Can ‘the Pill’ Cause Acne? What to Know About Androgenic Progestins in Birth Control

There are many different birth control options available. Hormonal birth control, such as birth control pills, is a common method that many women choose. There are two types of hormones that can be included in these birth control options: progestins and estrogens. While both hormones can provide benefits beyond birth control, it’s the progestin component that primarily helps prevent pregnancy.

However, not all progestins are created equal. Some, like androgenic progestins, may make certain side effects more likely.

What are progestins?

Progestin is a lab-made hormone. It’s designed to mimic a naturally occurring sex hormone called progesterone.

Progesterone prepares the uterus for a potential pregnancy by thickening its lining. But high, continuous levels of progesterone (like during pregnancy) stop the body from ovulating (releasing an egg). This is why women typically don’t ovulate while they’re pregnant.

Progestins are used for birth control, emergency contraception, and other reproductive health conditions. They were developed because they’re better absorbed by the body in pill form than progesterone. But even though they’re lab-made, our bodies use progestins just like they would use progesterone.

What are the four progestin generations, and how do they work in birth control?

Progestins primarily prevent pregnancy by stopping ovulation. This prevents fertilization (when the sperm meets the egg). Progestins also work by:

• Thickening cervical mucus, making it more difficult for sperm to reach the egg.

• Slowing the movement of sperm and eggs in the fallopian tubes (the tubes that connect the ovaries and uterus).

• Thinning the lining of the uterus to prevent implantation of a fertilized egg.

Progestins are grouped into four generations. These groups represent when they were discovered and brought to market. First-generation progestins were the earliest developed, and fourth-generation are the most recent. Scientists continued to develop new progestins in an effort to help reduce the likelihood of common side effects.

Let’s discuss some examples of each progestin generation.

1. First-generation progestins

First-generation progestins include norethindrone, ethynodiol diacetate, and medroxyprogesterone. Examples of birth control methods that contain a first-generation progestin include:

• Heather (norethindrone)

• Depo-Provera (medroxyprogesterone)

• Kelnor (ethynodiol diacetate/ethinyl estradiol)

• Junel 1/20 (norethindrone acetate/ethinyl estradiol)

2. Second-generation progestins

Second-generation progestins include levonorgestrel and norgestrel. Examples of birth control methods that contain a second-generation progestin include:

• Mirena IUD (levonorgestrel)

• Cryselle (norgestrel/ethinyl estradiol)

• Twirla (levonorgestrel/ethinyl estradiol)

• Plan B One-Step (levonorgestrel)

3. Third-generation progestins

Third-generation progestins include norgestimate and norelgestromin, as well as etonogestrel and desogestrel. Examples of birth control methods that contain a third-generation progestin include:

• Sprintec (norgestimate/ethinyl estradiol)

• Apri (desogestrel/ethinyl estradiol)

• Nexplanon (etonogestrel)

• Nuvaring (etonogestrel/ethinyl estradiol)

• Xulane (norelgestromin/ethinyl estradiol)

4. Fourth-generation progestins

Fourth-generation progestin include drospirenone, dienogest, and segesterone acetate. Examples of birth control methods that contain a fourth-generation progestin include:

• Slynd (drospirenone)

• Annovera (segesterone/ethinyl estradiol)

• Natazia (dienogest/estradiol valerate)

• Yaz (drospirenone/ethinyl estradiol)

What are androgenic progestins?

Androgenic progestins are progestins that have similar properties to androgens. Androgens are a group of sex hormones found in both men and women. The most well-known androgen is testosterone. Overproduction of androgens in women can cause male-like features, such as hair growth on the chest or back, and other unwanted symptoms to develop. Androgenic progestins may cause some of these same issues as side effects, which we’ll discuss below.

First- and second-generation progestins have more androgenic properties. Of them, norethindrone is one of the most androgenic. These progestins may be more likely to cause certain side effects, like acne.

The third generation progestins are newer and have fewer androgenic properties. Fourth-generation progestins have no androgenic activity. These progestins have a greater risk of blood clots (discussed more below).

List of androgenic progestins

For easier reference, here’s a list of popular birth control methods with androgenic progestins:

• Heather

• Depo-Provera

• Kelnor

• Junel 1/20

• Mirena IUD

• Cryselle

• Twirla

This is not a complete list of all androgenic progestins. Ask your pharmacist or healthcare provider if your hormonal birth control contains one of these progestins.

Risks of progestins

Like with all medications, progestins have some risks. One risk that’s important to be aware of is blood clots. The risk is higher if you’re taking a combined oral contraceptive (COC), meaning it has both progestin and estrogen. This is because of the estrogen in the pill.

But there are some differences in blood clot risks between progestins, too. The risk is highest if you’re taking a COC with a third- or fourth-generation progestin, such as Apri or Yaz. COCs with a second-generation progestin, such as Cryselle, have a lower risk for blood clots.

Most progestin-only birth control methods, such as Mirena, don’t make blood clots more likely. The exception to this is the Depo-Provera shot, which does carry a risk of clots.

The following characteristics raise the risk for blood clots while using a combined hormonal contraceptive:

• Age of 35 or older and a current smoker

• Obesity with a body mass index (BMI) over 30

• Extended periods of immobility (such as bedrest for several weeks after a surgery)

• History of blood clots

• Personal or family history of blood clotting disorders

Common side effects of androgenic progestins

Androgenic progestins may be more likely to cause the following side effects:

• Acne

• Oily skin

• Weight gain

• Excessive hair growth on the face, chest, and back

• Male-pattern hair loss

• Headaches

• Water retention (bloating)

• Mood changes

This is not a comprehensive list of birth control side effects. If you notice any bothersome side effects, let your healthcare provider know. Together you discuss whether birth control with a different progestin might be more tolerable.

Are progestin-only pills safer than combination birth control pills?

Deciding on a birth control option can be overwhelming because there are so many options. Choosing the one that suits you best should be a conversation you have with your healthcare provider.

In general, progestin-only pills (POPs), like Heather, have a lower risk for blood clots compared to COCs, like Apri. POPs are also usually preferred for women who are breastfeeding because the estrogen in COCs can reduce milk supply.

What is the safest progestin?

There’s no progestin that is safest for everyone. Every type of birth control has its risks. For example, if you have a history of blood clots, then you may be advised to avoid third- or fourth-generation progestins, as well as Depo-Provera.

The safest progestin is going to differ from person to person. What may be safe for someone else may not be safe for you. Talk to your healthcare provider to find out which birth control method would be best for you.

Benefits of progestins

In addition to birth control, progestins can help reduce or stop menstrual bleeding. COCs with less or non-androgenic progestins, like Yaz, can also help treat acne and some symptoms of polycystic ovary syndrome (PCOS). Progestin-only birth control can be helpful for women who have sensitivities to estrogen, as well.

Disadvantages of progestin-only birth control

A disadvantage of progestin-only birth control is that it can cause irregular bleeding or spotting, especially during the first few months. This should improve over time. If bleeding continues to be heavy, or gets heavy after being light for a while, talk to your healthcare provider.

A disadvantage specific to POPs is that you can’t be late taking a pill. Even being 3 hours late for your daily dose can put you at risk for an unintended pregnancy. If you do miss this window, use a barrier method of protection (like condoms) or avoid having sex for 2 days. Medication reminder apps can be a helpful tool for remembering to take your pills on time.

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Written by:

Dima Cheetany, PharmD

Dima Cheetany is a clinical pharmacist, clinical instructor, and academic detailer at the University of Illinois at Chicago. She graduated with her Doctor of Pharmacy from Roosevelt University College of Pharmacy in 2016.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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