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Acne and Birth Control

Birth control pills are sometimes prescribed for women to control acne. Find out if they are effective, which of these pills work and what side effects to expect from this hormonal acne therapy.
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What Are Birth Control Pills?

Birth control pills are also known as oral contraceptives. These pills include different combinations of two types of hormones, estrogens and progestins. Examples of the two classes of hormones are estrogen and progestogen.

Some birth control pills only include a progestin hormone.

Birth control pills were the first form of contraceptives introduced in most countries. They are primarily used to prevent conception by inhibiting female fertility.

The main mechanism of action of birth control pills is the negative feedbacks they produce for the release of gonadotropins which are essential to female fertility. By supplying estrogen and progestin hormones, the body is tricked into thinking it is already producing enough. Therefore, it shuts down the production of natural estrogens and progestogen.

When progestogen (progestin is a synthetic form of progestogen) is supplied to the body by birth control pills, it decreases the secretion of gonadotropin-releasing hormone or GnRH from the hypothalamus. This action causes corresponding fall in the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Therefore, progestogen and other progestins prevent follicular development and reduce the levels of estradiol.

All of these effects lead to the prevention of ovulation.

Estrogen produces the same effect. It blocks the release of FSH from the anterior pituitary to prevent follicular development and ovulation. However, estrogen is also required to stabilize the endometrium and reduce the bleeding associated with menstrual cycles.

Progestin also works by a secondary mechanism to prevent contraception. It prevents sperm from getting to uterus and fallopian tubes by decreasing the secretion of the cervical mucus while making it thicker.

Other mechanisms may exist by which estrogens and progestins provide contraceptive cover. These mechanisms are usually obtained from modified molecules of brand-name birth control pills.

What Are Estrogens?

Estrogens are the primary female sex hormones. Natural estrogens are steroidal hormones while the synthetic ones are non-steroidal hormones.

There are 4 natural estrogens found in women. These are estrone, estradiol, estriol and estetrol.

Estradiol is the most abundant estrogen during the reproductive years while estrone is the major estrogen during menopause and estriol is secreted in high amounts during pregnancy. Estetrol is only produced during pregnancy.

Of the estrogens, estradiol is the most potent and it is 80 times stronger than the weakest estrogen, estriol.

All of the natural estrogens are synthesized from androgens especially testosterone and androstenedione. They are mostly produced in ovaries although they can be produced in other body parts in specific physiological states. For example, estrogens are also produced in the placenta during pregnancy and during menopause, they are also produced in the liver, breasts and adrenal glands.

Estrogens are also produced in men although in much smaller amounts. In men, they contribute to libido and the maturation of sperm.

In women, estrogens are responsible for most of the female secondary sex characteristics.

They are needed for the growth and maintenance of the uterus, vaginal wall and endometrium; they trigger sexual drives and ovulation; they reduce muscle mass and increase bone formation; and because they increase cortisol and help maintain the skin, they are useful anti-acne, anti-androgen hormones.

Besides their use in oral contraceptives, estrogens are used in hormone replacement therapy and in the treatment of acne.

What Are Progestins?

Progestins are synthetic progestogens which have effects similar to those of progesterone.

Progestins are used to compliment estrogens in birth control pills or counterbalance the effects of estrogens in hormone replacement therapy. Progestins can also be used as oral contraceptive pills alone without estrogens.

There are other medical uses of progestins ranging from the treatment of cancers and uterine bleeding to chemical castration of sex offenders.

Progestins were developed after it was discovered that progesterone could suppress ovulation during pregnancy. However, progesterone proved to be a difficult drug to formulate since it has poor bioavailability when taken orally and it causes local pain when injected.

The synthetic hormones which were modeled after progesterone proved to be effective oral drugs.

The first oral progestin was ethisterone which is an analog of testosterone. A more potent progestin, norethisterone, was derived from ethisterone and the chemically similar isomer of this new molecule, norethynodrel, was introduced earlier to the US where it became the first oral contraceptive in 1960.

Other progestins have been approved since then and these include the progestins used in the 3 birth control pills approved by the FDA for treating acne.

3 FDA-approved Birth Control Pills for Acne

Ortho Tri-Cyclen – Ethinyl estradiol + Norgestimate, a third-generation progestin

Estrostep – Ethinyl estradiol + Norethindrone, a first-generation progestin

YAZ – Ethinyl estradiol + Drospirenone, a fourth-generation progestin

How Birth Control Pills Treats Acne

Birth control pills are effective acne remedies because they modify the hormonal balance of the body in ways that favor the skin.

