What You Need to Know About Treating Acne with Hormonal Therapy

Tried all sorts of acne treatments and you’re still struggling with breakouts? For women, there’s another option that’s worth exploring with your dermatologist: hormonal therapy.

Hormonal therapy refers to any medication that acts on our hormones. Two in particular have proven effective at clearing acne in women:

• Oral contraceptive pills (also known as “birth control pills” and simply, “the pill”)
• Spironolactone (spy-ren-lac-tone)

Here’s a primer on both. They require a prescription, so this is intended only help inform your discussion with your board-certified dermatologist.

BIRTH CONTROL PILLS

How effective is it: The pill has been found to be effective at treating blackheads, whiteheads, pimples, and acne nodules and cysts by many studies. To the point that the FDA has approved some oral contraceptives for the treatment of acne.

How safe is it: The pill is considered safe for most women. It increases the risk of blood clots, heart attack, and high blood pressure, but most women who are healthy do not experience side effects. To determine whether the pill is an option for you, your dermatologist will check your blood pressure to rule out high blood pressure. You won’t need a Pap smear or pelvic exam. Your dermatologist will also carefully review your medical history, including prior and existing conditions, medications you’re taking, recent procedures you’ve undergone, and your immediate family’s medical history. Some women develop melasma, or dark patches on their face, while on the pill. Protecting your face from the sun can help prevent it.

How long does it take to work: Most will seek a decrease in their breakouts and oiliness within a few weeks. That said, when a hormonal therapy is prescribed to treat acne, patients typically remain on it for a long time. Though, hormonal therapy is effective on its own, so your dermatologist will likely stop any other treatments.

SPIRONOLACTONE

How effective is it: Dermatologists have been prescribing it for years to treat acne and excess hair growth in women. It can effectively treat deep-seated, tender acne on the lower face, jawline, and neck. Recent studies have shown a 50% to 100% reduction in acne. Its effectiveness can be further increased when it’s used in combination with the pill.

How safe is it: Spironolactone is considered safe for most women. However, it’s essential to take it in conjunction with birth control. If you become pregnant while taking spironolactone, your baby can have serious birth defects. When taking it without birth control, the most common side effects include: painful periods and cramping, irregular periods, breast tenderness, and breast enlargement. Some women may also experience mild fatigue, headaches, and dizziness. It’s also worth noting that spironolactone is a diuretic, so you’ll find yourself urinating more often. Your dermatologist will conduct some blood tests prior to prescribing it. And once it is prescribed, you’ll need to see your dermatologist every four to six weeks initially because spironolactone requires that you gradually increase the dose.

How long does it take to work: Most will seek a decrease in their breakouts and oiliness within a few weeks. That said, when a hormonal therapy is prescribed to treat acne, patients typically remain on it for a long time. Though, hormonal therapy is effective on its own, so your dermatologist will likely stop any other treatments.

With either treatment, it’s important that you take the medication at the same time every day. Also: Be patient. I know you’ve probably heard that before, as other treatments failed to have much of an effect. While the evidence behind the pill and spironolactone is promising, they still need time to work.