Acne Treatment: Birth Control Pills And Other Hormone Therapy

Oral contraceptives (OCs) have been available since 1960, and have been modified since then to reduce their risk of side effects. They are the favoured method of contraception by most young couples. Oral contraceptives prevent ovulation and make conditions difficult for a fertilized egg to implant on the uterus wall.
Oral contraceptives can either be made up of progestin alone (called the minipill), or of a combination of synthetic estrogen and progestin. The combination pill has estrogen, which is usually in the form of ethinyl estradiol, or mestranol (only occasionally).

The vast majority of contraceptive pills use ethinyl etradiol as the estrogen, which acts to lower levels of luteinizing hormone (LH) and increase the sex hormone binding globulin (SHBG). This in turn lowers testosterone, thus reducing the drive of the oil glands that are responsible for acne to produce excess oil.
The level of testosterone in women with acne is within the normal range, but the level is lowered in those on OC’s. Some experts believe that the normal range of testosterone for women that is set by laboratories is higher than it should be. If this is true, it could mask the results for some people whose level, although considered to be within the normal range, is actually high for them individually. In such women, their acne improves when their testosterone is lowered by taking the OC pill.

A number of different forms of progestins are used depending on the brand. The progestins can be used at a constant dose throughout the cycle (monophasic), or the daily dose can vary (biphasic or triphasic). Progestins are hormones that have a differing influence on your body, depending on their molecular structure.
Some progestins have effects that can be androgenic (acting like male hormones), while others are anti-androgenic (blocking the production of androgens or blocking androgen receptors, which allow your body to absorb and use the androgen), and some are even estrogenic (estrogen-like).