Acne (young people)

Acne treatments: hormonal contraceptives

Hormonal contraceptives are sometimes taken by women to help with acne. The idea behind these as an acne treatment is to regulate hormonal changes which might be causing or contributing to spots. Some women we spoke to had tried oral hormonal contraceptive pills as an acne treatment. Most had taken the combined pill (known as ‘the pill’) which contains both oestrogen and progesterone. Hester had also tried the progesterone-only pill (‘the mini pill’). As well as standard combined pills, there are versions that that contain an anti-testosterone, such as Dianette which Naomi and Sarah had taken. Most people had tried a few different brands of contraceptive pill.

Deborah used the hormonal contraceptive pill to help her acne.

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Age at interview: 25

Sex: Female

Age at diagnosis: 12

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With hormones, is there anything that you've tried before? For example the contraceptive pill?

Yeah, absolutely. They do, they do get a little better when I'm on the pill. And sometimes I'm just on the pill just because it does mediate my skin a bit better. Rather than I'm needing them for contraception. So I definitely do prefer to be on the pill because it, it helps my skin. Doesn't make it go away entirely, and I still get a monthly fluctuation in my skin. But it's less noticeable. I do try and have a, a couple of months off every, every year or so when I'm on the pill. And I can definitely notice then my skin get considerably worse. I haven't noticed a difference between them, though. Like I've tried quite a few different pills, and I don't, I haven't found one that's miraculously cured everything. So just sort of pick them on the other side of things, rather than acne being my main, main prioritisation. I don't think there's any other medication that's impacted them that much though.

Hester doesn’t take the combined contraceptive pill because she’s had migraines before.

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Age at interview: 21

Sex: Female

Age at diagnosis: 15

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You mentioned about migraine, would that have been the contraceptive pill that you couldn't take?

Yeah. I think it's, I think it's the combined that you can't take. And I don't think my GP had realised, to be honest, that that- he'd never asked me. But I think when I came to uni, because they're so much more on it with, they just, obviously the doctors prescribe a lot of contraceptives , she did-. She just checked the list with me. And I said, “That's something that no one's ever asked me before.” And she was like, “I'm quite surprised, because yeah, you're not, you're not supposed to give it to people with that.” So then I went on the progesterone-only, when I was on my Roaccutane (isotretinoin). And yeah. That was, it kind of surprised me that if it was a big deal, that I hadn't been asked. But I don't know if it's that my GP didn't prescribe many contraceptives, or I've, he just assumed it wasn't a problem. Because I think at that point I'd definitely, I'd had- and it was only one migraine. So probably it never would have occurred to me to have checked. But, yeah. I think, yeah. But it was a bit surprising for me, but. I guess it's just kind of taught me that I probably do need to check, when I get prescribed things, or like to have a look at the list of it and just check for yourself. Cos I guess GPs are human and they probably do, they might just forget or, but. Obviously it's your health, so it's quite, it might have quite significant repercussions for you.

The timing of when women tried (or were offered) hormonal contraceptives varied. Naomi, Emma and Nina had been offered hormonal contraceptives when they were around the age of 12/13 – they all felt uncomfortable about this. Naomi remembers thinking it was “really weird” taking the pill when she was “so young”. Nina thought it “really odd at the time” when she was offered the pill and declined because she was worried about what the other girls at school would think. She was also concerned that it might affect her puberty growth, adding that she was put off it as a treatment with “an equal mixture of uncertainty or fear and like embarrassment”. Hester was 15 when her GP suggested she try oral hormonal contraceptives for acne but felt this was still too young for her. Others were fine about taking ‘the pill’ as an acne medicine and weren’t fazed about its other use as a contraceptive.

Hester started on antibiotics as an alternative acne treatment to hormonal contraceptives.

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Age at interview: 21

Sex: Female

Age at diagnosis: 15

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So I took antibiotics for quite a while. I think that's because I was a bit younger, and they didn't want to give me the pill. Because a lot of my friends who have bad skin often get given the pill now and I think that's because, because we're a bit older. And it wouldn't be unusual for like a 20 year old woman to be on the pill, whereas I think if you're 15 it's a bit-. So they started me on antibiotics, I was on them for quite a while. Tried a lot of different topical things, so. Can't remember exactly. I think basically most of them that the NHS offers. So like gels and creams and lotions, and probably changed, changed to different ones quite often. But, yeah. And then I switched to the pill, cos the antibiotics weren't really working. Also the- I think after, because it was so long term, I think it started to affect my sort of, my tummy quite a bit. And, yeah, I wasn't very happy. It kind of gave me like almost IBS-like symptoms. And my Mum was like, “Maybe it's a good idea to get off antibiotics, because you've actually been on them for two and a half years,” [laugh] which isn't, isn't good. So then I changed to the pill and I found that wasn't massively effective. Cos I think, yeah. And then I tried, I tried different pills as well. And then at one point, and I was always on, always on the medicine with a topical thing. And then at one point I was on all three together, when it got really bad. And I think, I've also tried, I tried moments where I'd just go off all medicines, see what happened. And it would get really bad.

