It clears acne, prevents pregnancy, delivers periods that are lighter and on time but does the do-it-all pill come at a cost? CLEO talked to gynaecologists and a dermatologist to sift through the facts and fiction of using oral contraceptives to control acne, and five Singaporean girls who have had first-hand experience.

When a doctor introduced Evonne, now 27, to the possibility of using birth control to clear her acne, she was skeptical: could a pill that prevents unwanted pregnancy also cure the acne that had plagued her since she was 13?

“I know there are pills one can take to reduce acne, but I was a bit skeptical of their side effects so I never tried them.”

While she didn’t have a full face of acne, she had consistent zits on her forehead and temples with the occasional one on her cheeks. She had tried many topical treatments that would work for a few days before the problem came back with a vengeance. “Most treatments that I used were strong and caused my skin to become dry and flaky. The birth control reduced my acne very quickly and my skin was clear and almost glowy for once.”

“Honestly at first, I didn’t think it would work because it seemed like I’d tried everything from home remedies to expensive facials and nothing worked [prior to the pill].”

Her skin was so clear that she was able to stop using spot treatments and harsh exfoliators completely. “It was a great feeling and gave me such a confidence boost.”

She continued to take oral contraceptives on and off for four years between the ages of 18 to 22, citing a weight gain of five kilograms as the only downside.

“When I stopped taking the pill, my acne returned, but it was a lot more manageable and receptive to topicals. Even though I was originally prescribed birth control for my periods, if my acne turned bad again, I would consider going back on the pill to regulate my hormones.”

Does the pill impact fertility in the long-run? 

While birth control pills are known to help clear up acneic skin, many girls, like Evonne, are concerned about the side effects. In fact, a common concern is whether it would affect their fertility in the long run.

The good news is, it doesn’t.

Dr Kelly Loi, an Obstetrician & Gynaecologist who serves as the Medical Director of Mount Elizabeth Fertility Centre, says, “There is a common misconception that oral contraceptives have a negative impact on fertility and that a woman will have difficulty conceiving in the future once she starts using them.”

This belief may stem from … the reduction in fertility levels that is naturally associated with an ageing body.  

For women who started taking oral contraceptives many years ago, Dr Kelly Loi cautions that your body’s fertility will not return to what it was prior to taking the pill simply because if a woman started “[in her] twenties and she’s now in her late thirties, her chances of pregnancy would have fallen accordingly. Apart from current age, the level of fertility will be affected by various health and lifestyle factors.” 

Dr Tay Eng Hseon, Senior Consultant Gynaecologist & Medical Director Thomson Women Cancer Center, agrees and says that modern pills actually contain very low doses of hormones. “Women return to normal fertility very quickly and almost immediately after stopping the pills. In fact, the hormonal doses are so low that a woman loses the protection against pregnancy when she misses taking more than two consecutive pills.” 

Make sure you are taking the right pill

There are different types of oral contraceptives: the ones prescribed specifically for hormonal acne by dermatologists contain an additional ingredient that inhibits testosterone, specifically targeting one of the pathways for hormonal acne. Patients taking other birth control pills prescribed by gynaecologists may also see an improvement in skin because of the estrogen content. 

Although birth control pills are generally considered safe, as with any medication, always consult with a doctor to understand the risks involved, to check if you have any predisposed conditions that prevent you from taking the pill and to find which is the most suitable for you. 

A severe, but rare side effect of going on the pill, is the occurrence of thromboembolism, or blood clotting. However, most of the time, side effects are tolerable. They include:

– Headaches

– Weight gain

– Breast tenderness 

According to the gynaecologists, in addition to smokers over the age of 35 and women above the age of 45, pills are usually contraindicated in women who have medical conditions affected by hormones, such as:

– Past thromboembolism

– Cardiovascular complications

– Breast cancer

– Estrogen-sensitive tumours/cancers

Are there alternatives to cure acne? 

So what if you want to get pregnant, don’t want the associated risks, or need to stop taking birth control for other reasons? If your acne persists, Dr Teo Wan Lin, Dermatologist at TWL Specialist Skin & Laser Centre, says there are other evidence-based methods for keeping skin clear and under control. “Physical modalities such as blue light treatments and chemical peels would be appropriate. Other alternatives for the treatment of acne… really depend on the [root problem],” she says. 

 “If the cause of acne has been deemed to be underlying Polycystic Ovarian Syndrome… not addressing it with the appropriate hormonal therapy would be counterproductive because despite all other methods of controlling the acne, [the acne would persist because the main cause has not been addressed].” If you’ve been checked by a gynaecologist and don’t have any underlying conditions, then other causes of acne could be genetics, underlying inflammation or excessive oil production. In these cases, Dr Teo Wan Lin says the dermatologist may recommend “oral medications, topicals–such as retinoids, as well as antioxidants as adjuncts to treat acne.” In cases of mild acne, using an antibacterial face wash can also help. 

What’s it like to be on the pill? Four girls tell us 

Images: 123RF
Text: Claire Soong