However, not all birth control pills are effective in this way. The birth control pills that can help control acne are the ones that contain estrogens and/or progestins and reduce the levels of androgens, such as testosterone, in the body.

Clear, smooth skin is a pleasant secondary effect of birth control pills and it is one that has been exploited to create a second market for oral contraceptives.

The main mechanism by which birth control pills work in acne treatment is by decreasing the level of androgens in the body.

Androgens are primarily male sex hormones but they are also produced in women even though in smaller amounts than in men.

In fact, estrogens and progestins are naturally produced from androgens such as testosterone.

However, in some women, androgens can be produced in relatively high amounts. High levels of androgens in women can be due to underlying disease conditions such as PCOS (polycystic ovarian syndrome). It may also be due to falling levels of anti-acne estrogen hormones.

Therefore, the estrogens and progestins supplied in birth control pills supplement estrogen levels in the body and counteract the actions of androgens. Besides, when the levels of estrogen rises in women, the body steps down the production of androgens such as testosterone because these male sex hormones are produced in women primarily as precursors of female sex hormones.

Androgens act at androgen receptors found in sebaceous glands. When they interact with these receptors, they cause the enlargement of the glands and then increase the production of sebum.

Excess sebum filling the pores and reaching the skin surface is the chief cause of acne.

The estrogen and progestins found in birth control pills, therefore, lower the levels of androgens in women. The concentration of androgens reaching the skin cells are then dramatically lowered so that not enough of them can cause the excessive cell proliferation that leads to the enlargement of the sebaceous glands and the production of excess sebum.

How To Take Birth Control Pills For Acne

Birth control pills are routinely prescribed for women to treat mild to severe acne.

Besides the 3 oral contraceptives mentioned above, doctors sometimes prescribe other pills for controlling acne. However, some birth control pills do worsen acne because they increase testosterone levels in the body. Therefore, you should consult with your doctor before choosing an oral contraceptive to treat acne.

Oral contraceptives are usually prescribed for females who are at least 14 years old, already menstruating and who may need contraception.

Oral contraceptives are not magic bullets for acne. In fact, it may take a few months before the first signs of improvement are observed. Some people do experience acne flare-ups initially before the acne improves dramatically.

The use of birth control pills should not be primarily to treat acne. Rather, these pills should be used for the dual purpose of contraception and anti-acne. Therefore, the pills should be taken as if for birth control.

Birth control pills should be taken daily and around the same time of the day. Usually, the therapy includes 3 weeks of medications with active ingredient followed by a week of placebo, reminder pills.

For the best results, birth control pills should be combined with other anti-androgen drugs such as spironolactone and low-dose corticosteroids. They can also be combined with anti-acne medications such as topical benzoyl peroxide.

Birth control pills are not without their side effects.

To reduce the severity of side effects, some doctors prefer to prescribe low dose combination oral contraceptives.

Birth control pills are not for all women. To avoid risks of drug interaction and hormonal changes, these pills are not recommended for women who

  • smoke
  • have a history of cardiovascular diseases, blood clot, breast, uterine or liver cancer or migraine headaches
  • are 35 years and older
  • are obese or physically inactive
  • are pregnant or breastfeeding

Side Effects of Birth Control Pills

Although birth control pills today do not contain as much estradiol and progestin as in the past, they still produce some side effects.

Some of the mild side effects of birth control pills are nausea, constipation, diarrhea, abdominal cramps, bloating, changes in menstrual cycles, and soreness or swelling of breasts. Serious side effects include weakness, dizziness, fatigue, skin rash, respiratory difficulties, impairment of vision and heavy menstrual flow.

Birth control pills will also increase the risk of blood clots, strokes, heart attacks, some cancers (breast, liver and uterine), migraine headaches and depression.

Some drugs may also interfere with birth control pills.

For example, tetracycline may reduce the efficacy of oral contraceptive. Because tetracycline antibiotics are also used to treat acne, the two classes of drugs should not be combined in acne treatment. Where such combination is unavoidable, another form of contraception may need to be added to prevent contraceptive failure.

Sources


http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004425.pub4/pdf/standard

http://www.fertstert.org/article/S0015-0282(01)01938-0/abstract

http://www.springerlink.com/content/n158008065615416/

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