Hormonal birth control — cystic acne and migraine auras
December 9, 2018 1:10 PM Subscribe
I used to take birth control (tri sprintec/tri linyah) and it was great for a long time. I have always struggled with cystic acne and it is the only thing to ever clear it up long term. For a few years I had wonderfully cyst-free skin, until I started getting a ton of migraine auras.
I had never had migraines or auras in my life until last April. I had 10 total between April and July. Only one time did I also have significant pain. Every other time it was a painless aura lasting about half an hour. I suspected the pill might be to blame. I stopped taking the pill and had one or two auras the following week and then nothing at all, they’ve been totally gone.
Frustratingly my cystic acne has also come home to stay. It’s painful, very visible, almost exclusively on my jaw and chin. It’s driving me insane. I’d love to go back on the pill but I’m also terrified of it. My dad has a history of blood clots. I’m reasonably healthy (5’4” and 120 lbs, 28 years old, non smoker) but the frequency of the migraines put the fear of God into me.
I have had a LOT of bad experiences with doctors not listening, disregarding my concerns, or telling me XYZ treatment totally won’t have ABC side effect when a google search explicitly says that it can. I considered getting an IUD and my GYN insisted that it won’t make hormonal acne worse when the Internet is riddled with reviews stating that it can definitely do that.
She did mention that my previous BC prescription was a high hormone dose and said we should try a low dose. I got a prescription for Lo Loestrin, but it’s $20 a month with my insurance. I did some digging and there’s a lot that gives me pause about taking Lo Loestrin, so I’m planning on calling my GYN tomorrow to discuss options and possibly schedule another appointment.
My general question is—is there a hormonal treatment for cystic acne that isn’t going to give me a premature heart attack? Should I be extremely concerned about the migraine auras? My GYN didn’t appear to be worried about them but thought a low hormone pill would be good (my sex drive also took a nose dive on the pill but that was the only other noticeable side effect). I’m worried that a low hormone pill won’t help my skin.
My anxiety levels about all of this are super high and I feel generally uncomfortable and untrusting toward basically any of my doctors, no matter what, which isn’t helping. Any and all anecdata would be helpful so I can be an advocate for myself when I do talk to her. I’m also planning to call my GP to see if I can get my hormones checked out.
I had never had migraines or auras in my life until last April. I had 10 total between April and July. Only one time did I also have significant pain. Every other time it was a painless aura lasting about half an hour. I suspected the pill might be to blame. I stopped taking the pill and had one or two auras the following week and then nothing at all, they’ve been totally gone.
Frustratingly my cystic acne has also come home to stay. It’s painful, very visible, almost exclusively on my jaw and chin. It’s driving me insane. I’d love to go back on the pill but I’m also terrified of it. My dad has a history of blood clots. I’m reasonably healthy (5’4” and 120 lbs, 28 years old, non smoker) but the frequency of the migraines put the fear of God into me.
I have had a LOT of bad experiences with doctors not listening, disregarding my concerns, or telling me XYZ treatment totally won’t have ABC side effect when a google search explicitly says that it can. I considered getting an IUD and my GYN insisted that it won’t make hormonal acne worse when the Internet is riddled with reviews stating that it can definitely do that.
She did mention that my previous BC prescription was a high hormone dose and said we should try a low dose. I got a prescription for Lo Loestrin, but it’s $20 a month with my insurance. I did some digging and there’s a lot that gives me pause about taking Lo Loestrin, so I’m planning on calling my GYN tomorrow to discuss options and possibly schedule another appointment.
My general question is—is there a hormonal treatment for cystic acne that isn’t going to give me a premature heart attack? Should I be extremely concerned about the migraine auras? My GYN didn’t appear to be worried about them but thought a low hormone pill would be good (my sex drive also took a nose dive on the pill but that was the only other noticeable side effect). I’m worried that a low hormone pill won’t help my skin.
My anxiety levels about all of this are super high and I feel generally uncomfortable and untrusting toward basically any of my doctors, no matter what, which isn’t helping. Any and all anecdata would be helpful so I can be an advocate for myself when I do talk to her. I’m also planning to call my GP to see if I can get my hormones checked out.
I had to stop both Yaz and Lo-lo estrin due to migraines, and the migraines stopped immediately.
posted by gryphonlover at 1:44 PM on December 9, 2018
posted by gryphonlover at 1:44 PM on December 9, 2018
I had very good luck with spironolactone for my cystic acne. It took a few months to really work, but once it did the results were stellar.
posted by elsietheeel at 1:45 PM on December 9, 2018 [2 favorites]
posted by elsietheeel at 1:45 PM on December 9, 2018 [2 favorites]
I loved trisprintec for the way it cleared up my pcos symptoms (terrible skin and hair) but the high blood pressure/leg pain it brought me was too much. So I’m there with you. I’ve read positive studies on spironolactone for the treatment of hormonal acne but it is apparently very slow to work. Effective and safe but slow.
posted by Young Kullervo at 2:06 PM on December 9, 2018
posted by Young Kullervo at 2:06 PM on December 9, 2018
Response by poster: Thank you all for these answers!
