Post-pill acne is real: Here's how to manage the breakouts

Remember the time right before you first went on the contraceptive pill? B.C. — before contraception. You were most likely briefed about the potential side effects of going on the pill, with many women receiving a leaflet so large, it could've been hung on the wall like a poster.

Whether you've already stopped using hormonal birth control, or you're just thinking about it, the not-so-fun fact about the pill is there are also side effects when you stop it.

You may have heard first-hand from friends, or from the depths of skincare forums, that post-pill acne is one of those side effects. We'll give you the what, the when and the why and, of course, the how, to treat post-pill acne.

What is post-pill acne?

The name does kind of give it away — post-pill acne is acne that arises after coming off the pill and it will generally pop up across your face, from your forehead to your jawline and temples.

But to explain it properly, firstly we have to rewind to what the contraceptive pill is and exactly how it works.

What do birth control pills do?

When we talk about "the pill" — a medication so renowned, we don't even use its proper name — we're talking about the oral contraceptive pill (also known as birth control).

It's one of the most commonly used medications worldwide [1].

When it comes to Aussie women, approximately 50-80% of us have used it at some stage during our reproductive lives [1].

The birth control pill isn't just about contraception (read: preventing pregnancy), even though that's one of its biggest sells. It can also assist with regulating some of your hormones that are currently out of whack (hormonal imbalances, hormonal chaos — whatever you want to call it).

Practitioners also recommend it as a way to treat acne, assist with severe cramps, and regulate irregular cycles.

How does hormonal birth control work?

Quick recap: it's a daily tablet, with synthetic versions of oestrogen (oestrogen) and progestogen. When you take the contraceptive pill, the natural occurrence of your entire sex hormone system can be masked, in favour of these synthetic hormones.

It's how the contraceptive pill stops your ovaries from releasing an egg [2]. And, as we all know, no egg, no pregnancy.

In addition to this, it thins out the uterine lining, so even if an egg and sperm were able to find each other, they've got no place to stay. Around your cervix, fluid is thickened to prevent sperm from entering.

Where does hormonal acne come from?

Acne is largely influenced by hormonal regulation (that's why they call it hormonal acne) and is why you often experience breakouts around your period thanks to fluctuating hormones.

A lot of it can be traced back to just one of your sex hormones — androgens. This specific sex hormone is produced in our ovaries; for men, it's the testes. Not only do these sex hormones kick off puberty, but they also play a role in our reproductive health [3].

And androgens stimulate receptors found in sebaceous glands. Our sebaceous glands are actually dependent on these sex hormones. When too many of these receptors are stimulated, sebum fluid accumulates, as does keratin with the hair follicle.

The result? A clogged hair follicle (or 2, or 3 or 4), oily skin, blackheads and whiteheads [4].

How does the pill help hormonal acne?

It's not all bad news. High doses of oestrogen (like that found in your contraceptive pill) can inhibit the androgen production by your ovaries. In turn, sebum production decreases — in some cases, it can suppress adult sebum production altogether [1]. Some women say that they see pores disappear entirely.

Taking the pill works at managing acne for you. It's effective at treating blackheads, whiteheads, pimples, acne nodules and cystic acne [5].

One study even suggests that it's reasonable to expect a reduction in inflammatory and noninflammatory lesions by 30-75%; with an improvement in acne in at least half of the cases — stating it could be as high as 90% [6].

So why does post-pill acne happen?

What goes up, must come down. Once you stop taking your birth control pill, the high doses of oestrogen within your system — that have been inhibiting androgen and suppressing sebum production — will be reduced.

When your body stops receiving this source of synthetic oestrogen and artificial hormones, your entire sex hormone system scrambles to find its old baseline level. It's a bit of hormonal chaos, if you will.

And something that's super common is that your ovaries will be over-compensating, temporarily making way more androgens — therefore more sebum — as they kick back into action [7]. In fact, this will be way more than your skin has been used to, for whatever length of time you've been on the pill.

It is a common complaint that when you stop hormonal birth control, it can lead to acne flares, due to the increase in adult sebum production [8].

And, unfortunately, it doesn't matter if you went on the pill because you experienced acne prior or for contraceptive reasons, post-pill acne doesn't discriminate [6].

