November 13, 2023
By Claudia Guzik, Drexel University College of Medicine

If you’ve ever had acne, you’ll know that there are a million things that can cause it, and another million things that are supposed to get rid of it…including birth control. Birth control pills are well known for improving acne, but what about other types of hormonal birth control? How does the IUD stack up? In the past, it has been accepted that IUDs only deliver hormones to the uterus, and that the level of hormones was too small to make it through the bloodstream to other places in the body. Studies are now suggesting that it is possible that hormones in the IUD can and do worsen acne.

So how does acne work? Acne is caused by three different processes that, together, combine to create comedones, or the little bumps called acne. The first process is the overgrowth of a bacteria called Cutibacterium acnes. While it’s not an infection, per se, these bacteria cause inflammation that causes the painful, red bumps. One category of treatments is antibiotics, which not only target C. acnes but also directly reduce the inflammation. The second process happens when there are too many dead skin cells on the skin’s surface. These cells plug oil glands, causing a backup and eventually a pimple. The treatments for this include topical exfoliants like salicylic acid, and topical retinoids, which help normalize the number of dead skin cells. Finally, when oil glands produce too much oil, that stimulates bacteria and the gland can get blocked by the dead skin cells. That’s where hormones come in. The oil glands are stimulated by hormones called androgens. Birth control pills help mitigate the effects of these hormones.

Combination birth control has two types of hormones — estrogen and progestin. Estrogen blocks the effects of androgens on the oil glands, leading to less growth of the glands and less production of oil. Progestins are necessary to counter-balance the estrogen, because too much estrogen without progestin can cause serious adverse effects, like blood clots and cancer inside the uterus. There are many different types of progestins, and most of them act just like androgens at the androgen receptors, mimicking the hormones causing pimples. Some progestins act just like androgens and stimulate the receptor a lot, and can cause a lot of acne, while others only stimulate the receptor a little bit or not at all. Combination birth control that is used for acne typically has the kind of progestin that doesn’t stimulate the receptor, or does but just a little.

So what about the IUD? The hormonal IUD has a type of progestin called levonorgestrel, which unfortunately has a very high androgenic effect. It was previously thought that in such small doses, the hormone doesn’t get anywhere except the uterus. However, some people started noticing acne after getting the IUD, and a couple studies have shown that maybe the IUD could be to blame. Let’s talk about those studies.

One study looked at people who were first-time birth control users. Compared to starting the pill, people who had never had acne before were slightly more likely to get acne after getting the IUD. For people who had acne in the past, the IUD group was more likely to need more acne treatment than the pill group. Another study did a survey and asked people who went to a dermatologist for acne treatment whether their birth control had affected their acne. People with the IUD said that it made their breakouts worse. Another study asked people about their symptoms on the IUD or on the pill. More people said they had acne in the IUD group than the pill group. Finally, two other studies found that about 8% of people had their IUDs taken out because of acne.

So what do we take from this? Well, it is possible that the hormonal IUD worsens acne. We don’t have a ton of data to support this, but it seems like the hormone effects may reach further than was previously thought. Since the IUD is such an effective method of birth control, the pros and cons have to be weighed by each individual with the help of their doctor(s). For some, the IUD doesn’t cause enough acne to bother them, or none at all! For others, it might cause too much to make the form of birth control worth it. For some in between, they might have to step up their acne treatments to make up for a slight worsening with the IUD. With more data on the topic, we’ll know more about this in the future, but for now with the information that is available, there stands a possibility that the IUD is influencing those pesky pimples.

Sources/Resources:

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