So you’re thinking about taking the oral contraceptive pill (OCP) for skin support? For some people with acne, the OCP works as a magic little pill, getting rid of their pimples like a magician and her wand. But you know there’s no such thing as a magic fix, right? And whilst it might look like magic from the outside, there’s a lot of things going on behind the scenes that at first look, aren’t clearly obvious. Let’s dig a bit deeper to find out how the pill can, and can’t work, for skin support.
So first things first. How does the OCP work to control acne? It works in two ways; firstly, the pill suppresses sebum production – sometimes reducing it to pre-pubescent levels! Secondly, it reduces androgen receptor stimulation on our oil glands, effectively reducing how these hormones impact the skin (it also ironically increases steroid hormones, but that’s for another time). The OCP also increases sex hormone binding globulin, which binds to free testosterone and reduces the consequences it can have on the skin. This is all good and well whilst we’re taking the pill, but what happens when we stop? Often people will get a rebound effect on their skin and hormones, because without suppression, the body will try to get back to its ‘normal’ state. Sebaceous glands will start to produce much more sebum (remember, it’s trying to alter the levels from a 10-year old’s to a 20-30 something year old’s) and the ovaries (and potentially adrenals if stress is part of your picture) will start to produce more androgens. Suddenly you have the double whammy effect of extra sebum and extra hormones, leading to post-pill acne. Sigh.
This is something that I see a lot in clinic. The pill simply masks hormonal problems which are driving skin presentations, so when you come off the pill (which we all do eventually), you’re right back where you started. In the above instance, say you worked with a practitioner that identified from the outset that hormonal problems were driving your acne; rather than mask the extra androgen output with the pill, imagine if they’d corrected the imbalance from the outset? No more hormonal problems and no more acne. I have to say, I have never treated a patient who has had their hormones even tested prior to going on the pill; there is simply minimal investigation done into biochemical drivers like nutrient deficiency (hey, zinc), stress, and hormone dysregulation (whether that’s stemming from the ovaries, the thyroid or the adrenals).
Another thing I see commonly is poor gut function due to the OCP. Many patients I treat have noticed that their niggling gut issues have resolved after coming off the OCP (also weight changes and mood changes). The simple truth is that the pill disrupts our gut microbiome. The importance of our gut microbiome can’t be overstated – it is one of the most significant factors when it comes to our health. When you have an abundant, diverse microbiome, you have fewer health problems. Period. A healthy microbiome will house a diverse collection of bacteria – the ‘good’ bacteria literally crowd out the ‘bad’, so there is nowhere for them to live. But when we don’t have a broad and diverse microbiome, there is opportunity for the bad guys to proliferate, creating infection and inflammation. The gut’s immune system communicates with the skin’s immune system, and suddenly our body is on high alert, looking for the bad bugs. Cue inflammation (aka redness) and infection (aka pustules) on our skin.
The pill also affects our moods – for the worse. It can increase the likelihood of depression and anxiety in those who have a predisposition for it. A 2016 Danish [1] study of over 1 million females showed that depression is a significant potential side effect of the OCP – particularly in adolescents. OCP users were 1.23 times more likely to be diagnosed with depression versus non-users, with this number skyrocketing in 15 – 19 year old’s. This adolescent group was 1.8 times more likely to have depression if taking combined oral contraceptives, but if using a progesterone-only contraceptive, their depressive risk increased to 2.2 times versus non-OCP users.
And did you know that OCP use can change who we are attracted to? An article in Psychology Today states, “women who had used hormonal contraceptives when they first met their partner and then ceased to take them experience lower levels of sexual and relationship satisfaction and are more likely to get divorced”. I find this so fascinating! One of the mechanisms behind this is the way that the OCP shuts down one of the hormones that make us attracted to people who have a different immune system than us (which evolutionarily leads us to breed with people who have a greater genetic diversity than us, creating stronger offspring).
I have worked with many, many clients for whom hormonal dysregulation is at the heart of their acne. Many times they have taken the OCP, and wish they knew before what they know now about the pill’s side-effects – on their skin and their overall health. If you want to learn what is driving your acne, take my free Naturopathic Skin Appraisal to find out your answers. And if you want to know more about hormones and their effect on your skin, watch my 90 minute deep-dive Hormone Masterclass here, where I discuss all these aspects of how the OCP works, what to look for in your own self-research when it comes to hormone markers and what we can do to help create positive changes to acneic skin.
For the love of skin,
Em (Founder, Naturopath, Skin-thusiast)
References:
1. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154–1162. doi:10.1001/jamapsychiatry.2016.2387
