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Progestin Based IUD and Hormonal Imbalance

The use of the Mirena, Skyla, Liletta, and Kyleena hormonal IUD supplies synthetic progestins in the gonadal area which are going to suppress the body's production of progesterone dramatically. As a result, the rest of the body begins to suffer from insufficient progesterone; thus, estrogen dominance hormonal imbalance.

Acne in part can occur when high androgen levels such as testosterone get turned into its more potent form called dihydrotestosterone or DHT, via the action of an enzyme called 5-alpha reductase. DHT then causes sebum production to increase, leading to oily skin, clogged pores, and acne. Balanced levels of progesterone act directly by inhibiting the activity of 5-alpha reductase and prevents it from converting testosterone into DHT. When progesterone levels are balanced, it results in DHT levels staying low. However, when estrogen is high, and progesterone is low, your sebaceous glands produce an enormous amount of sebum!

An extensive study in Europe looked at the most frequent reasons women chose to discontinue use of their hormonal IUD (a 20 ug/day dose IUD). At five years, 8.4% of women had abandoned the use of the IUD. Acne was the second most common reason for stopping, accounting for 2.3% of women. Therefore, although the number of women who discontinued its use due to side effects is small, 1 in 4 women who stopped using the IUD did so because of acne (read here)

It’s essential for those with acne prone skin to stay away from progestin-only contraceptives. These include the levonorgestrel IUDs, arm implants, and injections, as well as the mini-pill. These methods have been proven to exacerbate acne and should be avoided at all costs by acne-prone women seeking clear skin.

Best birth control for women with acne-prone skin are the ones which contain a higher dose of estrogen and lower in androgen potency (during your consultation we can provide you a list of acne-safe birth control options). Let's note that acne cannot be ‘cured’ by the aforementioned hormonal birth control – it can only temporarily mask the hormonal imbalance. While the body is receiving a daily dose of estrogen from the birth control pill, the hormones are settled and regulated – but without the pill, hormones will return to their natural levels and acne can return with a vengeance. Many women find that their acne after taking birth-control pills is much harder to get rid of than the acne they had before starting the pill. The ParaGard Copper IUD is not a hormonal contraceptive, making it a neutral option.

If you are wondering whether getting a hormonal IUD inserted or starting progestin-only birth control might have a detrimental effect on your complexion, it is unlikely that you might immediately experience hormonal cystic acne upon insertion of a levonorgestrel IUD or other progestin-based birth control; in some cases, hormonal imbalances may take a few years to show.

If you are truly serious about overcoming side effects of hormonal birth control and improving your skin health, and you’re looking for something intensive, science-based, individualized and tailored to your specific situation, we would like to invite you to schedule a consultation and skin analysis with our skin care coach and get your skin back on track.

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