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:
– 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
I started [taking the pill] when I was 16 to regulate my menstrual cycle, which was all messed up. Before the pill, my period was very erratic, sometimes only once every two to three months, and I also had raging hormonal acne. My body was very receptive to the contraceptive; my acne completely went away, my period came on the same day every month and I didn’t experience any negative side effects.
I stopped taking it for a few months when I was 28 because I was concerned that, after years of medically inducing my period, I wouldn’t be able to get pregnant when I eventually wanted to. For the first two months post-birth control, my period came three to four days late, which was OK, but the third month it was just MIA. I had really bad cramps, which I never had while taking the pill. I also experienced really bad acne on my chest and back––like cystic acne, with pus and everything. At first I thought my body was just readjusting and I wanted to give it time to regulate, but after a few months, the acne was just unbearable. In addition to my back and chest, I also started getting it on my face.
I recently started taking [the pill] again because I couldn’t handle all the side effects of being off it. Once I was back to taking it, my period came on schedule and my skin cleared up fairly quickly. I need to get checked by a gynaecologist soon. I think if I’m unable to get pregnant, it will be due to some other issue with my body and not the pill since it’s obvious that my body was able to revert to the state it was in when I first started taking the pill when I was 16.
The main reason I went on birth control was to prevent unwanted pregnancy, but I also hoped that it would clear my skin up. I typically have mild acne with more severe breakouts near my period. While it’s prevented pregnancy (so far), I have seen no change in my skin whatsoever, which was disappointing to me because it’s worked for all of my friends. I’ve been on it for four years now and I’m really good about taking it on time each day. I’ve considered switching brands just so I could double down on the benefits, but I’ve been a bit lazy and don’t want to go messing with my hormones or the potential side effects of a new medication. However, a GP once mentioned that my acne may not be due to hormones, in which case the birth control may not help even if I switch brands.
When I was 18, I lied to my mom about wanting to go on birth control to control my acne, but in reality I was planning to lose my virginity to my first boyfriend and was paranoid about getting pregnant. It helped that I did have acne–not the super angry red kind, but the type that surfaces underneath and makes your skin texture uneven. I didn’t notice the difference until random people started telling me that they were envious of how smooth and soft my skin was… this was maybe a month or two after I started. Unfortunately, two other changes I didn’t notice until people pointed them out were my mood swings and weight gain. I thought the negative side effects would subside, and while my moods balanced out, I couldn’t shake the weight. I stuck to that brand for a year and a half but stopped immediately after my boyfriend and I broke up. A year later I started taking another brand of birth control after consulting with a GP, and while this one didn’t make me gain weight or have extreme mood swings, it also didn’t help my skin as much. I’ve been completely off birth control for three years now and while my complexion was better when I was on the pill [both times], I feel like risking my hormone levels isn’t worth going back on it.
I’ve been on the pill for a year now to regulate my menstrual cycle and my skin. Prior to taking birth control, I had a consistent streak of acne on the left side of my face–alongside my upper cheekbone. I tried facials, topical treatments and was vigilant about my skincare regimen, but nothing worked. Once I started taking birth control, it completely disappeared and my face is always clear now. Shortly after I started taking birth control, I became a trainer. Since I sweat on a daily basis when demonstrating moves or working out alongside my clients, I thought this would eventually make my acne return, but it hasn’t! I only plan to stop taking birth control when I’m ready to get pregnant, otherwise I love the positive impact that it has made on my body.
Text: Claire Soong