‘mix the cocktail’ for you. Examples of pills that may make your acne worse would be those at the bottom of the list below but I stress that these brands DO NOT cause acne in women with normal levels of androgen.

Low dose birth control pills with a low androgenic activity and a higher doses of estrogen help to reduce the side effects related to androgenic activity. What the effect may be on blood clots, we have yet to discover. It is swings and roundabouts and the merry - go -round of trialing low dose birth control pills can be a test of endurance.

Yaz/Yasmin

Low dose birth control pills such as Yaz/Yasmin contain a unique type of progestin (drospirenone) to all the others and also has low androgenic activity in the body which probably accounts for this brand’s popularity and success with many acne sufferers.

Low dose birth control pills listed according to androgenic activity (low to high)

A. Androgen activity based on Methytestosterone mg/28 days

B. Ortho Tri-Cyclen (Norgestimate): 0.15 and Mircette (0.15 Desogestrel) Levlen (0.15 Levonorgestrel)

C. Ortho-Cept or Desogen (Desogestrel): 0.17

D. Modicon (Norethindrone): 0.17

E. Ortho-Cyclen (Norgestimate): 0.18

F. Demulen 1/35 (Ethynodiol Diacetate): 0.21

G. Ortho-Novum 777 (Norethindrone): 0.25

H. Triphasil (Levonorgestrel): 0.29

I. Alesse (Levonorgestrel): 0.31

J. Ortho-Novum 1/35 (Norethindrone): 0.34

K. Nordette (Levonorgestrel): 0.46L. Lo-Ovral (Norgestrel): 0.46

M. Estrostep (Norethindrone Acetate): 0.53

N. Loestrin 1/20 (Norethindrone Acetate): 0.53

O. Loestrin 1.5/30 (Norethindrone Acetate): 0.80

Be aware that if you also have an issue with weight gain or suffer from other medical conditions such as endometriosis for instance, this will most likely have been taken into consideration when your doctor prescribed the type of progestin that would be most suitable for you. I hope that understanding the link between progestins, androgen activity and acne will help you to manage your low dose birth control much better. Hormonal birth control does not have to be part of everyone’s contraceptive career, however, so don’t be afraid to explore something different, ask lots of questions and be optimistic about finding the right solution for YOU. Hormones are not to messed with so a DIY approach to treating your acne just by changing your low dose birth control is not a good idea- talk to your doctor.

References:A. Cerel-Suhl (1999) Am Fam Physician 60(7):2073B. Speroff (1993) Obstet Gynecol 81:1034 C. Dickey (1998) Managing Contraceptive Pill Patients

Frederick R. Jelovsek MD, MS

http://www.fpnotebook.com/Gyn/Pharm/PrgstnAndrgncActvty.htm

Low Dose Birth Control is helping lots of women control their acne but in really severe cases of this condition, Accutane may be prescribed, which can cause birth defects if you become pregnant while on it- this means that you are taking a huge risk if you rely SOLELY  on your low dose birth control method to stop you from getting pregnant.

The excerpt below is from a recent article I found on treating acne and if you take Accutane for this condition, as well as some form of low dose birth control to prevent pregnancy, please read the warnings.  Hopefully your doctor will already have warned you that it is VITAL that you do get pregnant while taking Accutane.  It is your responsibility to make sure that you ‘double up’ by using an additional method of contraception along with your low dose birth control.

If you have questions after reading this excerpt, you know what to do- go back and discuss your birth control regime with your doctor.

TIP: Always have a pregnancy test kit on hand while you are taking Accutane.

Excerpt:

“What are the important warnings for females taking Accutane?

You must not become pregnant while taking Accutane, or for 1 month after you stop taking Accutane. Accutane can cause severe birth defects in babies of women who take it while they are pregnant, even if they take Accutane for only a short time. There is an extremely high risk that your baby will be deformed or will die if you are pregnant while taking Accutane. Taking Accutane also increases the chance of miscarriage and premature births.

Female patients will not get their first prescription for Accutane unless there is proof they have had 2 negative pregnancy tests. The first test must be done when your prescriber decides to prescribe Accutane. The second pregnancy test must be done during the first 5 days of the menstrual period right before starting Accutane therapy, or as instructed by your prescriber. Each month of treatment, you must have a negative result from a urine or serum pregnancy test. Female patients cannot get another prescription for Accutane unless there is proof that they have had a negative pregnancy test.

A yellow self-adhesive Accutane Qualification Sticker on your prescription indicates to the pharmacist that you are qualified by your prescriber to get Accutane.

