Alternatives to Taking Oral Contraceptive Pills for Acne

Out, damned spots!
woman closely checking her face in a mirror
©Can Stock Photo / sumners

Acne can be frustrating, embarrassing and painful no matter your age. Drug stores are filled with pads, lotions, soaps and creams that claim to completely eliminate acne, advertisements online tout creams and pills that will remove those pesky red blemishes and birth control is routinely prescribed as the “cure all” for all your pimple woes. However, if you are like the majority of people, none of these things work well, only work for a limited time, or come with problems of their own like drying and toxicity.

Now how could that be? Well likely, it’s because you aren’t getting to the root cause of what is causing the acne. Acne is a symptom—it tells us that something is off somewhere inside of us. It’s our job to listen to what our body is trying to tell us.

Acne begins inside

So let’s chat about healing acne from the inside out. Acne vulgaris is a frustrating skin condition you may know all too well caused by an overgrowth of bacteria called Propionibacterium acnes. This occurs when hair follicles become clogged with dead skin cells and excess sebum (your body’s natural oils) produced from surrounding sebaceous glands.

Common causes of acne include:

  • hormone imbalances

  • gut inflammation and microbiome disruption

  • liver congestion

But there’s pill for that, right?

Oral contraceptive pills seem to be an enticing solution for dreaded bouts of acne. The rationale behind this is sound: oral contraceptive pills use very strong synthetic hormones to shut down communication between the brain and your ovaries so the body stops ovulating. By stopping ovulation, it also stops the cascade of hormonal fluctuations.

Around ovulation your body produces big bursts of estrogen, luteinizing hormone, progesterone, and testosterone. These shifts in hormones throughout your cycle are what often cause breakouts and these spikes are all blunted when taking oral contraceptive pills.

Sounds good, right? But you know what they say about sounding too good to be true…

While oral contraceptives work for some, they can also cause a host of new problems and even compound the issue of acne. Birth control has been shown to deplete essential nutrients that help our skin remain clear, causes gut inflammation, and creates liver congestion so the liver can’t clear out hormones and toxins properly.

Furthermore, after stopping birth control, some women experience a phenomenon called “androgenic rebound” where testosterone, dihydrotestosterone (DHT) and/or dehydroepiandrosterone (DHEA) levels jump up and cause renewed bouts of acne. DHEA, testosterone, and DHT are all in the androgen class of hormones. We have many androgen receptors on sebaceous glands in our face and their job is to make sebum which, at normal levels, keeps our skin moisturized. DHEA and testosterone become problematic when they are converted to DHT. DHT triggers these sebaceous receptors very acutely which causes excessive sebum production that, in turn, causes acne lesions to form. Not fun!

So, whether you are recently jumping off the pill or want to heal your acne naturally, the solutions are fortunately the same!

Step One: Go with your gut!

For starters, it’s important to heal the gut! Our external condition is often a direct reflection of what is going on inside and when our gut is inflamed it often manifests as skin problems.

  • Inflammatory foods such as eggs, gluten, and especially dairy can greatly influence our skin. So it’s a great time to kick the biggest offenders to the curb and replace them with as many anti-oxidant-packed leafy greens and brightly colored fruits as possible. Sugar is inherently inflammatory and causes spikes in blood sugar, which can lead to insulin resistance, which causes more inflammation and may even trigger testosterone production. So, stopping that sugar habit in its tracks and focusing on improving insulin sensitivity by eliminating carbohydrate-dense foods and sugary snacks is key. A focus on healthy fats, plenty of protein, and tons of fruits and vegetables help regulate the blood sugar and promote ideal conditions for skin healing!

  • Oral contraceptives, environmental toxins, and certain foods all disrupt our gut microbiome. Good bacteria such as Lactobacillus and Bifidobacteria help keep bad bacteria, yeast, and parasites from taking over. A healthy microbiome allows us to better absorb nutrients and protects us from harmful microorganisms. Getting a high quality probiotic on board and loading up with fermented foods is a great first step in treating acne.

