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Birth Control Pills for HS: What To Know

Posted on October 18, 2022
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Maureen McNulty

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.”

Why Might Birth Control Help Treat HS?

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.

Types of Oral Contraceptives Used for HS

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:

  • Norgestimate and ethinyl estradiol (Ortho Tri-Cyclen)
  • Drospirenone and ethinyl estradiol (Yasmin)
  • Norethindrone acetate and ethinyl estradiol (Loestrin FE)
  • Levonorgestrel and ethinyl estradiol (Lutera)

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 Forms of Hormone Therapy

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.

Who Is a Candidate for This Treatment?

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.

How Effective Are Birth Control Pills for HS?

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.

Member Experiences With Birth Control

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: The Benefits and Risks

Birth control pills can bring several benefits beyond improving HS. For example, these medications also help protect against several conditions, including:

  • Ovarian cysts
  • Pelvic inflammatory disease
  • Ovarian cancer
  • Endometrial cancer (cancer of the uterus)

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:

  • Nausea or vomiting
  • Abdominal pain or bloating
  • Swollen gums
  • Changes in appetite
  • Weight gain or loss
  • Diarrhea
  • Constipation
  • Darkened patches of skin
  • Tender breasts
  • Irritation, itching, or swelling in the vagina
  • Bleeding between periods

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.

Talk With Others Who Understand

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.

References
  1. Hidradenitis Suppurativa: Overview — American Academy of Dermatology Association
  2. Hidradenitis Suppurativa — American Osteopathic College of Dermatology
  3. A Concise Clinician’s Guide to Therapy for Hidradenitis Suppurativa — International Journal of Women’s Dermatology
  4. Reproductive Hormones — Endocrine Society
  5. Clinical Considerations in the Management of Hidradenitis Suppurativa in Women — International Journal of Women’s Dermatology
  6. Anti-Androgen Therapy — DermNet
  7. Hormonal Treatment of Acne and Hidradenitis Suppurativa in Adolescent Patients — Dermatologic Clinics
  8. Oral Contraceptive Pills — StatPearls
  9. Types of Combined Oral Contraceptives Used by U.S. Women — Contraception
  10. North American Clinical Management Guidelines for Hidradenitis Suppurativa: A Publication From the United States and Canadian Hidradenitis Suppurativa Foundations — Journal of the American Academy of Dermatology
  11. Hidradenitis Suppurativa (HS) — NHS
  12. Hidradenitis Suppurativa: Diagnosis and Treatment — American Academy of Dermatology Association
  13. A Double-Blind Controlled Cross-Over Trial of Cyproterone Acetate in Females With Hidradenitis Suppurativa — British Journal of Dermatology
  14. Hidradenitis Suppurativa in 64 Female Patients: Retrospective Study Comparing Oral Antibiotics and Antiandrogen Therapy — Journal of Cutaneous Medicine and Surgery
  15. The Role of Oral Contraceptive Pills in Hidradenitis Suppurativa: A Cohort Study — Life
  16. Birth Control Methods — Office on Women’s Health
  17. Estrogen and Progestin (Oral Contraceptives) — MedlinePlus

All updates must be accompanied by text or a picture.
Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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