Can Birth Control Have a Side Effect of Acne? Nexplanon and Beyond

Stories about acne while taking hormonal birth control can often be polar opposites: Either the birth control helped clear someone's skin—or made it worse.

To prevent pregnancy, hormonal contraceptives contain varying doses of sex hormones, such as estrogen and progestin (a synthetic type of progesterone). These hormones can prevent ovulation (release of an egg from an ovary).¹ But since hormonal imbalance can play a role in the development of acne, taking hormonal birth control might trigger changes in the skin based on how your individual body responds.²

Acne is a side effect of several types of hormonal birth control, including Nexplanon. Here's what you need to know about acne, Nexplanon, and other birth control methods.

What Is Nexplanon?

Nexplanon is commonly known as the birth control implant. It is a small, flexible rod (about the size of a matchstick) that releases progestin (a type called etonogestrel) to prevent pregnancy.^3,4

The implant is 99% effective at preventing pregnancy, primarily by blocking ovulation. But Nexplanon does not protect against any sexually transmitted infections (also known as sexually transmitted diseases).³

How is it inserted?

A healthcare provider can insert Nexplanon under the skin of your non-dominant arm.⁴ This is a minor surgical procedure that requires local anesthesia.⁴ Once the implant is inserted, you do not need to do anything else to prevent pregnancy.³

You will need to take a pregnancy test first and should schedule the insertion during the first five days of your period.⁵ If it is after the first five days, use a backup contraceptive method, such as a condom, for the first week after your insertion to ensure pregnancy prevention.³

How is it removed?

Nexplanon is a long-acting reversible birth control. Its contraceptive effects can last up to three years and stop working upon removal.³ A healthcare provider can remove the implant at any time with a procedure that's very similar to the insertion.⁶

Why Can Acne Be a Side Effect of Nexplanon?

It is unclear why acne is a side effect of Nexplanon. However, it may be because it contains progestin, a synthetic version of progesterone that can produce side effects similar to natural progesterone.⁷

During a typical menstrual cycle, levels of sex hormones, including progesterone, estrogen, and testosterone, can rise and fall. These hormonal changes may impact the amount of sebum (oily substance) in the skin and how the body responds to that sebum.²

More specifically, increased levels of androgens (a group of hormones including testosterone) can lead to sebum buildup in the skin. More sebum can reduce the amount of natural protective oils in your skin, making it prone to acne-related bacteria (P. acnes). When your immune system responds to sebum and bacteria buildup, that may lead to acne.²

It is possible that some progestins may lead to androgen-related effects, such as the development of acne, but modern-day progestin-only contraceptives tend to have low doses of progestin and less androgen-like effects. In general, there is very limited research on whether progestin-only birth control affects the development of acne.⁸

In addition, how often acne occurs while on Nexplanon varies widely. Across four studies, 11% to 45% of users reported acne.⁹

Other factors for acne

While users of progestin-only birth control have reported acne as a side effect, other factors could contribute to breakouts.⁷ For example, genetics is a major factor: Some people may be genetically more likely to have acne (including in adulthood) than others. Diet, stress levels, smoking tobacco, and health conditions that affect hormonal balance could also trigger or worsen acne.²

It's also possible that your previous birth control method is responsible for changes in your skin health. For example, worsening acne after switching to Nexplanon may not necessarily be from the implant; it could be from stopping a previous contraceptive that helped improve your skin.²

Other types of birth control, namely combined birth control pills, contain both estrogen and progestin and are effective treatments for acne. A few studies also suggest that progestin-only contraceptives are more likely to be associated with acne, compared to combined pills.¹⁰ This difference may be from the estrogen in combined pills: More estrogen can block the release of androgens and reduce the amount of sebum in your skin.²

Currently, limited studies show mixed results on whether or not acne is associated with the birth control implant and other progestin-only contraceptives.¹⁰ Experts say more research is needed to determine what actually causes the side effect of acne with these methods.⁸

What Type of Acne Can Occur With Nexplanon?

Each person will have a different response to Nexplanon. You might have no acne, a little bit of mild acne in the first few months, or a lot of new acne. There's no way to predict exactly what you'll experience while on Nexplanon.

But in general, women who experience adult acne (whether from hormonal birth control or a combination of acne-prone factors) tend to have whiteheads and cystic acne on the chin, jawline, and neck. Some women experience acne on the chest and back, as well as other parts of the face, including the temples, forehead, and cheeks.²

Other Side Effects and Health Risks of Nexplanon

Beyond acne, other common side effects of Nexplanon include:¹¹

• Pain (in abdomen, breast, or insertion site)
• Changes to menstrual periods
  • Spotting between periods
  • Longer, shorter, lighter, or heavier periods
• Headache
• Mood changes (nervousness, depression)
• Weight gain
• Nausea and dizziness
• Hair loss

Some people shouldn't take Nexplanon, including those with a history of blood clots, liver disease, breast cancer, unexplained vaginal bleeding, and allergy to Nexplanon. Also, people who are pregnant should not take Nexplanon.⁶ On the rare chance that you become pregnant while the implant is in place, you may be more likely to have an ectopic pregnancy (a medical emergency when the fertilized egg is outside the uterus).³

Not everyone who takes hormonal birth control, including Nexplanon, has side effects. Sometimes side effects only last for the first few months.¹² Make sure to ask your doctor about possible side effects before insertion, and see the full prescribing information for more details about the potential risks of using Nexplanon.

