Investigators evaluated adolescent and young adult study participants seeking progestin-only long-acting reversible contraception (LARC) and found there was a risk of the contraceptive worsening acne.1
Of 1,319 subjects who had LARC insertion, 28.5% experienced worsening acne after using progestin-only LARC.1
Acne was listed as a contributing factor to LARC removal in only 3% of people.1
When adolescent medicine physicians and OB/GYNs counsel adolescents and young people about contraceptives, the impact on acne may not be a priority in the counseling session. But it could be important to their patients.
“A majority of teens have acne — 85% to 90%. For young adults, the percentage goes down,” says Sarah Pitts, MD, attending physician and co-director of the Adolescent Long-Acting Reversible Contraception (LARC) Program, division of adolescent/young adult medicine at Boston Children’s Hospital in Massachusetts.
“For some people, acne is a much more significant concern,” she adds. “Sometimes, it’s severe acne, but most of the time it’s managed by primary care providers.”
Any progestin-only contraception, whether it is an intrauterine device (IUD), implant, pills, or Depo shot, can worsen acne, Pitts says.
“The reason is because estrogen reduces the body’s own production of antigens,” she explains. “Estrogen bumps up proteins, which is why we think of estrogen as being good for acne.”
Any birth control option that does not have estrogen has the potential to worsen acne, she adds.
Each progestin-only method works differently and can have varying levels of impact on acne.
“IUDs work differently than pills, which work differently than shots, which work differently than implants,” Pitts says. “The Depo shot lowers the body’s production of estrogen.”
IUDs work more locally, so the body still can produce some estrogen, and the same is true of progestin pills, she adds.
For example, the new over-the-counter progestin-only birth control pill, Opill, has some androgenic properties but supplies a low dose of progestin. A small proportion of people could get acne when using it.
“The implant reduces estrogen some but not as much as Depo does,” Pitts says.
All of these details about which methods have the greatest and least effects on acne are important to know as clinicians counsel patients about their contraceptive options. It also is important to find out whether a patient is concerned about acne.
“Everyone has a different level of acne they’re struggling with,” Pitts notes. “Some with moderate or more severe acne are not always bothered by it, so it has to be a patient-centered approach.”
Reproductive healthcare providers also could offer patients suggestions for treating acne, such as topical agents, she adds.
When counseling patients on the impact of hormones from contraception, acne should be part of the discussion.
A clinician could say, “You may have a little acne from Opill, but we can talk about treatment options if that’s a concern to you,” Pitts suggests.
Providers can reassure patients that starting on the progestin-only contraception does not mean they will have terrible acne and need to see a dermatologist. It may mean they will try some over-the-counter acne treatments, and this will manage it well.
In the population Pitts and co-investigators studied, participants were split between those who used the implant and those who had the IUD.
“A lot of people think the implant would [have more impact on acne] because it has more hormones, but we found it wasn’t different,” she says. “The other thing is that 17% of people who reported acne [brought it up] as a new concern to them.”
Only five people had their LARC device removed because of acne, less than 1% of removals.1
“What’s important for all contraceptive counseling is to be honest about the potential side effects, and acne is one of those side effects,” Pitts says. “You may experience worsening acne, and if you do, we can switch to another agent.”
This helps the young person feel informed, and if acne symptoms occur, they will not be surprised.
“With our teens, we need to educate them and [accept] they know their selves best.”
REFERENCE
- Boos MD, Ryan ME, Milliren C, et al. Relationship between long-acting reversible contraception and acne in a cohort of adolescents and young adults. Pediatr Dermatol 2024; March 5. doi: 10.1111/pde.15578. [Online ahead of print].
Investigators evaluated adolescent and young adult study participants seeking progestin-only long-acting reversible contraception (LARC) and found there was a risk of the contraceptive worsening acne.
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