Most women get acne at some point in their lives, generally when they are teenagers. But for some women, acne continues to be a problem beyond those teen years, and especially during particular times in their menstrual cycles. For these women, estrogen levels may play a role in triggering their acne.
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Several factors generally combine to cause acne. According to the American Academy of Dermatology (AAD), acne results when the skin's sebaceous glands produce too much of the oil known as sebum, clogging pores and causing an overgrowth of the bacteria that normally lives in those glands. This leads to inflammation, whiteheads and blackheads. Low levels of estrogen, coupled with high levels of androgen hormones, can cause the sebaceous glands to overproduce sebum.
The two hormones, estrogen and androgen, normally balance each other in women. Androgens trigger sebum oil production. When estrogen levels are low and androgen levels are high, the androgens can overstimulate the sebaceous glands and cause too much oil production. In the second half of the menstrual cycle, androgen levels are naturally high and estrogen is naturally low, which is why many women get premenstrual acne. In other women, especially those with polycystic ovary syndrome (PCOS), hormone levels are far out of balance. These women are likely to have hormone-related acne all the time.
Birth control pills containing both estrogen and progestin can stop hormone-related acne, according to the AAD. The pills reduce the levels of androgens in the bloodstream, restoring the estrogen-androgen balance and stopping the overproduction of sebum oil that causes acne. Two brands of oral contraceptives, Estrostep and Ortho Tri-Cyclen, are U.S. Food and Drug Administration-approved for acne treatment in women. However, the AAD notes that many brands of oral contraceptives are effective in controlling acne.
In fact, a 2009 review of the medical literature published in the Cochrane Database looked at 25 different studies involving a variety of oral contraceptives. The review found that all the oral contraceptives containing both estrogen and progestin were similarly effective in treating acne lesions, although the researchers noted that few studies have compared oral contraceptives to other acne treatments.
Because oral contraceptives don't address the inflammation or bacterial overgrowth associated with acne, dermatologists who recommend oral contraceptives to treat acne generally urge patients to first try other treatments, such as antibiotics and prescription creams. However, oral contraceptives can be an effective treatment option for women who suffer from acne triggered by low levels of estrogen and high levels of androgen hormones.