Ask Dr. Sally: Will Birth Control Get Rid of My Acne?

Blemishes! Breakouts! Acne! Pimples! Zits!

Whatever you want to call them, there’s one thing all those words have in common… we don’t want them! Personally, I didn’t experience acne throughout my teen years. However, once I hit my twenties, (and the rollercoaster of the real world began) life became stressful and my hormones decided to act up. This led to adult acne (No thanks!). When I saw a question about using birth control pills to treat acne asked on our site, I knew I had to answer it due to my personal experience.

Ask Dr Sally Birth Control for Acne

First up: Does birth control get rid of acne?

I’ll give you a quick answer to diminish your anxiety while reading this article. YES! YES, it can get rid of acne!

How does birth control treat acne?

There’s a crystal clear connection between hormones and acne. Acne is stimulated by an excess formation of oil, known as sebum, by the glands in your skin. This eventually has the talent of clogging pores and allowing bacteria to build up. Which hormone causes the production of sebum? Androgens. An example of an androgen would be testosterone. (Side note: Women typically produce lower levels of androgens compared to men.) In women, higher levels of androgen can lead to excess sebum. Therefore, taking a BC that contains estrogen (a hormone) and progesterone (another hormone) can lower the amount of androgens in your body. Voila! Acne can go away now! However, patience is definitely key. This does not happen overnight. It takes about two to three months before the skin clears up.) Why is that? Your body needs time to adapt. Plus, BC helps stop new blemishes but your current ones need to heal on their own.

Before starting birth control, it is important to discuss all options with your health care provider. Other options include antibiotics, sometimes killing the bacteria in your skin pores is all you need (but, resistance can occur!). There are both topical and oral options. You have a vast amount of options when treating your acne!

Which birth control works best?

There are tons of different birth control medications to choose from. Only four of them are FDA-approved to treat acne. These three oral birth control products contain both estrogen and progestin (a synthetic form of the natural progesterone hormone). You DO NOT want to use a BC that only has progestin – those pills can actually make your acne worse. Just because a birth control pill isn’t approved for acne, doesn’t mean it won’t work. But there are some formulations that are better than others. Ask us if you have a specific question.

The FDA approved BC products are:

  • Ortho Tri-Cyclen: This pill is approved to treat moderate acne in females ages 15 and above.
  • Estrostep: This pill is approved to treat moderate acne in females ages 15 and above.
  • Yaz and Beyaz: These pills are approved to treat moderate acne for females ages 14 and above.

Are there side effects to worry about?

There are always side effects when taking any medication. The degree of each side effect varies person to person, but some common side effects of taking birth control are nausea, vomiting, headaches, breast tenderness, mood changes, decreased sex drive, weight gain, and change in menstrual flow. Serious risks are rare and include heart attack, stroke, and blood clots. Some people shouldn’t take any birth control pills if they have a history of heart disease, hypertension, blood clots/blood clotting disorders, or smokers over the age of 35. (Side note: If you’re a smoker, let’s help you in trying to quit!)

Birth control pills should not be used to treat acne by girls who have not had their period yet.

How can I get the maximum benefit of taking birth control pills when trying to get rid of my acne?

  • Ask your doctor for topical medications that you can use while also on BC.
  • Tell your pharmacist or physician about any other medications that you are taking (there can be drug interactions!).

 

BiancaAbout the Author:

Bianca S. Faridian is a third-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Blog picture from Jade via Flickr.

Ask Dr. Sally: What Can I Do For Endometriosis Symptoms Since My Birth Control Refills Ran Out?

I was diagnosed with endometriosis 6 years ago and my symptoms improved by taking Beyaz birth control.  My doctor unexpectedly closed her office last month and I have been unable to refill my prescription.  I’ve been off the birth control pills for 3 weeks and I’m experiencing difficult side effects including dizziness, headaches, cramping, and fatigue.  I am not happy with how extremely my body is reacting to the hormonal change.  I would like to try different ways to treat the symptoms of my endometriosis.  I would LOVE to hear more about my options to manage my current symptoms and long-term pain management.

Endometriosis Birth Control Sally Rafie(photo credit: Growley-Ferret via Flickr)

Up to 10% of reproductive-age women have endometriosis, a condition where the endometrial tissue typically found in the uterus exists outside the uterus.  Endometriosis can have a range of symptoms and you’re clearly experiencing some intolerable ones.  Women may experience pain in many forms…just before and during their periods, with bowel movements, with urination, with sex, or general pelvic or back pain.  As many as 1 in 5 women who have endometriosis will experience infertility.  Since you are not trying to conceive at this time, the treatment will be focused on reducing your pain and other related symptoms.