While you are taking Accutane, you must use effective birth control. You must use 2 separate effective forms of birth control at the same time for at least 1 month before starting Accutane, while you take it, and for 1 month after you stop taking it. You can either discuss effective birth control methods with your prescriber or go for a free visit to discuss birth control with another physician or family planning expert. Your prescriber can arrange this free visit, which will be paid for by the manufacturer.

You must use 2 separate forms of effective birth control because any method, including birth control pills and sterilization, can fail. There are only 2 reasons you would not need to use 2 separate methods of effective birth control:

1. You have had your womb removed by surgery (a hysterectomy).
2. You are absolutely certain you will not have genital-to-genital sexual contact with a male before, during, and for 1 month after Accutane treatment.

If you have sex at any time without using 2 forms of effective birth control, get pregnant, or miss your period, stop using Accutane and call your prescriber right away.

I recommend that all patients should read the rest of this Medication Guide. Here’s the link to the FULL article

After writing about one contraceptive pill (Desogen) for acne treatment in yesterday’s post, today I am going to focus on another brand, the Yasmin (or Yaz) contraceptive pill, which has the same synthetic estrogen hormone ingredient as other combined oral contraceptives but contains a different type of synthetic progestin hormone ingredient called DROSPERINONE that is not based on testosterone. Many acne sufferers would argue that Yasmin is the best birth control pill for acne.

Finding the best birth control pill to treat your acne really is just like finding the best birth control pill to prevent pregnancy- it’s an individual affair and one brand cannot universally claim to be ideal for everyone. The effectiveness of a birth control pill for acne treatment depends on how much MALE hormone (androgen) you produce and subsequently, how much oil (sebum) your skin produces. As I stated yesterday, this is the reason why one brand of birth control pill can be extremely effective or in some cases, just not be compatible with the level of androgen being produced in certain women so their acne seems to get worse. Ethinyl etradiol is the synthetic estrogen hormone in contraceptive pills that affects the level of androgen.

If you take a closer look at the YASMIN (Yaz) contraceptive pill, you’ll see that it is a low dose, combined, monophasic oral contraceptive pill that, when prescribed to protect against pregnancy, comes recommended for its for reduced side effects but Yasmin (Yaz) also has a following with acne sufferers. Why? Because this low dose birth control pill, unlike other combined oral contraceptive pills, contains DROSPERINONE, 3mg to be exact, that appears to have an excellent effect on skin and hair.

Another benefit of Yasmin (Yaz) contraceptive pill

During the first half of your menstrual cycle, estrogen produces water in your body and the natural progesterone helps your body to get rid of it. The synthetic progestin in all other contraceptive pills is based on testosterone and does not eliminate water, hence the tendency to put on weight and feel bloated. The synthetic progestin hormone, drospirenone, in Yasmin is less likely to have this effect.

If you decide to switch to the Yasmin (Yaz) contraceptive pill from another brand, YASMIN (Yaz)  should be started on the same day that a new pack of the other brand of oral contraceptive pill would have been started.

Precautions

Yasmin (Yaz) contraceptive pill may increase your potassium levels so READ MORE about the possible side effects and warnings when taking Yasmin then have that thorough chat with your doctor to see if it will be OK for you to change over, (especially if you are currently on other types of medications) There’s also a link on that page that will take you to a site that supplies Yasmin at the best on line price. Yasmin does not protect against HIV infection (AIDS) and other sexually transmitted diseases but you knew that didn’t you?

Yasmin (Yaz) Contraceptive Pill is claimed by many women to be the best birth control pill for acne following a decade of good results. It may be that you have never contemplated taking a contraceptive pill for acne, especially if you are not sexually active so as always, no matter how desperate or embarrassed you are about your acne symptoms, discuss your options with a health professional after reading this or any other DIY research information.

PS. Tomorrow I shall explain in simple terms the differences between pill types including monophasic, biphasic, triphasic and combined .

It is widely known that the birth control pill is often prescribed for the treatment of women’s acne but do you REALLY know what causes acne, WHY the birth control pill is prescribed for this condition and which is the best birth control pill for treating acne? This  post will answer the first two questions, tomorrow’s post will help you to answer the third.

The FDA approved the birth control pill for the treatment of acne  in 1997.  If you are considering asking your doctor for one of the popular brands of birth control pills such as Desogen  and Yasmin, there are some facts you should know, especially if you have certain health problems or inherited medical conditions. I’m going to deal with each pill, one post at a time.  This post will deal with Desogen, the next one will address Yasmin, which seems to have a bigger following for acne treatment, due to one MAJOR change of ingredient.
What exactly is Desogen and How does Desogen treat acne?

