Birth control medications may be a treatment option for those living with hidradenitis suppurativa (HS), also known as acne inversa. This skin condition causes abscesses or nodules, often in the armpits, groin, or inner thighs.
Although birth control pills (also called oral contraceptives) don’t work for everyone, they can help control HS symptoms in some individuals.
Many members of myHSteam have asked for advice about taking birth control with HS. “Has anyone tried birth control pills to help with flare-ups?” asked one member. “I was told they help.”
HS develops when the apocrine glands, which produce sweat, are blocked. Experts don’t yet know exactly what causes these blockages, but some research suggests that hormones may play a role. Birth control may counteract the effects of certain types of hormones linked with HS.
Hormones are molecules that send signals between different parts of the body. Certain types called sex hormones and reproductive hormones help control processes like puberty, menstruation, sex drive, fertility, pregnancy, and sperm production.
Androgens such as testosterone are hormones that encourage the development of male characteristics. Although androgens are typically found at higher levels in men than in women, everyone has these hormones.
Androgens may affect HS by prompting sweat glands to step up the production of oily substances, which can cause inflammation and clog nearby hair follicles. HS flares (periods when symptoms increase) also seem to be affected by hormone levels in many people. HS often flares up as hormone levels drop before a menstrual period, after giving birth, or during menopause. The condition also lessens for about half of people in postmenopause.
Many myHSteam members have noticed these effects. “Can someone tell me why my HS starts hurting when it gets close to my time of the month?” questioned a member. “I have relatively mild HS but will frequently get a cyst a week before I start my period,” shared another. One member wrote, “I just had a baby, and my HS is doing much better now that I’m not pregnant.”
Birth control pills are forms of anti-androgen medication — in other words, they block the effects of androgen hormones. This treatment may prevent fluctuating hormone levels from triggering HS symptoms.
HS can be treated with a type of birth control called a combined oral contraceptive.
Birth control pills contain estrogen or progesterone — hormones that encourage the development of female characteristics. Combined oral contraceptives include both estrogen and progesterone, which may counteract androgens and balance hormone levels to help with HS. Examples of these prescription medicines include:
Other forms of birth control pills contain only progesterone. These contraceptives aren’t recommended for people with HS because there is a chance they could make this skin disease worse.
Other types of medications that affect hormone levels are also used to treat HS. Although they’re not birth control pills, spironolactone (Aldactone), finasteride (Proscar), and cyproterone acetate (Diane-35) can reduce the effects of androgen hormones and are sometimes recommended for people with HS.
Doctors often recommend antibiotics as a first treatment for HS. Many people also initially try topical medications (creams or ointments applied directly to the skin). If initial treatments don’t work or for more severe cases, doctors may recommend other strategies, including birth control pills.
This treatment may be a good idea if your HS seems to be connected to your hormone levels. In particular, if you tend to experience HS flares right before your period, birth control pills could help keep HS symptoms under control.
According to DermNet, birth control pills may help treat HS in women but aren’t prescribed to men with HS. Additionally, birth control pills shouldn’t be taken during pregnancy.
Only a few studies have looked at the effects of birth control medications in people with HS. The findings have shown that, although the treatment doesn’t work for everyone, birth control can sometimes help reduce HS symptoms.
The first clinical trial (a type of research study) to look at whether hormone therapy could treat HS was published in 1986. Some of the 24 participants were given an estrogen-containing medication along with cyproterone acetate, and others received ethinyl estradiol and norgestrel (Cryselle). The researchers found that the combinations were equally effective, with HS clearing or improving in two-thirds of the people who finished the trial.
A 2007 study found that more than half of 64 participants saw improvements in HS when using hormone treatments (birth control pills, cyproterone acetate, and spironolactone), which seemed to work better compared with oral antibiotics. However, other participants experienced no changes in or even worsening of their HS while using hormonal treatments.
More recently, a 2021 study with 100 participants found that 54 percent had fewer abscesses and nodules after taking birth control pills. This treatment worked better for those who’d had HS for a shorter time and those who noticed a connection between HS flares and their period.
Members of myHSteam have reported varying results when taking birth control.
Some have found the treatment very helpful. “My daughter is much better now that she takes a birth control pill daily,” wrote one member. “Hormones definitely contribute to this.” Another shared, “No new flares since October! I really think birth control is working for me.”
Birth control pills have been ineffective for others and, in some cases, have worsened HS. “It didn’t work for me,” commented one member. “I was put on birth control a few years ago, and I still had really bad breakouts!” reported another. “I tried them only once, to be fair, but they sent me into an itching fit in my HS sites,” wrote a member. “I was miserable until it cleared my system.”
Birth control pills can bring several benefits beyond improving HS. For example, these medications also help protect against several conditions, including:
Taking birth control pills could also help lessen symptoms of endometriosis, uterine fibroids, or other gynecological problems.
Additional possible benefits include making periods lighter, reducing menstrual cramps, and treating acne. However, birth control pills sometimes have the opposite effect, leading to heavier periods or worse acne. Other side effects include:
Birth control pills can also slightly raise your risk of developing conditions like blood clots, heart attacks, breast cancer, or liver cancer. In addition, if you are being treated for an autoimmune disease, you should discuss starting oral contraception with your doctor for that condition.
If you’re interested in trying birth control medication to help with your HS, talk with your dermatologist to get help weighing the benefits and risks. Your health care team can help you understand whether this treatment is likely to help with your condition and if you should watch out for any potential concerns.
On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 28,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.
Are you living with hidradenitis suppurativa? Have you tried birth control pills as a treatment? Share your experience in the comments below, or start a conversation by posting on your Activities page.