Using A Pain Reliever

To alleviate some of the pain, over-the-counter anti-inflammatory medicines, such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken.  This helps reduce the inflammation that may be contributing to the pain.  These medicines should be used and not acetaminophen (Tylenol) because that works in a different and in this case, less effective, way.  Talk to your health care provider about appropriate dosing since you may need more than what is typically recommended for these over-the-counter medicines.

Manipulating Hormones

To really get at the root of the problem and regulate the hormones, we have to manipulate the hormones by taking hormones.

Birth Control Pill

The first step is to try a hormonal birth control such as a birth control pill with a combination of estrogen and progestin hormones.  When taking a combination birth control pill, eventually the endometrial tissue stops building up.  Talk to your health care provider about which formulation would be best for you.  Typically, a formulation that is progestin dominant and contains a more androgenic progestin will be most effective.  The pills should be taken continuously, and the inactive placebo pills skipped, to get the maximum benefit of reducing pain.

Beyaz is similar to Yaz, a popular birth control pill, with added folic acid (to prevent neural tube defects in case of pregnancy).  While this formulation is progestin-dominant, it is not an androgenic-progestin.  An alternative to try would be to try Loestrin 1/20 or Microgestin 1/20.

Birth Control Shot

Another form of birth control that can help relieve symptoms of endometriosis is the injectable shot, known as DepoProvera (depot medroxyprogesterone acetate).  This shot is given only once every 3 months.

Birth Control IUD

The Mirena intrauterine device releases a progestin hormone to alleviate the painful symptoms of endometriosis similarly to the birth control shot.  The hormone is released locally in the uterus and therefore has fewer side effects such as weight gain and bone loss.  This is also a highly effective form of birth control that, once inserted, works to prevent pregnancy for five years.

Oral Progestin Hormones

If you are not interested in preventing pregnancy while treating endometriosis or this treatment doesn’t give you enough relief, there are other options.  Pills with higher doses of progestin hormone can be used and work similarly to prevent buildup of endometrial tissue.  Side effects may include weight gain and breakthrough bleeding.

Gonadotropin-Releasing Hormone Agonists

These medicines last much longer than the other hormones.  This is a good option for women who did not respond to birth control pills.  These medicines, known as nafarelin nasal spray (Synarel), leuprolide shot (Lupron Depot), and goserelin shot (Zoladex), work by reducing estrogen levels in the body, creating a state similar to menopause.  This medicine has some uncomfortable side effects (see previous post).  Combination estrogen and progestin hormones or progestin alone can be added on to manage these side effects.

Danazol

This is a derivative of the hormone testosterone and was the first treatment actually approved for endometriosis.  It works by counteracting estrogen and comes along with the effects of testosterone, such as unwanted hair growth, mood changes, acne, and deepening of the voice.

Surgery

Surgery is the closest thing to a permanent fix to this problem.  Although one surgery may not be enough and we always have to weigh the risks of surgery with the benefits.

Problematic tissue can be treated by laparoscopically visualizing the lesion and either removing it or ablating it with a laser.  For more severe endometriosis, there are other procedures to interrupt nerve fibers.

Women who are not planning to become pregnant can consider a hysterectomy to remove their uterus, potentially along with the ovaries.  This basically puts a woman in menopause, so there are other symptoms to manage there.

Natural Options

There are some natural options that may help cope with a minimal or mild form of this condition.  See the list in a recent post on this subject.

I hope this information is helpful and guides the discussion with your healthcare provider.

Got a question? Send it to us.

— Dr. Sally Rafie

This is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment, and is not meant to replace a one-on-one relationship with a healthcare provider.

Ask Dr. Sally: What Can I Take For Painful Periods?

We received another great question and here’s our response…

I have fibroids in my uterus and they make my periods really painful.  I’m looking for something I can take for relief from the pain and I prefer natural therapies. What do you recommend?

(photo credit: TipsTimes via Flickr)

Many women suffer from painful periods.  There could be different reasons for painful periods and fibroids are a common cause.  Fibroids are benign tumors that grow in the walls of the uterus.  As a result, women with fibroids may have heavier and more painful periods.  They may also feel bloated, have lower back pain, have pain with defacation, or feel the urge to urinate.  If there are no symptoms, there is no need to treat and the fibroids will shrink on their own over time, especially after menopause when the body stops producing estrogen. If there are bothersome symptoms, then these are the treatment options that can be considered first:

  • The birth control pill.  The combination birth control pills (estrogen plus progestin hormones) work really well to have lighter and more predictable periods.  The birth control pills can also be used to suppress the period altogether.  In fact, the bleeding that women experience when they are on the birth control pill is not a natural period.  It is actually the body’s response to withdrawing from the hormones in the birth control pills during the hormone-free or placebo pills.  There is no medical or health benefit to this withdrawal bleeding and it’s safe to skip it, though some women like the reassurance of a monthly period.  If interested in skipping periods, the same pills can be taken on an extended cycle to reduce the frequency of periods to once every few months or they can be taken on a continuous cycle to skip periods for as long as desired.  Using birth control pills to reduce pain from fibroids has the added benefit of preventing pregnancy in women who are looking for that.  The birth control ring and patch work the same way as the pill.
  • Mirena intrauterine device.  This device is placed in the uterus and releases a progestin hormone for 5 years.  It helps women have lighter and less painful periods.  Up to 20% of women with a Mirena will stop having periods altogether.
  • Ibuprofen. This is the most popular medication from a class known as non-steroidal anti-inflammatory agents (or NSAIDs for short). Another option is naproxen. These medications help reduce cramping and heavy bleeding. Most women have one of these in their medicine cabinet, so it is readily accessible if needed. Ibuprofen can be taken in high doses several times a day for the first few days of menses. There are risks with taking these medications, so please consult with your healthcare provider before taking ibuprofen or another NSAID regularly. Aspirin should not be used for this purpose and can actually increase blood loss.
  • Lysteda.  This is the brand name for tranexamic acid and prevents blood loss.  It is an oral medication taken 3 times a day for up to 5 days at the beginning of menses.  Fewer doses are needed in women who have kidney problems.
  • The birth control shot. Also known as Depo-Provera.  The progestin helps counteract the estrogen and may help the fibroids shrink.  Prevents pregnancy too.
  • Oral progestin.  If a woman cannot take estrogen because of a medical contraindication, then a high-dose progestin is still an option.  Options include medroxyprogesterone and norethindrone taken on a daily basis.

If there are still bothersome symptoms after trying those medications, then these are the more aggressive treatments to consider:

  • Lupron or Zoladex.  These medications actually help shrink the fibroids that are causing the problems.  They are injections and work by reducing estrogen production.  For this reason, they can cause side effects that mimic menopause.  They are generally only used for a few months before surgery due to cost and side effects.
  • Surgery.  The fibroids can be surgically removed (myomectomy) or the entire uterus can be surgically removed (hysterectomy).  As with all other treatment options, it will be important to weigh the risks of these surgeries against the benefits.
  • Non-surgical procedures.  These procedures are an alternative to surgery.  Options are blocking uterine arterines (uterine artery embolization), removing the endometrial lining (endometrial ablation or hysteroscopic resection).

For those who prefer natural approaches to managing the discomfort, you’ll be happy to hear there are options for you.  Natural remedies may not be as effective for painful periods caused by fibroids.  Especially if the heavy periods are causing other health problems like anemia or infertility, which would have their own treatment options.  Some of the natural remedies that may generally help with menstrual cramps and pain include:

  • Heat pad.  The heat and pressure applied with a heat pad are very comforting.  Check out our handmade TheraPillow with natural contents.
  • Hot bath.  Again heat helps.
  • Magnesium.  This is essentially a salt that helps relax muscles.  You can take tablets, drink it, or soak in it.  Check out our handmade Soothing Salt satchels that can be placed in a bath.
  • Exercise.  Gets the blood flowing and brings oxygen to the muscles in your uterus to help provide some relief.  Yoga may be a good option.
  • Massage.  When doesn’t a massage help?
  • Acupuncture.  Not a lot of science behind this one either but it’s low-risk and may help.
  • Eat fruits and vegetables.  Women who eat a few servings of fruit and vegetables a day have lower rates of fibroids than women who eat one or no servings.  This finding is just an association and we can’t make any conclusions about causation.
  • Plants.  Maca root is used for many sexual and reproductive health issues, including menstrual cramps.
  • Avoid soy.  Soy products, like tofu, have phytoestrogens in them.  These compounds act like weak estrogens in the body and can theoretically contribute to fibroid growth and cramps.

I hope this information is a good start.  I’m always happy to discuss any of these treatment options further and help you make a decision.

Got a question? Send it to us.

— Dr. Sally Rafie

Ask Dr. Sally: Forgot to Take My Pill

We welcome questions from readers.  Here’s a question we got this week and our response…

I take my pill like clockwork around 7 am when I get ready. Today I stayed in sweats and just remembered to take it now!  What should I do now?

Late Birth Control Pill(photo credit: Evan via Flickr)

This happens all too frequently, so do not panic!  Before answering this question, it’s important to clarify that you are taking a combined birth control pill.  Another important piece of information is that you realized you missed your morning pill in the early afternoon, so it is only a few hours late.