Desogen is an oral birth control pill that contains a combination of synthetic female hormones to stop an egg being released from a woman’s ovary. If an egg is not released, it cannot be fertilized by a male sperm- so the woman cannot become pregnant. Most women take Desogen to prevent them from falling pregnant but others have found it to be extremely effective for clearing up their acne or significantly reducing breakouts.
Desogen does this by controlling the level of androgen (a male hormone) connected with the production of oil in our skin (from our sebaceous glands). 

Why does acne occur and what does it look like?

On the surface of our skin are little ‘breathing holes’ or pores and ‘pockets’ (follicles) out of which each hair grows. The sebaceous gland in each follicle produces oil or sebum. When too much sebum is produced, these glands become blocked and inflamed which results in pimples, ‘zits’ and blackheads - a chronic outbreak is known medically as acne.  In acute cases, these pustules can result in cysts or abscesses that become infected and scar the skin’s surface.  If the production of sebum can be decreased then the acne is usually reduced also.

Why is the amount of oil produced by our sebaceous glands important?

Since the hormone, androgen, controls the release of sebum, it is not surprising that if there is an imbalance in hormone levels, especially during adolescence, then there is going to be an imbalance in the level of sebum produced. Even though contraceptive pills work effectively on acne treatment, they are not ideal for teenagers to take if they are not sexually active (unless they have had a thorough talk to their doctor first).

Desogen and acne is a ‘balancing act’.

Since Desogen affects the level of the androgen hormone within a woman’s body, it follows that every woman’s body will be operating on varying levels of hormone production so, to some degree,  it is trial and error with a contraceptive medication  such as Desogen for controlling the level of sebum produced and therefore controlling the severity of her acne. It is for this reason that Desogen can be extremely effective or in some cases, just not be compatible with the level of androgen being produced in certain women so their acne seems to get worse.  Ethinyl etradiol is the synthetic estrogen in contraceptive pills that affects the level of androgen.

The birth control pill, Desogen, resolves acne conditions in many women

Doctors prescribe Desogen specifically for the treatment of acne in woman they consider suitable for this combination of synthetic hormones. Woman who can take Desogen will find that this birth control pill balances their hormones effectively and is the ideal drug for helping them to manage their acne.

It should be noted though, that no single treatment for acne, including Desogen, should be relied upon to treat this severe skin condition. A dirty skin, make up and bacteria also aggravate acne so topical products, such as lotions, creams and anti bacterial skin cleansers should be considered for use in conjunction with Desogen.

Always consult your doctor if you wish to try Desogen for your acne treatment and tell him which other medications/topical products you are also using.

As with many medications, however, some women find they do experience various side effects when taking Desogen.
Some common side effects include nausea, headaches, slight bleeding, weight gain (less likely with Yasmin) and possible mood changes.
After taking Desogen for three months, many of these effects disappear but you should monitor your body closely and consider a different treatment, maybe switching to Yasmin, if they persist or if they worsen.

The clearly documented risks associated with all contraceptive pills  must be noted for Desogen also, whether taken for acne or as  your preferred birth control method. These risks include stroke, blood clotting and breast cancer (although the contraceptive pill has positive benefits in reducing ovarian and uterine cancer)

Smoking is bad for you anyway but the risks of developing heart disease increase if you are on the ‘pill’.

If you do take Desogen to prevent acne, take it as prescribed by your doctor - even if you save money by buying  it on line

Missing a dose of Desogen or Yasmin will not have such a bad effect on your acne but it will affect your risk of getting pregnant if you are sexually active.
Check the leaflet that comes with the Desogen pack if you miss a pill and of course, if you are unsure as to whether you can two pills on one day, check with your doctor or medical practitioner. To reduce the anxiety or stress further, it would be wise to use additional contraception at this time.

Desogen is ideal for reducing the painful and embarrassing condition of acne in many women but unfortunately it is unsuitable for a certain percentage of woman. It is probably worth trying though as the benefits can be excellent and it is likely that if you keep in contact with your doctor you will eventually find a combination of the ‘pill’ and a topical skin product that will help you through your acne ‘chapter’.

Come back here tomorrow to see what makes YASMIN different from all the other oral contraceptives and why many women would argue that this oral contraceptive, not Desogen, is the best birth control pill for acne.