  • Increasing water intake not only keeps your body, and thus skin, hydrated, but it also allows for adequate bowel movements that enable us to effectively expel toxins. To determine your therapeutic daily water needs, drink half your body weight in ounces of water. Say you weigh 140 pounds, then your daily water intake should be approximately 70 oz (8-9 cups or 2 litres) of water daily.

Step Two: Give your liver some love

Your liver is where your phase 1 and 2 detoxification pathways occur. It helps filter your blood, package excess hormones for excretion, and produces bile to get rid of toxic byproducts.  The liver converts toxic chemicals into less harmful forms and then bundles them up to get them out of the body. When you aren’t excreting hormones and toxins properly, acne often results.

You can support these processes in your liver by incorporating liver-loving herbs such as milk thistle, taraxacum, and curcumin. Broccoli sprouts are chock full of a constituent called sulphorophane that benefits healthy estrogen detox. Cruciferous vegetables contain the compound I3C (indole-3-carbinol) which is converted to DIM (diindolylmethane) by your stomach acid, which allows you to better process and excrete estrogens (which often are present is significant amounts after years of oral contraceptive pills). Glutathione and N-acetyl cysteine directly support phase 1 and 2 detoxification pathways and are fantastic additions as well. Eating good quality meats and vegetables like Brussels sprouts, kale, watercress, and mustard greens to increase your glutathione levels; and yogurt, cheese, eggs, sunflower seeds, and legumes for cysteine provide even more liver support!

Step 3: Expel excess androgen

Androgenic acne often manifests on the jawline and cheeks and can be accompanied with male pattern baldness and dark hair growth on the upper lip, chin, and nipples.

Testing hormone levels is a good place to start if you think you may be suffering from androgen excess post birth control. If your androgens are elevated, herbs like saw palmetto can be extraordinarily helpful in reducing their stimulatory effect on sebaceous glands by decreasing testosterone’s conversion to problematic DHT.

Step 4: Non-toxic topical remedies

Now that you’ve done the work to heal your gut, improve your diet, detox your liver, and checked on your hormones… it’s time to treat the outside. Traditional “drug store” remedies contain ingredients such as benzoyl peroxide, a powerful bleaching agent, that has been banned by the European Union but is still legal in the US. These harsh chemical “quick fixes” are often combined with endocrine disrupting ingredients such as parabens and phthalates. These soaps, creams and pads tend to over dry the skin and can even cause larger problems such as premature skin aging, slower skin healing, and even acne rebound!

  • Exfoliating the skin gently 1-3 times a week helps break down and remove hyperkeratotic skin cells that could eventually clog pores and cause acne. Great methods for exfoliating include finely ground oats mixed with honey or rubbing the inside of papaya skins on your face—the enzyme papain is a great natural exfoliant!

  • Gently cleanse your skin morning and night and never skip the moisturizer! Hydrated skin heals better and faster than dehydrated skin which tends to over stimulate sebum production, worsening acne. Also, keep what touches your face clean and consider changing your pillowcase nightly or slipping a clean t-shirt over your pillow before you go to bed.

  • Breakouts always seem to pop at the most inopportune times despite your best efforts! When you need an emergency spot treatment consider applying a mixture of ground turmeric (a natural, potent, anti-inflammatory herb) mixed with a bit of coconut oil (which helps the curcumin to better penetrate the skin and is anti-microbial itself), allow it to sit for a couple hours or overnight to reduce the size and redness of inflammatory lesions.

  • If things really get out of control or while you are working on cleaning up your insides, a mask of bentonite clay mixed with apple cider vinegar applied to the face for 10-20 minutes can help remove toxins, kill pathogenic microorganisms, shrink pores, and control sebum production.

While acne can be frustrating, there are tons of tools you can implement to begin healing your skin today! Healing takes time and often the skin, being a “less-essential” organ, is the last to heal as the body’s energy is focused on repairing the more crucial internal ones. So next time a pimple rears it’s ugly head, remember that it is a conversation your body is trying to have with you. Pay attention and give your body what it is asking for. Beautiful skin comes from the inside.

Further Reading

Beyond The Pill by Dr. Jolene Brighten