If a pill is late (it has been less than 24 hours since the last dose was due), the late pill can be taken right away and the daily regimen continued afterwards.  So go ahead and take your late pill now.  You will then continue taking the rest of your pills at the regular time.  In your case this means take the late pill today (a few hours late) and the next pill tomorrow morning.  In other cases, it may mean taking the late pill and the next pill in the same day.  For example, if a woman usually takes her pill every night before bed but forgets a pill and remembers the following morning, she can take the late pill in the morning and the next pill at the usual time at night.

Being a few hours late will not affect the effectiveness of your birth control.  So you don’t need emergency contraception (also known as the morning-after pill) unless you missed other pills recently.  A pill is considered missed if it has been more than 24 hours since it should have been taken.  You could consider taking emergency contraception IF you had missed active pills (pills with hormones) either in the last week of your last pill pack or earlier in this pill pack.  You don’t need to use another form of birth control either since your birth control pills should prevent pregnancy.

I hope this information alleviates your concerns.  It sounds like you’re generally able to stick to your schedule.  If that changes, you can either change your regular pill schedule to a different time of day or think about changing to an easier method.

Ask Dr. Sally: Taking My Pill After a Blood Clot

We received another important question from a reader…

If your blood clot symptoms (pain in legs and arms) go away, does that mean it’s OK to keep taking your birth control pills?

Birth Control Pills and Blood Clot

(photo credit: eflon via Flickr)

One of the potential side effects of birth control methods that have estrogen is a blood clot.  This is a serious side effect.  When blood clots form in the deep veins in your body, usually the legs, that’s called deep vein thrombosis.  These clots can lead to leg pain and swelling.  If you are having these symptoms, contact your doctor for evaluation.

If a clot dislodges from your leg, it can potentially travel to your lungs.  A clot in the lung is called a pulmonary embolism and will cause difficulty breathing.  If you are having unexplained shortness of breath (not after exercise or other activity that would cause this normally), chest pain when you take a deep breath or cough, lightheadedness, or coughing up blood, seek medical attention immediately.

If you are diagnosed with blood clots, you can no longer use any birth control method with estrogen in it.  This means no OrthoEvra patch, no NuvaRing vaginal ring, and no combination birth control pills (like OrthoTriCyclen, Loestrin, Yaz, etc) ever again.

Birth control pills with progestin only would be safe to use if you’ve had a blood clot.  Any other methods that have progestin only, like the DepoProvera injection, Nexplanon implant, Skyla IUD, or Mirena IUD are safe.  The copper IUD is safe to use, as well as any barrier methods like condoms.  So you still have a lot of great options available to you.

It will be important to let your healthcare providers, including your pharmacist, know about this new medical condition or medical history.  Your providers will help make sure you don’t receive an estrogen-containing birth control method in the future.  Your providers can help advise you of other medications or situations that may increase your risk of another blood clot, like being pregnant, and provide prevention when appropriate.

Thanks for sending us your question.  Don’t be shy to ask your pharmacist any questions about your birth control pills or other birth control methods.  We look forward to answering many more questions!

Ask Dr. Sally: Took the Wrong Pill

We received our first question from a reader today!

Just realized I took my pill today (Wednesday) but I took the wrong day’s pill (Friday).  What now?  Are they pretty interchangeable at that part of the month?  I take a generic version of Yaz.WrongBirthControlPill

Let me alleviate your concerns!  Yaz is a combination birth control pill, which means there is a combination of both estrogen and progestin hormones.  This is the most popular type of birth control pill and a minority of women use progestin-only pills.  Among the combination birth control pills, there are many different formulations.

Yaz has 24 “active” pills, all with the same doses of both hormones, and 4 hormone-free or “placebo” pills at the end of the pack.  The two active pills are the exact same.  So in this case, the fact that the wrong day was punched out and taken does not make any difference.  It’s just important to remember this and continue taking one active pill a day until you are back on track later this week.

For women taking other birth control pills, the response to this question would depend on the formulation.  Some pills have different doses of hormones every week or sometimes the dose changes after just a couple days.  Your pharmacy, doctor’s office, and community or family planning clinic are resources if you find yourself with a contraceptive mishap.  When asking a question, be sure to let your pharmacist, doctor, or other clinician know which birth control pill or other method you are on…know the medication name!  This way, you’ll get an answer specific to the medication you are on…and this goes for all medications, not just birth control.

Thanks for sending us your question.  Don’t be shy to ask your pharmacist any questions about your birth control pills or other birth control methods.  We look forward to answering many more questions!