Abbie was offered the pill but declined for a number of reasons.

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Age at interview: 17

Sex: Female

Age at diagnosis: 13

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And I know another option they gave me was to go on the Pill, which like could help. But I was quite young and I didn’t really want to do that. So I think that’s why they went for the, like the gels and the creams and the stuff before Accutane (isotretinoin).

Yeah. Could I ask why you weren’t keen to go on the Pill at that point?

So I think when like I first started going to the GP then they didn’t even mention that. And I think it was when I was around 15 that they were like, “Oh, yeah, the Pill would work.” And I knew one of my friends had gone on the Pill for acne like purposes. And like she, me and her are quite like sporty and she told me that with going on the Pill she’d put on weight. So I didn’t really want to go on it because I didn’t really wanna put on weight. If that sounds kind of bad. But that was one of the main reasons I didn’t really wanna go on it. And also because I wasn’t, like I didn’t need contraception. And I think that was just, I just found it a bit pointless. I’d rather have done something else specifically for my acne rather than something that might help my acne.

As with antibiotic tablets, taking oral contraceptives meant having a routine and getting repeat prescriptions. Marga takes her pill at the same time as her morning antibiotics. She doesn’t like taking so many tablets every day though and this is why she declined antidepressants when offered. At points, both Naomi and Hester had taken a combination of topical treatments, antibiotics tablets and the contraceptive pill for acne.

Oral hormonal contraceptives can have side effects and risks. Some people find they had mood changes whilst taking the pill. This is one reason why Nina hasn’t taken oral contraceptives for acne, or isotretinoin (e.g. Roaccutane). Sarah says oral contraceptives helped her skin but affected her mood, caused mouth ulcers and weight gain. Hester also found she gained water weight whilst on the pill. Molly gets more spots around her period and thinks that hormonal contraceptives might help her acne. She’s worried though about increased chances of blood clots/deep vein thrombosis.

Sarah found the side effects from the contraceptive pill outweighed the benefit for her skin.

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Age at interview: 22

Sex: Female

Age at diagnosis: 16

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I’ve been on a number of different pills. All of them have made me quite volatile. The first one I was on which was Dianette, which was kind of prescribed particularly because of the high oestrogen levels in the hope that that would help my acne. That gave me really bad mouth ulcers which is not listed as a side effect of Dianette but they stopped the minute I stopped taking it and I can’t think of anything else that would have caused that to happen. I think all of them also made me gain weight which, I mean, I‘m aware that this is very silly because I could stand to gain a bit of weight but I did not like it. And in general I just found that I was happier off them than on them, in spite of the impact they had on my skin, and without fail every contraceptive pill I’ve been on has improved my skin.

So for you, it was sort of weighing up the side effects against the improvement in your acne at that point?

Yeah.

Molly hasn’t tried hormonal contraceptive pills because of a family history of deep vein thrombosis. She wants to have a test to find out her risks of this.

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Age at interview: 20

Sex: Female

Age at diagnosis: 11

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I had like one doctor offer like, when we were talking about the contraceptive pill as a thing, she wanted to do like a test, like a lipid test or something like a scan. And then she was, but she was like only there for a little while and then I went to see another doctor and they were like that’s really, it might not be lipids I don’t know much about science, but they were like that’s a really expensive test, what she wanted. It’s basically to see like whether I would have like whether I would be inclined to like have a blood clot, which I wouldn’t necessarily like to know either like I, so I probably would’ve said no. But yeah, when I went to s-see another doctor they were like ‘those tests are really expensive and like we don’t really use them for like this purpose’. Cos I wasn’t like going because I was, I felt like I was at risk of having a blood clot. That has been, so that’s been offered to me but that was kind of blown out of the water by another doctor and I would’ve turned it down if I’d been offered it because I just wouldn’t, I probably wouldn’t wanna know.