To those who mentioned spironolactone, I did actually try this in college and only stopped taking it due to a bad experience with the derm. She had never heard of it when I requested it, gave me a prescription and a print-off of info and side effects. I took it for a few months but my period completely vanished. When I went for a follow-up I mentioned that and she literally howled at me that I must be pregnant (reader, I was not!). Of course, amenorrhea is one of the listed side effects... I stopped taking it, instantly had my period, and never called that derm again. I don’t remember if it actually helped and I may not have taken it long enough to see the results!
Spiro sounds ideal and worth asking a new derm about. Has anyone had a similar experience with a totally absent period? Is there any anecdata about that being particularly harmful or totally fine?
Thank you all again, this is so immensely helpful!
posted by caitcadieux at 2:15 PM on December 9, 2018
To those who mentioned spironolactone, I did actually try this in college and only stopped taking it due to a bad experience with the derm. She had never heard of it when I requested it, gave me a prescription and a print-off of info and side effects. I took it for a few months but my period completely vanished. When I went for a follow-up I mentioned that and she literally howled at me that I must be pregnant (reader, I was not!). Of course, amenorrhea is one of the listed side effects... I stopped taking it, instantly had my period, and never called that derm again. I don’t remember if it actually helped and I may not have taken it long enough to see the results!
Spiro sounds ideal and worth asking a new derm about. Has anyone had a similar experience with a totally absent period? Is there any anecdata about that being particularly harmful or totally fine?
Thank you all again, this is so immensely helpful!
posted by caitcadieux at 2:15 PM on December 9, 2018
Anti-androgens (spironolactone is the main one prescribed) definitely seems like a logical route to take. Birth control pills help with acne because they help inhibit androgen/testosterone production.
From my brief personal experience with spironolactone, it made my periods irregular, which was a pain, and my early-20s self didn’t have the patience to deal with that so I stopped taking it.
Regarding hormone levels - as a person with acne and a lot of body hair and a somewhat low voice, I’ve always assumed I had higher than usual testosterone for an XX-chromosome person, but my GYN basically said “eh, you might have higher T or you just might have more receptors and be more sensitive to it, I’ll just write you the script for spiro, the test isn’t important.” 10 years later a different, more test-happy GYN did measure my testosterone levels and while my acne is a little better these days, my testosterone (at least as measured, it can fluctuate) was indeed on the *lower* end of normal.
posted by needs more cowbell at 2:15 PM on December 9, 2018
From my brief personal experience with spironolactone, it made my periods irregular, which was a pain, and my early-20s self didn’t have the patience to deal with that so I stopped taking it.
Regarding hormone levels - as a person with acne and a lot of body hair and a somewhat low voice, I’ve always assumed I had higher than usual testosterone for an XX-chromosome person, but my GYN basically said “eh, you might have higher T or you just might have more receptors and be more sensitive to it, I’ll just write you the script for spiro, the test isn’t important.” 10 years later a different, more test-happy GYN did measure my testosterone levels and while my acne is a little better these days, my testosterone (at least as measured, it can fluctuate) was indeed on the *lower* end of normal.
posted by needs more cowbell at 2:15 PM on December 9, 2018
Forgive the slightly woo answer but on the recommendation of an herbalist friend, both my roommate (who also deals with hormonal cystic acne) and I started drinking spearmint tea daily and our cystic acne cleared up completely. I did not expect this to work, but I had tried Differin and it made me feel like my face was on fire and I cannot take hormonal birth control so I was ready to try just about anything.
posted by ananci at 2:21 PM on December 9, 2018
posted by ananci at 2:21 PM on December 9, 2018
Also it is not unhealthy to not get your period. I think we all feel it is cheating somehow, but I’ve asked several doctors about this back when I was still on BC and they always assured me it’s fine, and sometimes healthier if you’re prone to anemia or hormone-caused issues.
posted by ananci at 2:23 PM on December 9, 2018 [4 favorites]
posted by ananci at 2:23 PM on December 9, 2018 [4 favorites]
FWIW, I go to a fantastic neurologist. Fantastic. I get regular migraines but very rarely aura. However, she noted that if I ever got 3 or more auras, I should talk to my gyn about getting off my estrogen-containing pill. My gyn felt very strongly that I should, so now I have a Mirena IUD.
posted by bookworm4125 at 2:30 PM on December 9, 2018
posted by bookworm4125 at 2:30 PM on December 9, 2018
If you take doxycycline per limeonaire's recommendation, be aware that it is can render some birth control ineffective.
