Does Opill Cause Acne? What to Expect from Your Skin on OTC Birth Control

Did you know that you can grab a pack of birth control pills off the shelf on your next drugstore run, or even buy it online and have it delivered?

For the first time since oral contraceptives were introduced in the 1960s, there is now a birth control pill that is available without a health care provider’s prescription. It’s called Opill, and it is the only over-the-counter (OTC) birth control pill to have been approved by the U.S. FDA.


I found this ON THE SHELVES in CVS in Washington DC!! #obgyn #washingtondc #districtofcolumbia #opill @CVS Pharmacy @Opill® #Inverted

♬ original sound – Dr. Jennifer Lincoln

This is a groundbreaking step for reproductive health, offering more autonomy and access to contraception, but what about our skin? You’re not alone if you are wondering will Opill cause acne?

What is Opill?

Opill is the first FDA-approved over-the-counter daily birth control pill. It is taken in a cycle of 21 active pills followed by 7 placebo pills that trigger your period. It belongs to a category known as mini-pills or progestin-only pills (POPs), which, as the name suggests, contain just one hormone, progestin, which is a synthetic version of the progesterone in our bodies. This differentiates them from combination oral contraceptives that contain both estrogen and progestin.

Initially, contraceptives were all combination pills, containing both estrogen and progestin. Progestin-only pills were developed later, providing an alternative for those who experienced side effects from estrogen or had health conditions making estrogen use risky. POPs like Opill are still prescribed to people who can’t tolerate estrogen for a variety of reasons. 


Today is a BIG moment for women in the United States! Thanks @Opill® for being the first over-the-counter #birthcontrol pill! This OBGYN is super excited for this step forward in reproductive freedom. ❓drop your questions below! #opill #birthcontrolpill #birthcontrolcheck #obgyn #womenshistorymonth #greenscreen

♬ original sound – Dr. Jennifer Lincoln

Norgestrel, the progestin used in Opill, was first approved for use by prescription in 1973. After almost a decade of research, its application to switch from prescription to over-the-counter was approved in 2023 and it was made available in stores in March 2024. Most importantly, it is as effective as prescription birth control pills when taken correctly. So, although adding birth control pills to your Amazon order or picking them up next to condoms and emergency contraception on a store shelf is a brand new experience, the medication in Opill has been used for over 50 years!

As of writing, Opill is sold for $20 for a one month supply, $50 for three months, and $90 for six months. If you have an FSA or HSA account, Opill is an eligible expense for your pre-tax money. If you have health insurance a prescription for birth control might be cheaper, and in many states a pharmacist can prescribe birth control to you directly.

How Does Opill Work?

Progestin-only birth control pills, like Opill, work mainly by thickening the cervical mucus, which makes it harder for sperm to enter the uterus and in some cases, they can even prevent ovulation (the release of an egg). This dual action significantly reduces the likelihood of pregnancy.


How does Opill® work anyway? Opill® is a progestin-only pill (POP) that prevents pregnancy in two ways! Watch to learn how. #Opill #OpillEducation #C0ntraceptionEdücation

♬ Lemonade – Kupla

Like other contraceptives, its effectiveness depends on consistent and correct usage. With perfect use it is 98% effective and with typical use it is 91% effective. These pills are taken daily, without a break, and it’s important they’re taken at the same time every day because progestin only stays elevated for 24 hours after taking a pill. For maximum effectiveness, set an alert on your phone for the time of day you decide to take it, and make sure to bring your pill along if you will be out of your house at that time. 

Does Opill Cause Acne?

Acne is a possible side effect of progestin-only birth control pills like Opill for some people. Why does this happen? Well, for many of us our acne is hormonal. The progestin hormone that prevents pregnancy can also increase your skin’s oil production. And where there’s more oil, there’s a higher chance of breakouts. 


In my practice, I have seen multiple patients whose acne flared badly after getting on a progestin only hormonal IUD. Of course, for each person, this is a personal choice. I have also had patients who didn’t have acne to begin with who did not have acne after their hormonal IUD implant either. It really depends on the patient. However, if you ALREADY suffer from acne, you may want to discuss other options with your OB/GYN for contraception, other than hormonal IUD. iiudiiudinsertionddermbyparkaacnehhormonalacned#dermatologylesson

♬ original sound – random.shii089

The excess oil can mix with dead skin, clogging your pores. Blocked pores create a perfect home for acne-causing bacteria to grow, leading to inflammation and swelling in the area. This process results in the acne we see, like blackheads, whiteheads, pimples, and sometimes more severe forms like cysts. However, the impact of progestin-only pills on acne is highly individualized, so the effect it has on your skin might be very different from how it affects someone else.

