Balancing Hormones and Skin Health: A Focus on Oral Contraceptives in Dermatology View PDF

OCs, commonly known as birth control pills, are one of the most widely used methods of contraception globally [1]. First introduced in the 1960s, these pills revolutionized reproductive healthcare by giving women greater control over family planning and fertility [2]. The two primary types of OCs are combined OCs (COCs), which contain both estrogen and progestin, and progestin-only pills (POPs) [3]. COCs work by suppressing ovulation, thickening cervical mucus to block sperm, and altering the uterine lining to prevent implantation. POPs, commonly known as the “mini pill,” are often recommended for women who cannot tolerate estrogen, such as those who are breastfeeding or have certain health conditions [3].

The benefits of OCs extend beyond preventing pregnancy. For instance, COCs are frequently prescribed to regulate menstrual cycles, alleviate symptoms of PCOS, and reduce the severity of premenstrual syndrome [4]. Moreover, studies have shown that long-term use of COCs can reduce the risk of ovarian and endometrial cancers by up to 50% [5]. However, OCs are not without risks. They can slightly increase the likelihood of developing blood clots, particularly in smokers and women over the age of 35 [6]. POPs have fewer associated risks but may cause irregular bleeding in some users. Despite these considerations, OCs remain a highly effective and convenient option for many women, with typical use resulting in a failure rate of around 7%, compared to nearly 20% for condoms [7].

Recent advances have led to more innovative formulations of OCs, with lower hormone doses to minimize side effects. For example, ultra-low-dose pills like Yaz and Loestrin are designed to reduce mood swings, nausea, and bloating often associated with traditional options [8]. Additionally, there is increasing attention on improving accessibility, such as over-the-counter availability and cost reduction initiatives. In low-income settings, expanding access to OCs has been shown to significantly reduce unintended pregnancies, contributing to better health outcomes and socioeconomic opportunities for women. The development and ongoing refinement of OCs underscore their pivotal role in advancing women’s health and empowerment worldwide [9].

OCs and Dermatology

OCs, commonly referred to as birth control pills, have long been used as a reliable method of contraception, but they also play a significant role in dermatology [10]. These medications, especially COCs containing both estrogen and progestin, have been shown to effectively address a variety of skin conditions, particularly those influenced by hormonal fluctuations [11]. Their use in dermatology is primarily focused on conditions like acne, hirsutism (excessive hair growth), and even certain aspects of aging skin (Table 1) [12, 13]. By regulating hormones that affect sebum production and skin inflammation, OCs offer a therapeutic option for women struggling with persistent skin issues [13].

Hormonal imbalances are a key contributor to skin problems like acne, which often arise due to overactive sebaceous glands driven by androgens such as testosterone [14]. By suppressing ovarian androgen production and increasing levels of sex hormone-binding globulin (SHBG), OCs can reduce circulating free testosterone levels [15]. This hormonal modulation decreases sebum production and inflammation, making OCs particularly effective for women with moderate to severe acne, including cases resistant to topical treatments [16]. Thus, OCs provide both contraceptive benefits and solutions for dermatological challenges, making them a multifaceted treatment option.

One of the most well-documented uses of OCs in dermatology is in the treatment of acne vulgaris, particularly in women with hormonally driven acne that worsens during the menstrual cycle [17]. Studies have demonstrated that certain COCs, such as those containing ethinyl estradiol with drospirenone (e.g., Yaz) or norgestimate (e.g., Ortho Tri Cyclen), can reduce inflammatory and non-inflammatory acne lesions by 40% to 70% after six months of use [18, 19]. These results are attributed to the reduction in sebum production, which is driven by the suppression of androgen activity. In contrast, POPs or contraceptives with androgenic progestins may not provide the same dermatological benefits, emphasizing the importance of selecting the right formulation for acne treatment [20].

In addition to acne, OCs can be used to manage hirsutism, a condition characterized by excessive hair growth in areas such as the face, chest, or back, typically due to elevated androgen levels [21]. OCs reduce the production of androgens and increase SHBG, which binds free androgens in the bloodstream [22]. This process lowers androgenic stimulation of hair follicles. A 2019 meta-analysis found that OCs improved hirsutism in women with PCOS by approximately 30% - 40% when used consistently over 6 to 12 months [23].

Literature also suggest that OCs may have secondary benefits for reducing seborrhea (excessive oily skin) and mitigating conditions like hormonal melasma [24]. Hormonal melasma is a form of hyperpigmentation often linked to estrogen and progesterone fluctuations. While melasma management with OCs is less consistent and may require adjunctive therapies, some studies have observed improvement in cases where hormonal regulation is achieved [25]. This makes OCs a versatile option for addressing multiple dermatological concerns, particularly those stemming from endocrine abnormalities [26].

OCs are a game-changer in dermatology, offering women a treatment option that goes beyond skin-deep benefits. For many women, managing chronic acne or other hormone-related skin issues can significantly improve self-esteem and quality of life [27]. By providing effective solutions for conditions like acne and hirsutism, OCs enable women to feel more confident in their skin. Additionally, their dual-purpose nature-providing both contraception and dermatological benefits-enhances convenience and cost-effectiveness for patients [28].

The future of OCs in dermatology is bright, with ongoing innovations focused on minimizing side effects while maximizing skinrelated benefits. Ultra-low-dose formulations and new combinations of hormones are being developed to provide effective treatments with reduced risks of adverse effects like weight gain, mood swings, or nausea [29]. Furthermore, increased awareness among dermatologists and patients about the multifaceted benefits of OCs ensures that more women can access treatments tailored to their needs. As a cornerstone of hormone-based dermatological care, OCs continue to empower women by offering healthier skin and improved well-being.