Acne With Other Types of Birth Control

Acne can be a side effect of other types of progestin-only birth control. These methods include:

• Hormonal intrauterine devices (IUDs): After a healthcare provider inserts an IUD in your uterus, it can last for 3–7 years, depending on the brand.³
• Mini-pill: You would take this pill daily to prevent pregnancy.¹³
• Birth control shot: A healthcare provider would give you this injection of progestin every three months.¹³

Your skin may respond differently to each progestin-only method. Similar to Nexplanon, scientists don't know whether these hormonal contraceptives are responsible for the acne.^8,10 But research suggests that IUD users with a previous history of acne were more likely to have severe acne and need antibiotic treatment.¹⁰

Birth control that could improve skin

If you are concerned about developing acne while on hormonal contraceptives, talk with your healthcare provider to determine the birth control method that's best for you. Combined birth control methods, which release estrogen and progestin to prevent pregnancy, are less likely to have acne as a side effect and may even improve the skin.^10,14 These methods include:

• Combined birth control pills: You would take this oral contraceptive ("the pill") daily.¹⁴ Some combined pills are also FDA-approved to treat acne, including severe acne.^10,15
• Vaginal ring: This is a flexible birth control ring. You can insert it in your vagina, where the ring lasts for 21 days.¹⁴
• Patch: This is an adhesiveskin patch. You would wear a new patch each week for three weeks, skipping the fourth week for your menstrual period, and repeat this cycle.¹⁴

Though these combined contraceptives may help protect the skin, each person's skin will respond differently. Remember that other underlying factors (genetics, lifestyle) could also make your skin more prone to acne.²

How to Care for Acne-Prone Skin

Caring for acne-prone skin involves a delicate balance of cleansing without overcleansing, which can strip your skin of its natural oils. Typically, washing your face with a mild, gentle cleanser twice per day—once in the morning and once at night—is a good skincare routine. Rinse the cleanser off gently with lukewarm water, and don't scrub your skin—as this can irritate it.¹⁶

People with acne or acne-prone skin may also benefit from using over-the-counter (OTC) products that prevent or treat acne. These include:¹⁷

• Toners, exfoliators, and serums that contain the following ingredients:
  • Salicylic acid or retinoids, which can reduce sebum
  • Benzoyl peroxide, which can reduce acne-related bacteria
• Oil-free, non-comedogenic (non-pore clogging) moisturizers, which can keep your skin hydrated and free from excess oil

Lifestyle habits can also affect your skin health. To improve and maintain your skin:

• Remove all makeup before bed.¹⁸
• Use oil-free, non-comedogenic makeup and hair products.¹⁸
• Reduce stress.¹⁹
• Get enough sleep daily.¹⁹
• Eat a healthy diet of fresh vegetables and fruits.²⁰
• Limit consumption of cow milk and added sugars.²⁰

When to See a Healthcare Provider

If you have acne while taking Nexplanon and your acne is not improving with at-home care, talk to your doctor, dermatologist, or other healthcare provider. They can recommend a new skincare plan, prescribe acne medication, or suggest a different contraceptive method that may improve your skin.

And if you experience any serious, non-acne side effects after Nexplanon is inserted, call your doctor or seek emergency medical care right away. This includes:²¹

• Severe chest or lower leg pain
• Shortness of breath
• Sudden, severe headache
• Severe pain or tenderness in lower abdomen
• Symptoms of allergic reaction, such as tongue swelling or body itching
• Severe mood changes, depression, or insomnia
• Concern that the implant is no longer in position

Summary

People who are taking Nexplanon or other progestin-only birth control may experience acne, though it is unknown whether the birth control itself causes the acne. More research is needed on progestin-only contraceptives and acne, though studies do suggest that some estrogen-containing combined contraceptives can help prevent acne.^8,10

If you are experiencing acne, cleanse and care for your skin every day—if the acne does not improve, talk to your doctor about next steps.

Sources

1. American College of Obstetricians and Gynecologists. Birth control.
2. Bagatin E, de Freitas TH, Machado MC, et al. Adult female acne: a guide to clinical practice. An Bras Dermatol. 2019;94(1):62–75. doi: 10.1590/abd1806-4841.20198203
3. American College of Obstetricians and Gynecologists. Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant.
4. Organon. What is Nexplanon?
5. Organon. Insertion and removal of Nexplanon.
6. Organon. Frequently asked questions about Nexplanon.
7. Edwards M, Can AS. Progestin. StatPearls. 2022.
8. Bosanac SS, Trivedi M, Clark AK, Sivamani R, Larsen LN. Progestins and acne vulgaris: a review. Dermatology Online Journal. 2018;24(5). doi:10.5070/D3245040035
9. Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18(4). doi:10.1186/s12978-020-01054-y
10. Barbieri JS, Mitra N, Margolis DJ, et al. Influence of contraception class on incidence and severity of acne vulgaris. Obstet Gynecol. 2020;135(6):1306–1312. doi:10.1097/AOG.0000000000003880
11. Organon. Nexplanon prescribing information.
12. American Family Physician. Side effects of hormonal contraceptives.
13. American College of Obstetricians and Gynecologists. Progestin-only hormonal birth control: pill and injection
14. American College of Obstetricians and Gynecologists. Combined hormonal birth control: pill, patch, and ring.
15. American Academy of Dermatology. What can clear severe acne?
16. American Academy of Dermatology. Face washing 101.
17. American Academy of Dermatology. 9 things to try when acne won't clear.
18. American Academy of Dermatology. 10 skin care habits that can worsen acne.
19. American Academy of Dermatology. Who gets and causes.
20. American Academy of Dermatology. Can the right diet get rid of acne?
21. Organon. Risks and side effects of Nexplanon.