How to Treat Acne on Opill?

If your acne is becoming severe or difficult to control on Opill, be sure to speak to your doctor about switching to another birth control method or starting a prescription acne treatment. Hormonal acne can often become inflamed and even cystic which might lead to scarring that can be difficult to treat, so it’s important to see a dermatologist early if it feels like it is getting out of control. 

In addition to prescription acne treatments like retinoids, antibiotics, and Accutane, combination birth control pills that contain estrogen or spironolactone which blocks androgens are often prescribed to treat hormonal acne. There is also a new option called Winlevi (clascoterone 1%) which is a topical cream that can address the hormonal causes of acne directly on your skin.


Dermatologist approved ways to treat adult female hormonal acne – love using spironolactone for this! #Hormonalacne #Spironolactone #AdultAcne #HowToTreatAcne #AcneTok #Dermguru

♬ Funk Mozart – MC Nau

If your acne is not severe and you would like to continue to take Opill, there are several over the counter treatment options to help manage your breakouts:

Benzoyl Peroxide

If you are getting inflammatory acne (red and inflamed) on Opill, products with benzoyl peroxide are a good place to start to calm down this kind of breakout. Benozyl peroxide adds oxygen into your pores where the bacteria responsible for acne, Cutibacterium acnes, thrive in an oily environment. Since these bacteria cannot survive in an oxygen-rich environment, benzoyl peroxide can kill them off and decrease inflammation.

Start with a lower percentage benzoyl peroxide face wash to avoid overly drying your skin or damaging your skin barrier and then work up to a higher strength face wash or leave-on product if you don’t see improvement after a few weeks. Benzoyl peroxide can bleach fabrics so remember to rinse thoroughly and use white towels or a paper towel to dry your face after washing with a benzoyl peroxide product.

Salicylic Acid

If Opill has increased the sebum on your skin leading to clogged pores like blackheads and whiteheads, salicylic acid can help cut through the excess oil and clear out your pores. Salicylic acid is a type of beta-hydroxy acid (BHA) that works by helping to exfoliate the skin and remove dead skin cells that can mix with sebum and cause acne. What makes salicylic acid especially effective is its ability to penetrate into oily pores and dissolve the debris that leads to pimples. 

Salicylic acid can be drying, so start with a face wash that contains salicylic acid so you can use it consistently, but it will only be on your skin for a short time. If that is not enough and your skin can handle it, you can move up to a leave-on treatment, usually in a liquid or toner form, with 1-2% salicylic acid.


Derived from vitamin A, topical retinoids push your skin to shed dead cells which helps prevent pores from becoming clogged. Their powerful action doesn’t stop there; they also reduce inflammation, a key culprit behind red, painful pimples. 

Using retinoids can lead to clearer, smoother skin over time, but they require patience and consistent use as they slowly work their magic. They are known for causing irritation and purging at the beginning, also known as the retinoid uglies. Starting with a lower concentration can help minimize initial irritation, you can also slowly increase the nights you use it to give your skin time to adapt. 

Commonly prescribed by dermatologists, retinoids are a cornerstone of acne treatment. You can get them over the counter in the form of adapalene 1% and as retinol.

Skincare and Makeup

When we start to see more pimples crop up, our first reaction is often to completely overhaul our skincare routine and wear more concealer and foundation to cover our acne. However sometimes by doing this we can make a small breakout worse and create a vicious cycle.

If you start to see more pimples while on Opill, be careful not to make drastic changes in your skincare routine or start using too many new products at once. Choose one acne-fighting treatment at a time to avoid irritating and drying out your skin and give it enough time to work before switching to another treatment. Keep the rest of your skincare safe for acne-prone skin by using gentle and non comedogenic products. If you need to get new makeup to cover your acne while you are treating it, make sure it doesn’t contain any pore-clogging ingredients

Spearmint Tea

Some anecdotal evidence suggests that drinking spearmint tea may help reduce hormonal acne by lowering levels of certain androgen hormones that can increase sebum production. It might also increase estrogen levels.

Because it can have an effect on your hormones, you should discuss drinking daily spearmint tea with a healthcare provider before starting, especially if you have existing health conditions or are taking other medications.

The availability of Opill over the counter has dramatically simplified the process of obtaining birth control. Before starting Opill, make sure you understand any potential side effects, such as acne, so you can make an informed choice about both your contraceptive and skin needs.

This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for guidance on birth control and any health-related decisions.

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