Post-birth control acne: Why it happens & how to manage it

What is post-birth control acne?

Some estimate that acne affects up to 80% of people at some point in their lives [1], and many of us have experience with it in some shape or form. Women are also more likely to seek treatment for acne than men [2].

So, what is post-birth control acne? It refers specifically to acne that occurs after you stop using hormonal birth control, such as the pill, implant, or hormonal IUD. This is also known as post-pill acne, though it can happen when coming off any type of hormonal contraceptive. 

While there are records of post-birth control acne as far back as the 1970s [3], and it’s well-known by now that stopping birth control can result in acne breakouts [4], there hasn’t been a lot of research into the specifics of it, like how common it is or how long it lasts. However, one study that looked at the pill found that 63% of the study participants experienced skin blemishes after they stopped using it [5].  

How do hormones affect acne?

Before we jump into the nitty-gritty of acne after birth control, it’s important to know that acne and hormones often go hand-in-hand. With that in mind, it’s no surprise that acne breakouts are so common during times in our lives when hormones go a bit haywire — like during puberty, pregnancy, or even perimenopause [2]. Breakouts can also be triggered by the hormonal shifts within the menstrual cycle, which is why you might experience acne during ovulation or right before your period [2]. 

Acne is complex, and many different hormones and other factors are involved, but to keep things simple, we’ll talk about the most important ones. These are a group of hormones called androgens (testosterone being the most well-known example) [6]. High androgen levels have been linked with acne outbreaks because androgens are in charge of controlling glands in our skin that produce an oily substance called sebum. This is important for keeping our skin healthy, both by maintaining moisture and protecting it from infection [1], but if there’s too much sebum, the pores can get clogged. In turn, this allows bacteria to grow and can result in acne and inflammation [6].  

Other hormones also play a role in acne breakouts. The two main female sex hormones, estrogen and progesterone, as well as insulin, which helps regulate our blood sugar, are also involved. Progesterone and insulin trigger sebum production, while estrogen can decrease it and counteract the effect of androgens [6].  

How hormonal birth control works

There are two main types of hormonal birth control: those containing estrogen and synthetic progesterone (like the combination pill or vaginal ring) and progestin-only methods that only contain synthetic progesterone (like the hormonal IUD or mini pill). While you’re using these methods, your hormone levels will remain stable and you won’t have the cyclical fluctuations that come with the menstrual cycle, since they work by suppressing ovulation or making it less frequent [7].

Can birth control help acne?

Yes, it can! Hormonal birth control, and especially the birth control pill, is commonly prescribed as treatment for acne since it stabilizes your hormone levels and stops the menstrual cycle. Methods that contain estrogen, like the combination pill, also have anti-androgenic effects — meaning that the estrogen suppresses the androgens that trigger excess sebum production and oily skin [8].

However, acne can also be a side effect of hormonal birth control. It’s most common with progestin-only options, like the hormonal IUD or implant, but can happen with any method [9]. It’s also good to know that certain types of progestins are more likely to trigger acne [6, 9], so if you know you’re prone to outbreaks, it’s a good idea to discuss your options with your healthcare provider. And remember, you can always switch methods if needed.

Why do you get acne outbreaks when stopping birth control?

If you had acne before you started birth control or you were prescribed birth control to treat acne, there’s a chance it will come back after you stop using it. However, some people get acne after stopping birth control even if they haven’t had problems with it before. So, why does it happen? 

Androgens on the rise

If you were using a method that contains estrogen, like the pill, it may have to do with increasing androgen levels. As we mentioned earlier, estrogen suppresses the androgens that trigger our skin’s production of oil [6]. So, when you’re no longer adding a steady level of estrogen via your birth control, estrogen levels drop and androgen levels can become higher again — resulting in acne.

Fluctuating hormone levels

Another aspect of stopping hormonal birth control, regardless of which type you were on, is that your body will start adjusting back to its natural hormone production, meaning that your menstrual cycle will return. It’s common that it takes a while for your cycle to get back to its natural rhythm, and in the meantime, hormones may fluctuate a bit more than usual. This can lead to acne breakouts while your body is working to get back to normal. In general, hormonal shifts are notorious for causing symptoms like acne, which is why we can also get acne around ovulation or around the time we get our period [2]. 

Do you get post-birth control acne after all hormonal birth control?

Well, the short answer is that you might — but you also might not. Even though post-birth control acne might be better known under the name “post-pill acne”, it doesn’t just happen when you come off the pill. You may see acne breakouts when you stop any type of hormonal birth control, since your body will still need to adjust to your natural hormone levels.

To complicate things further, not everyone will experience acne flare-ups at all after stopping birth control. It can depend on which method you were on and the type and doses of hormones it contained, how sensitive your body is to hormonal shifts, and (perhaps more importantly) whether or not you had acne before you started birth control in the first place.

How long does post-birth control acne last?

Again, it depends. Some see their skin clear up after a few weeks, while others may have acne for several months after stopping birth control. We’re all different, and it’s individual how long it takes for the body to get back to its natural rhythm. 

Given enough time, post-birth control acne often goes away on its own. However, if your acne bothers you a lot, or if you had acne before going on birth control and it comes back, there are treatments available. Make sure you speak with your healthcare provider or dermatologist if you’re concerned or have questions — they can help you find a treatment plan that works for you.

How can you treat post-birth control acne?