When can acne occur after stopping the pill?

Your body will take a while to sort itself out with everything hormonal. Your natural cycle might take between 2-3 periods before it gets back to normal and you're likely to experience post-pill acne within the first 6 months of discontinuing the oral contraceptive pill [1].

When it comes to exactly who gets post-pill acne, one study found that it occurred in 47% of the women surveyed [9].

How long can post-pill acne last?

For some, post-pill acne can last up to 12 months, if not longer.

However, the peak of post-pill acne is most commonly at the 6-month mark. Once you hit that, you'll generally see improvements in your post-pill acne presentation afterwards [7].

Does post-pill acne go away?

When you're in the midst of this hormonal chaos — where your entire sex hormone system is re-regulating itself, trying to get back to B.C. levels — it might seem that it never ends.

But like we said above, it's roughly 12 months until you'll see your post-pill acne presentation begin to fade away. There are some ways to help move post-pill acne along, which we can help you with.

How do you get rid of post-pill acne?

When it comes to treating post-pill acne, the first thing we recommend — as does our government health organisation — is talking to a medical professional. Successful management of acne needs careful selection of anti-acne agents according to two things: clinical presentation, and the ever-important needs of the individual patient [10].

By talking to a healthcare provider, you can make sure you're getting what's right for you, your hormonal health, and your skin health. Some of the standard first-line treatment strategies for treating post-pill acne include retinoids, niacinamide, hyaluronic acid, azelaic acid, and antibacterials [11].

Retinoids

A topical treatment — meaning it's applied directly onto your body — retinoids help stimulate the rate of skin cell turnover. This, in turn, helps shed dead skin cells at a faster rate, preventing a build-up with your hair follicle. Retinoids helps reduce adult sebum production.

And if post-inflammatory hyperpigmentation is a concern of yours, retinoids are the therapeutic choice [12].

Niacinamide

Skincare — even those that you can get over the counter — should be part of the "therapeutic regimen for all clinical forms of adult female acne" [12]. Yep, including post-pill acne.

Niacinamide falls into that category, partly because of its anti-inflammatory effects — which can reduce the swelling and redness you might experience with post-pill acne. It also works by regulating the amount of sebum fluid your skin produces, and can help fade marks that acne lesions have left on your skin [13].

Hyaluronic acid

It might not be the first ingredient you think of taking care of post-pill acne — due to its hydrating abilities — but it's actually proven to reduce scarring, like the kind left behind by a hormonal acne case, or an incident of cystic acne [14].

AZA acid

AZA acid — also known as azelaic acid — is kind of like an all-in-one superhero when it comes to first-line treatment strategies for your post-pill acne.

It's anti-microbial, anti-inflammatory, depigmenting, works against blackheads and whiteheads, can treat post-inflammatory hyperpigmentation (dark marks and spots left behind after acne lesions), and works as an antioxidant [12][8]. Meaning it contributes toward healthy skin, which looks good too.

Antibacterials

Antibacterials are recommended for post-pill acne, due to its anti-inflammatory effects. If you have a hormonal acne case that's considered to be moderate to severe, you may find you get recommend antibacterials for a period of time [15].

Custom treatments

A good acne treatment will be tailor-made just for you and your skin. This is why Software's health practitioners create formulas personalised for your skin type and concern.

All you need to do is upload selfies and share your skin goals with your online practitioner. Then, a pharmacist creates your custom bottle, which is shipped straight to you. You also get access to professional, personalised advice on your skin, as well as ongoing, follow-up support from your practitioner as you use your treatment.

Can you prevent acne from occurring after stopping birth control?

By working on your skin in advance — at least 4 weeks prior to the date you stop hormonal birth control — you can help reduce the severity of post-pill acne [7].

This includes dermo-cosmetics and supplements, like the ones you'll find in our Acne Kit. This system brings you goodies like salicylic acid (reduces sebum content); zinc (reduces keratin, keeps your pores open, reduces inflammation [7]); and the aforementioned, super hydrating hyaluronic acid.

Oh, and please, please, please use sunscreen every day as it'll help protect your inflamed skin from the harsh UV rays.