Contraception in individuals with acne

All combined oral contraceptives (COCs) increase sex hormone–binding globulin and lower serum androgen concentrations, which may reduce acne. Evidence is lacking for an effect of the contraceptive vaginal ring on acne, but it is likely to have a similar effect to COCs.

Some COCs have an indication for acne; however, this does not indicate superiority to those containing other hormone combinations (in which trials to examine effect on acne have not been undertaken).

Although COCs containing an antiandrogenic progestogen (eg dienogest, drospirenone, cyproterone) or a less androgenic progestogen than levonorgestrel (eg desogestrel, gestodene, norethisterone) might theoretically be most beneficial, there is insufficient evidence to indicate superiority of one COC formulation over another for acne. COCs containing cyproterone, desogestrel, drospirenone or gestodene may be associated with a slightly higher risk of venous thromboembolism (VTE) compared to pills containing levonorgestrel or norethisterone (see Risk of developing venous thromboembolism with combined hormonal contraception).