Post-birth control acne can be treated similarly to other acne. One thing to note is that hormonal birth control itself is often used to treat acne. So, if you’ve recently stopped using it — and you don’t want to start again — that might affect your treatment options. Still, there are several others available. With that in mind, it’s always a good idea to speak with a healthcare provider before starting any treatment on your own. 

Medications to treat acne

There are several medications available to treat acne, both over-the-counter options and some that require a prescription. Let’s take a look at a few common ones.

• Topical retinoids: A class of chemical compounds derived from vitamin A, retinoids come in the form of over-the-counter creams, gels, or serums that you put on your skin. Some topical retinoids need to be prescribed by a doctor. Retinoids can be effective in treating acne and preventing new outbreaks, mainly by reducing inflammation and normalizing the skin's ability to shed dead skin cells so that the pores don’t become clogged, and can also help with acne scars. Keep in mind that retinoids can make the skin more sensitive to sunburn, so make sure to use sunscreen and avoid tanning while using it [10]. 

• Benzoyl peroxide: An over-the-counter treatment for acne that you put on your skin, and often combined with other methods like retinoids or antibiotics. Benzoyl peroxide is antibacterial and works by killing bacteria that can cause acne, and it also reduces inflammation. For some people, it can cause skin irritation in the form of redness, itching and/or skin peeling [10, 11].

• Antibiotics: Both topical antibiotics (in the form of creams you put on your skin) and oral antibiotics can be used to treat acne. They work by killing bacteria that causes acne and also have anti-inflammatory properties, and they are usually combined with other treatments like benzoyl peroxide or retinoids. Oral antibiotics are typically only used for severe acne [10].

• Spironolactone: A type of steroid that works by blocking androgens, which in turn reduces the production of sebum that leads to acne. Spironolactone needs to be prescribed by a doctor, but it’s worth knowing that you’ll need to use some form of contraception at the same time, as you shouldn’t use it while pregnant since it can harm the fetus. It’s often prescribed together with birth control pills to prevent pregnancy, so make sure you discuss your options with your doctor [12].

• Isotretinoin: Perhaps more known under the brand name Accutane, isotretinoin is an acne treatment that works primarily by reducing the production of oil in the skin (sebum). Because it can have some potentially serious side effects, it’s not typically used as a first treatment, but isotretinoin has been found to be effective for severe acne, as well as acne that doesn’t respond to other treatments. Similar to spironolactone, you need to use an effective birth control method while on isotretinoin, as it can’t be used during pregnancy [10].

Keep in mind that most acne treatments take time to work — often up to 12 weeks — before you see any results, so patience is also key.

Other treatments for acne

Aside from the medicines, there are also some natural options that may help with acne or can complement the medications listed above. However, research is more limited here, so it’s still a good idea to speak with your doctor if you’re thinking of trying some of these out.

• Skincare routine: It’s a myth that all acne is caused by bad hygiene, but there are some things you can think about when it comes to your skincare routine that may help reduce acne breakouts. Wash your face with gentle cleansers (but not too often; try to keep it to once or twice per day), and use gentle skincare products that don’t irritate your skin. Try not to touch your face too often or pick at your acne. And lastly, remember you can always ask your dermatologist or pharmacist if you need help finding good skincare products.

• Tea tree oil: An essential oil that has anti-inflammatory and antibacterial properties. It may help mild acne and has been shown to reduce outbreaks, but research is still limited when it comes to its effectiveness and safety [13].

• Alpha-hydroxy acids (AHAs): AHAs are a group of acids that are commonly used in different types of skincare products. They work by exfoliating the skin so that pores don’t get clogged, and reduce redness and inflammation. AHAs are often used together with other acne treatments like salicylic acid [14].

• Niacinamide: A type of vitamin B3 that comes in the form of topical creams that you put on your skin or as supplements. Niacinamide is said to have anti-inflammatory properties and to reduce the build-up of oil in the skin, which is why it could potentially help in treating acne [15]. However, there hasn’t been much research done on its effectiveness, so it’s not possible to say how well it works [10].

• Diet changes: While the relationship between diet and acne isn’t entirely understood, some studies suggest that certain diet changes can be helpful for some people when it comes to managing acne. For example, a low-GI diet — limiting refined carbs and sugar, and focusing on whole grains, healthy fats, fruits, and vegetables — and consuming less dairy has shown some promise when it comes to managing acne [16].  

• Managing stress: There’s research indicating stress can make acne worse, so managing stress levels may help reduce outbreaks [17]. We know that’s easier said than done, and acne can have a negative impact on our mental health on its own, but try to find ways to reduce your stress levels — whether it’s through mindfulness or medication, by going on walks in nature, taking breaks throughout the day, or just taking a moment to breathe.

We know acne can be challenging to deal with. Post-birth control acne will often go away on its own if given enough time, but don’t hesitate to speak to a doctor if you feel that your acne negatively impacts your life or mental health — there is help available.

Keep track of skin changes with Natural Cycles

Here at Natural Cycles, we believe that information is key to making informed decisions about your health. Knowing what to expect when coming off hormonal birth control can help you feel in control and manage symptoms as they come. The NC° app isn’t just an FDA Cleared and CE marked digital birth control method and fertility app — you can also use it to keep track of changes to your skin, including acne, along with other symptoms you may experience during your menstrual cycle. Curious to learn more about your body? See if Natural Cycles could be right for you today.