Androgens are responsible for those masculine qualities; acne, hair loss and hirsutism (excess facial hair) as well as an increase in both facial and body hair.

What Happens To Your Body During That Time Of The Month?

It is important to understand what happens hormonally during the course of a 28-day menstrual cycle to understand what role hormones play in monthly acne.

During your menstral cycle, estrogen levels increasing over the first 14 days, (days 1-14), until ovulation. Once the egg is released from the ovary, the levels of estrogen drop precipitously.

Overlapping the estrogen peak, starting at approximately days 12-14, the level of progesterone begins to rise.

Progesterone: is essential for preparing and maintaining the uterine lining for a successful pregnancy. If fertilization does not occur and the egg does not implant, progesterone levels begin to fall, assuming you have a “regular” cycle, menstrual flow begins at day 28.

Progesterone is made in the adrenal glands. Progesterone has qualities of both androgens and estrogen.

Essentially, Progesterone Is The "Good Guy" 

Natural progesterone competes with androgens, particularly when your estrogen levels drop at ovulation, helping prevent androgens from exerting their effects upon the skin.

Women can either make too much testosterone, make too little estrogen to mask the testosterone or have a genetic preference towards highly sensitive skin and hair follicle cells to “normal” levels of androgens.

By far the most common cause of androgenic acne is this natural ultra sensitivity to androgens.

Can Birth Control Pills Help Fight Acne?

Birth control pills is used to prevent ovulation (release of the egg from the ovary), which in 98.8% of cases prevents pregnancy.

There are currently an estimated 65 million women worldwide on oral contraceptives, which make for approximately 6% of all women of reproductive age.

Birth Control Pills (BCPs) contain different amounts of estrogen (Ethinyl Estradiol aka EE) and a derivative of synthetic progesterone known as a progestin. There are many forms of progestins. They are either derived directly from testosterone or from progesterone.

Why do BCPs help control acne? In order to treat acne hormonally, one of the following must occur to stop hormones from causeing acne flare ups in skin.

The BCP treatments must either:

•     Block the androgens from reaching the receptors.
•     Reduce the level of circulating androgens in the bloodstream.
•     Prevent the formation of the androgens in the first place.

Oral contraceptives can do all three of these actions. All oral contraceptives are anti-androgenic. BCPs increase sex hormone binding globulin (SHBG), which binds to androgens and literally prevent them from going anywhere. Sort of a sponge-action approach.

At the same time, the progestin component (the synthetic form of progesterone) of an oral contraceptive competes to bind to the androgen receptors.

All birth control pills decrease levels of circulating testosterone.

BCPs also help prevent the formation of active androgens. Testosterone must be converted to dihydrotestosterone (DHT) in order to be active.

BCPs prevent the enzyme 5 alpha reductase from functioning. Without this enzyme, the conversion process is stopped.

DHT is responsible for those unwanted skin changes such as acne formation, hair loss of the scalp and extra hair growth on the face and body.

Three factoids on Birth Control Pills:

•     Are anti-androgenic
•     Help reduce circulating levels of testosterone
•     Help reduce acne for the majority of women

What Makes A Good BCP For Acne Treatment?

The FDA has only given its approval for Ortho-Tricyclen to carry the indication for treating acne. This medication went through the rigorous testing and studies required to prove to the FDA that it indeed was beneficial for acne as well as its ability to be a quality oral contraceptive.

However, understanding that all BCPs have some benefit to helping acne and that there are going to be those that better for some women than others.