posted by ChuraChura at 2:33 PM on December 9, 2018 [1 favorite]
posted by ChuraChura at 2:33 PM on December 9, 2018 [1 favorite]
Have you considered accutane? It's basically the nuclear option when it comes to cystic acne but it does work for most severe cases. However, side affects are pretty bad (and it's known to cause severe birth defects). I experienced thinning hair and painful, cracked lips. But a 3 month course did wonders for my acne.
posted by emd3737 at 3:04 PM on December 9, 2018
posted by emd3737 at 3:04 PM on December 9, 2018
I tried spironolactone twice with disastrous results before, out of desperation, trying it again. This third time has been a miracle. (My side effects were gastrointestinal, not amenorrhea, but I think the takeaway is that your body won’t necessarily respond the same every time.)
posted by HotToddy at 3:13 PM on December 9, 2018
posted by HotToddy at 3:13 PM on December 9, 2018
Maybe I should also mention that my periods are in fact irregular, mostly more frequent, but that’s almost certainly due to perimenopause and even if it weren’t, I’d rather have periods than cystic acne. BY FAR.
posted by HotToddy at 3:16 PM on December 9, 2018
posted by HotToddy at 3:16 PM on December 9, 2018
Have you considered accutane?
afaik in the US you still can't get a prescription for accutane without also being on hbc, which makes it not useful in this particular case.
posted by poffin boffin at 3:25 PM on December 9, 2018
afaik in the US you still can't get a prescription for accutane without also being on hbc, which makes it not useful in this particular case.
posted by poffin boffin at 3:25 PM on December 9, 2018
Personally and professionally, I'd be extremely cautious about using estrogen in someone with a history of migraine with aura. The World Health Organization and the American College of Obstetrics and Gynecology consider that an unacceptable risk. The International Headache Society is more hand-wavey, but even they "recommend reevaluation or discontinuation of combination contraceptive use for women who develop escalating severity/frequency of headaches, particularly outside of the pill-free interval; new-onset migraine with aura symptoms; or nonmigrainous headaches persisting beyond 3 months of use." (Consensus statement, might be paywalled)
If the primary goal is to reduce your cystic acne, there are other treatment options like spironolactone and doxycycline, as above. Might mean you have to try an alternative, non-estrogen-based birth control method, which might end up costing a bit more, but to me, at least, it would be worth it. (If you do go for an IUD, get the copper Paraguard rather than the hormonal Mirena -- that may be what your GYN was thinking about.)
posted by basalganglia at 4:22 PM on December 9, 2018 [1 favorite]
If the primary goal is to reduce your cystic acne, there are other treatment options like spironolactone and doxycycline, as above. Might mean you have to try an alternative, non-estrogen-based birth control method, which might end up costing a bit more, but to me, at least, it would be worth it. (If you do go for an IUD, get the copper Paraguard rather than the hormonal Mirena -- that may be what your GYN was thinking about.)
posted by basalganglia at 4:22 PM on December 9, 2018 [1 favorite]
My neurologist gave me a stern lecture about a month ago on the risk of stroke for people who use hormonal birth control (which I do, for compelling non-contraceptive reasons) and who experience migraine with auras.
posted by Secret Sparrow at 6:38 PM on December 9, 2018
posted by Secret Sparrow at 6:38 PM on December 9, 2018
When I stopped eating dairy, my cystic acne disappeared. Completely. It's worth a try, not as difficult as you might think, and, in my opinion, a far better solution than taking pills.
posted by Dolley at 7:14 PM on December 9, 2018
posted by Dolley at 7:14 PM on December 9, 2018
I took low dose birth control for several decades and the number of migraine auras I got gradually ramped up from one every couple of years to four or five a month. My doctor still wasn't hugely concerned but I decided to switch to a copper iud instead.
For nearly a year afterwards I had terrible acne. I wanted to cry every time I saw my face or back. My back scarred. But it went away almost completely pretty much after a year. This could still happen to you. The main difference is that I never really had acne problems in the past and it sounds like you did.
I did also start using retinoids, about a month before the acne cleared up. But I only use them on my face and my back has cleared up pretty well too. (Like now I get two or three giant painful zits per month instead of 10-15 at any given time.)
posted by lollusc at 12:11 AM on December 10, 2018
For nearly a year afterwards I had terrible acne. I wanted to cry every time I saw my face or back. My back scarred. But it went away almost completely pretty much after a year. This could still happen to you. The main difference is that I never really had acne problems in the past and it sounds like you did.
I did also start using retinoids, about a month before the acne cleared up. But I only use them on my face and my back has cleared up pretty well too. (Like now I get two or three giant painful zits per month instead of 10-15 at any given time.)
posted by lollusc at 12:11 AM on December 10, 2018
Regarding what ananci said above, spearmint tea has been shown to have anti-androgen properties. So that’s not quite as woo as it might seem!
posted by needs more cowbell at 10:18 AM on December 22, 2018
posted by needs more cowbell at 10:18 AM on December 22, 2018
This thread is closed to new comments.
posted by limeonaire at 1:23 PM on December 9, 2018 [2 favorites]