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Does getting off of birth control cause acne?

Does getting off of birth control cause acne?

Kindara | February 1, 2021 | Ask Kindara

Whether you've been on hormonal birth control (HBC) for 1 year or 10, it's important to know what might happen when you stop taking it (1). You might experience mood swings, headaches, withdrawal bleeding (the bleeding that occurs when your body is reacting to a cessation of hormones), and... acne. 

Maybe you escaped adolescence without the acne scourge or started taking hormonal birth control to clear it up; either way, having a sudden breakout on your skin may be jarring. Why does it happen, and what can you do? Let's get into it.

What is hormonal birth control and what does it do?

Hormonal birth control is contraception that is powered by synthetic hormones either estrogen and progestin, or progestin only. Methods of hormonal birth control include birth control pills, the contraceptive implant, injection, patch, the vaginal ring, and certain IUDs (intrauterine devices). Depending on what kind of hormonal birth control you're on, it will either prevent ovulation or thicken the cervical mucus to prevent sperm from traveling to fertilize an egg, or both. Hormonal birth control does come with side effects, and, you guessed it, they vary depending on what kind you're using. Some of the more common side effects include spotting, breast tenderness, nausea, and headaches (2, 3). 

In addition to preventing pregnancy, hormonal birth control can also reduce pain caused by your period and endometriosis, as well as reduce the risk of ovarian cysts, and ovarian and endometrial cancer (4). 

What happens when you stop taking hormonal birth control?

Once you discontinue hormonal birth control, whatever symptoms or conditions that it was mitigating will likely return because your body returns to the hormone levels that existed before you went on the birth control, which brings us to...acne. 

If you look up "post birth control acne" online, you might come across something called post birth control syndrome (PBCS). PBCS, according to naturopathic doctors, refers to the symptoms that can accompany going off the pill, like acne, weight gain, anxiety, depression, migraines, and an increased sex drive . PBCS isn't an officially recognized medical condition, and not everyone experiences these effects after they stop the pill, but you may find that your body is behaving differently because of the change in hormone levels. So even if you didn't have acne before the pill, you might find yourself checking out  blemishes on your face afterwards (4). 

Why do you experience post-HBC breakouts?

Acne occurs when hair follicles become clogged with oil and dead skin cells, and it can be triggered by bacteria, changes in your diet, certain medications, and hormonal changes — like those that come with stopping hormonal birth control (5). Certain kinds of hormonal birth control are super effective at suppressing acne since they inhibit the flow of androgens. Androgens, such as testoterone, are the hormones responsible for the development of the cisgender male reproductive system, although cisgender women have androgens as well). Androgens also promote the generation of sebum, an oil in the skin, which then results in acne (6). Oral contraceptives may actually work better than antibiotics for the longer term management of acne (7).

If you've been on HBC for a really long time — say you started the pill when you were 15 and now you're 35 — you might have forgotten what life was like in your pre-HBC body. Therefore, when you stop HBC and acne returns, you might panic. "When women develop acne after stopping birth control, it's usually due to the fact that the birth control is masking the acne that is being caused by the endogenous hormones produced by the body," says Susan Marks, MD, of Vive Dermatology. "Once the hormonal influence of the birth control agent ceases, the body resumes its usual production of hormones." In other words, after you stop taking HBC, there's a spike in the hormones that were being suppressed by the contraceptives, and that can lead to breakouts, which will likely cease once your hormones regulate. 

What can you do about post-pill acne?

It's understandable to not be psyched about the presence or resurgence of acne, but no need to panic. "This situation is usually temporary," says Dr. Sashini Seeni, a General Practitioner of Medicine with DoctorOnCall. "Testosterone will calm again to the normal levels as it was." According to Seeni, some doctors may recommend being vigilant about your skincare routine in the months leading up to going off hormonal birth control. 

If you have polycystic ovary syndrome (PCOS) or a hormonal imbalance, however, acne could be an ongoing problem.  Until the underlying hormonal and metabolic issues are treated and life-style modifications (ie: healthy diet and exercise) are part of everyday life, cosmetic treatment will only offer a temporary relief (8). 

If you're already finding yourself dealing with post-pill acne, you may want to make some changes in your daily skin maintenance, such as choosing a pore cleanser that contains salicylic acid, an ingredient which promotes natural exfoliation, and has few side effects (9). Zinc has also been shown to have favorable effects on acne, and you can apply it or take it as a supplement. It shouldn't be used as a substitute for other acne treatment, though (10). Another option may be Aczone, a topical acne medication containing dapsone, an anti-inflammatory gel shown to be effective in treating mild to moderate acne with few side effects (11). However, if you're discontinuing HBC with the intention of trying to conceive, you'll want to consult your doctor; dapsone is a new acne treatment so not much is known about its impact on pregnancy (12). Spironolactone, a medicine used in the treatment of congestive heart failure, cirrhosis, hypertension, may also be a good option — it inhibits androgens and therefore sebum production, and while it has side effects, studies show it's generally well tolerated (13). Because it blocks hormones, it's not for those who are pregnant or trying to get pregnant (14). Always check with your doctor before starting a new supplement or medication to make sure it’s right for you and your situation.

If you find that your acne isn't clearing up but instead getting worse, or just being stubborn in resolving, you should definitely see a doctor. Remember that while it might seem like hormonal birth control is a cure for issues such as acne, it's actually a temporary resolution, so finding out what's going on beyond your HBC is an essential part of getting and staying healthy.

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About the author

Chanel Dubofsky's writing on gender, reproductive health, popular culture, and religion, can be found in New York MagazineLilith, RewireModern Fertility, Cosmopolitan, and others. She lives in Brooklyn, New York. Follow her on Instagram at cdubofsky.

References +
1

6 Things That Can Happen When You Stop Taking The Pill. (2019, August 07). Retrieved November 8, 2020, from https://health.clevelandclinic.org/6-things-that-can-happen-when-you-stop-taking-the-pill/

2 Combined Hormonal Birth Control: Pill, Patch, and Ring. (2018 March). Retrieved November 8, 2020, from https://www.acog.org/womens-health/faqs/combined-hormonal-birth-control-pill-patch-ring 
3

Progestin-Only Hormonal Birth Control: Pill and Injection. (2020 October). Retrieved November 9, 2020, from https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection

4

What You Need to Know When Going Off the Pill. (n.d.). Retrieved December 22, 2020, from https://walnuthillobgyn.com/blog/what-you-need-to-know-when-going-off-the-pill/

5

Birth Control: Pros and Cons of Hormonal Methods. (2019, May 29). Retrieved November 8, 2020,  from https://www.uofmhealth.org/health-library/tw9513

7

How Do Birth Control Pills Help with Acne? (2020, July 09). Retrieved November 9, 2020,  from https://www.scripps.org/news_items/7002-how-do-birth-control-pills-help-with-acne

13

Is any acne treatment safe to use during pregnancy? (n.d.) Retrieved November 9, 2020, from https://www.aad.org/public/diseases/acne/derm-treat/pregnancy