After stopping the contraceptive pill, acne can come back for people who are prone to it. Breakouts tend to slowly return after several weeks or months and in some cases it might even feel that the acne is worse than it ever was. In this article, we’ll explore what the contraceptive pill does to your skin and why acne returns after coming off it. We’ll also review how long post-pill acne tends to last and how to treat it including if you’re trying for a baby.
Why Does Acne Come Back After Stopping the Pill?
The combined contraceptive pill can effectively reduce acne in women and stopping it often results in rebound. This is because the combined pill contains an oestrogen and a progestin. Together, they switch off ovulation, and in doing so they reduce the ovaries’ production of androgens such as testosterone. The oestrogen also increases levels of a protein called sex hormone-binding globulin. This mops up testosterone in the bloodstream leaving less free testosterone stimulating the sebaceous glands to make more oil. The result of this is fewer blocked pores and less acne formation. When you come off the pill, ovulation restarts and the androgen level rises back to what your body usually makes. For those who were previously suffering from acne, this can lead to rebound.
Which Contraceptives Cause Acne When You Stop Them?
Not all contraceptives lead to acne rebounding. In fact it is really just a phenomena with combined oral contraceptive pills which contain both a synthetic oestrogen and progestin. There are lots of different drugs in this group with popular ones like Dianette and Yasmin often prescribed for managing symptoms of polyendocrine metabolic ovarian syndrome (PMOS) and hormonal acne as well as for contraception.
Progestogen-only contraceptives like the mini pill, implant, injection and the hormonal coil contain no oestrogen. As such, they don’t typically improve acne in the first place and in some cases can even make it worse. If you’re prone to acne, it’s important to discuss with your GP whether any contraceptives will affect it eitherway.
How Long Does Post-Pill Acne Last?
There is no good study data that puts a number on how long post-pill acne lasts. However, there is a typical journey that most people experience. Skin effects tend to start after your own hormones return is usually within weeks of stopping the pill. That’s why acne typically comes back 1-6 months after stopping the pill rather. For many women, this continues for several months and gradually breakouts tend to settle as the hormones balance.
Unfortunately, for some women, the breakouts never settle. These patients tend to have acne that is particularly sensitive to hormones or have conditions like PMOS or other metabolic conditions. There are also women who may be peri- or post-menopausal and their symptoms were masked by the combined pill. After stopping the pill, these women may discover new onset adult acne.
How Do You Treat Acne After Stopping the Pill?
Because acne coming back after stopping the pill can resolve by itself, it is not unreasonable to wait a few months and see if this happens for you. Especially if your acne breakouts are mild. In this case, you can just use a basic acne skincare routine. Over the counter products like retinol, salicylic acid and benzoyl peroxide might help control mild breakouts.
However, if your acne is severe, getting worse or leaves behind scars or dark marks, it is best to act sooner and even seek professional help. Topical treatments are still likely to be the best option but your acne may require prescription actives. This may include retinoids like adapalene or tretinoin, antibiotics like clindamycin or high strength azelaic acid. Androgen blocking treatments like spironolactone or Winlevi may also be an option for some people. In more severe cases, oral antibiotics and roaccutane may be necessary. Ultimately, if the acne is not manageable, going back on a combined pill may be the best option.
What if You’re Trying to Conceive?
If you stopped the pill because you’re trying to conceive, the treatment options are more limited. This is because gold-standard acne treatments like topical retinoids as well as oral roaccutane are not suitable for use in pregnancy. You also need to avoid them once you start trying to conceive. Similarly, oral or topical spironolactone and antibiotics like lymecycline and doxycycline are also unsuitable.
There are however some pregnancy-friendly skin treatments that are suitable during this period. Topical benzoyl peroxide, clindamycin and azelaic acid are all usable with care in pregnancy. Between them, these actives unblock pores, reduce bacteria, lower inflammation, smooth skin and fade post-acne marks. Results tend to be slower with these, so start early and be consistent.
Whilst developing acne after stopping the pill can be distressing, there is some hope. Firstly, for many people this can be transient and may settle with a basic acne skincare routine after a few months. Intervention is best in cases where there is new onset or severe acne or if there is associated scarring and hyperpigmentation. This type of acne can require advanced treatment so seek medical help early. Although women planning to conceive have fewer acne treatment options, there are several pregnancy-safe options available.
At City Skin Clinic, we are passionate about personalised skincare. Through our online clinic, our doctors design custom topical acne treatments using prescription ingredients such as tretinoin, clindamycin, azelaic acid and spironolactone where appropriate. To get started, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