There were mixed experiences with how effective oral hormonal contraceptives were for controlling acne. Marga and Deborah found taking the pill reduced their spots within a few months. Alexandra didn’t notice much change. Hester thinks one hormonal contraceptive pill gave her more frequent breakouts. The impact on acne was often weighed up against other factors, such as whether there were side effects or if oral contraceptives were wanted for sexual health reasons. Marga was “determined to stay on” the pill as she found it was helping her skin. Naomi has tried other forms of contraception but found the implant (a hormonal contraceptive strip inserted under the skin of the arm) brought back her acne and the copper coil (a non-hormonal contraceptive inserted into the cervix) was too painful. She went back to taking oral hormonal contraceptives but doesn’t want to take many tablets in the long term.

Naomi’s acne returned when she tried the implant (hormonal contraceptive). She had recently stopped taking isotretinoin (Roaccutane) and so didn’t want the contraceptive pill.

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Age at interview: 22

Sex: Female

Age at diagnosis: 9

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And what about when sort of before you went on the third treatment of Roaccutane (isotretinoin), when it resurfaced, when you had the implant?

Yeah, yeah that was really awful because I’d only sort of a few months before I finished the previous one and I didn’t want to be taking a pill anymore every day because having taken so much medication all my life I just, I thought, you know, I want to be able to get up in the morning and not have to remember to take a pill, not that I forgot but I just, for me it was just another form of medication and I didn’t want that anymore. And so, you know, I went to the GP and they said, you know, “Try this implant” and initially I thought ‘oh well, I’d rather have a coil because they don’t have hormones in’ and like . But when I went to the like sexual health clinic place they were like, “Oh, don’t worry, like we can, we can just put this implant in, it’s really easy and it’s like much less painful than a coil.” and, you know, “If you have any problems, we can just take it out and it’ll be fine” and I think I should have stuck to my guns and said, “No,” but I was like, “Yeah, you know, I might as well.” And so they put it in and within a couple of weeks my skin was just ruined and so I, I was like well maybe I should just wait a bit ‘cos it might improve but it just didn’t get better. So I went back to the clinic place and said, “Please just take this out, I don’t want it here.” and obviously that whole process like took time as well because I had to wait to see if it improved then I had to phone and make an appointment and they didn’t have one for like four weeks. And yeah so then I had that taken out and then I was hoping that that would make things better but it just never really, like I waited for a few months and nothing happened and that was when I was just, I was so upset I just thought like ‘I just want to go private because I can’t face waiting again’.

Marga’s on the pill for her acne. She’s noticed that GPs keep asking her about switching to another contraceptive.

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Age at interview: 24

Sex: Female

Age at diagnosis: 18

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The fact that I'm on this Yasmin (contraceptive pill) sort of suggests that they said, “Well, it might be that your hor-” The first thing they stuck me on before they stuck me on any topical skin stuff or on pills was Yasmin. They said, “It could be the fact that you’ve got a hormone imbalance and the cycle-,” and they asked me at the time, “Do you get worse spots around the time of your period?” And I said, “Oh, I think so.” So they stuck me on that. I don’t think it makes that much difference to me really. Maybe like a few but . I mean I definitely think the Yasmin helps.

Mm

Interestingly however, I don’t know whether this is relevant, they always try and take me off it at the doctors. They say, “Have you considered any other contraceptions?” and I know it's because of they’re expensive [laughs]. And they-, every single time I go to the doctors and I ask for a re-prescription, or they notice that I'm on Yasmin, they’ll say, “Have you considered other forms of contraception?” or “Would-,” you know, “Would you consider going off this pill?” And then I say, “Well it's actually for my-, I'm partly doing it because of my skin,” and then they say, “OK, fair enough.”

But it's every-, honestly, every single GP.

That’s very interesting.

Yeah. And it actually started to annoy me because as I really considered last time to say, “Look, I don’t-, can you put on my notes I don’t want to go on off, go off it because I get asked every time.” I might do that next time they ask [laughs] but.

Do they say why that they're asking?

No, but I think I've made an assumption that it's about cost. Because it's every single GP and I-, something sounds a little bit suspicious there, I don’t know.

Mm, yeah

But then when I say that I'm on it for my skin and they say, “OK fair enough.”

There’s more about contraception in the section on isotretinoin side effects and risks because women are often required to have a reliable form of contraceptive (such as the pill) whilst taking this. This is because of risks of abnormal development of the baby if a woman taking isotretinoin became pregnant. Some of the women we talked to didn’t have to take contraceptives whilst on isotretinoin because they were so young, but some still had to do pregnancy tests every month when getting their next prescription for isotretinoin.