Hormonal Contraceptives and Skin Health | with Emily Bathgate

When it comes to hormonal skin concerns like acne, many of us have been told the same thing: “Just go on the Pill.” And while hormonal contraceptives can be helpful for some, they’re not a one-size-fits-all, long-term solution – especially when it comes to skin health.

Whether you’re navigating breakouts, considering a change in your contraceptive method, or simply trying to understand what’s really going on beneath the skin’s surface… let’s dive into how hormonal contraception influences your skin (for better or worse).

From the different types of synthetic hormones to their potential impacts on the skin’s oil production, inflammation and pigmentation, let’s unpack the lot – so you can make empowered, informed decisions about both your hormonal and skin health!

A Menstrual Cycle & Contraception Recap

Our menstrual cycle represents a delicate hormonal dance that will ideally last 23-35 days (28 being the ideal average). This cycle sees us flow from one period (aka menstruation – the shedding of your uterine lining) to the next, with ovulation being our midway point as well as our most fertile; you are most fertile on the day of ovulation as well as in the 5 days prior. After ovulation, our uterine lining, which steadily thickens across our cycle, will either support pregnancy (if the egg released during ovulation has been fertilised) or break down if you’re not pregnant, resulting in your next period.

Hormonal contraceptives – with their premise being pregnancy prevention – generally work by interrupting this natural cycle, preventing ovulation and altering our endometrial lining to prevent implantation.

Common Hormonal Contraceptives

Oral Contraceptive Pills (OCPs)

The Pill works by:

• Preventing ovulation by suppressing our body’s natural gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), and luteinising hormone (LH)
• Thickening cervical mucus, creating a sperm barrier
• Thinning the endometrial lining, reducing the likelihood of implantation

The Combined OCP contains both synthetic oestrogen (typically ethinylestradiol) and progestin, with the levels of each varying across the different versions.

Hormonal IUDs (like Mirena & Kyleena)

These are inserted into the uterus and:

• Act as a barrier against sperm movement
• Thicken cervical mucus
  - Thin the endometrial lining
• They release progestin locally over 3–5 years, with minimal systemic effect.

Depo-Provera Injection

An intramuscular injection that suppresses ovulation using medroxyprogesterone acetate (MPA), a synthetic progestin.

Implanon/Nexplanon

An implant in the upper arm that:

• Prevents ovulation
• Thickens cervical mucus

Hormones & Skin Health

Your hormones influence your skin in different ways at different phases throughout your menstrual cycle.

Situations like hormonal acne usually occur as a result of hormonal imbalances – most commonly: androgen excess, oestrogen dominance, and/or progesterone deficiency.

Hormonal contraceptives (particularly certain combined oral contraceptive pills – OCPs), are frequently prescribed specifically to address skin conditions like acne. This is based on the premise that they can work to reduce androgen levels and crack down on sebum production.

However, not all hormonal contraceptives are created equal when it comes to skin health…

You see, there are differences between the natural hormones our body makes and the synthetic, designed hormones in contraceptives.

Structurally, the hormones in contraceptives (provided in uniform dosages) are not identical to, or as adaptive as, our natural/endogenous ones. This means that these synthetic hormones can cross-react with our body’s receptors in unpredictable ways – potentially causing imbalances and side effects, including skin issues.

For example…

• On the Pill, many women notice clearer, less oily skin – but it’s also not uncommon to experience increased pigmentation or other skin issues while they’re on it.
• With a hormonal IUD, it’s not uncommon to experience changes in bleeding patterns in the first 3-6 months to a year, which might cause some slightly funky skin oiliness or breakout patterns.
• With Depo or Implanon, results really vary – making some women more susceptible to hormonal acne, and others notice dramatic improvements in their skin clarity.

Shining a Light on Progestins & Acne

The synthetic progestins used in hormonal contraceptives differ greatly from natural progesterone – usually produced after ovulation (which, again, hormonal contraceptives work to prevent) – in their molecular structure, creating different effects in the body… including in the skin!

There are a couple of kinds of progestins you (and your skin) should know about: Androgenic and Anti-Androgenic.

• ANDROGENIC PROGESTINS
  These progestins – like levonorgestrel and norethindrone – activate androgen receptors in the skin’s sebaceous glands, increasing oil production and potentially triggering acne.
• ANTI-ANDROGENIC PROGESTINS
  These block androgen receptors and/or lower free testosterone, leading to reduced oil and less acne – especially when paired with synthetic oestrogen.

It’s important to note that everybody responds differently to progestins due to genetics, hormonal sensitivity, and product formulations.

What about other skin concerns?

• MELASMA: Caused by increased melanin production triggered by synthetic oestrogen. Sun exposure and progestins can worsen this.
• ECZEMA & DERMATITIS: Hormonal shifts can alter immune responses and skin barrier function, sometimes triggering dryness, irritation, or flare-ups.

Holistic Hormonal Skin Care

Personally, I believe that it’s so important to be able to make an informed decision about which contraceptive option – hormonal or not – might be the best one for you. By combining my clinical knowledge with holistic wellness strategies, I absolutely love helping my clients navigate these important health decisions with confidence and clarity.

Every woman responds differently to hormonal contraceptives, and it’s important to take into account the bigger picture (family & medical history, existing or historic skin and/or hormonal conditions, lifestyle, stress levels, and more) when considering how they (and their skin!) might respond. The personal nature of hormone response means that no single contraceptive option is ever going to be ideal for everyone.

Whether you’re using a hormonal form of contraception or not, there are lots of ways we can tackle hormonal imbalances and skin struggles!

My naturopathic approach to hormonal skin concerns usually encompasses some:

• Skin-specific support – for a healthy skin barrier, balanced sebum production, and lower inflammation levels
• Liver loving – making sure that liver function & detoxification of any hormonal excess is tip-top!
• Gut health guidance – to ensure healthy hormone clearance & detoxification, plus healthy skin via a healthy immune system & microbiome
• Nutrient support – (Magnesium, Zinc, B Vitamins & Essential Fatty Acids) to boost skin health, correct deficiencies, and support hormone metabolism.

Love Emily.

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Emily is a qualified naturopath with a special interest in skin and hormonal health. Her approach integrates the latest research with timeless wisdom, empowering women to feel confident and radiant in their bodies.