Hormone Treatment

Hormone Treatment for Acne

Hormone treatment is a medication used for women with moderate or higher acne. Hormone treatment at our hospital is performed with a combination of medicines called “pill” and “spironolactone”.

The low-dose pill was developed in the United States in 1973 and is now a medicine that more than 100 million women around the world take every day. Japan is a backward country of the pill, but in Europe such as France, the Netherlands, and Germany, about 50% of women aged 15 to 49 who can become pregnant take the pill for contraceptive purposes, and it is also used as a treatment for skin diseases such as acne.

Spironolactone is a medicine that has been used for a long time as a diuretic and a treatment for heart failure, but it has the function of suppressing male hormones, and it has been applied to the treatment of acne since about 15 years ago. Formulations include spironolactone and aldactone neuable.

Effects and characteristics of hormone treatment

The efficacy rate of hormone treatment against acne is more than 95%, which is the second most effective treatment after Accutane treatment. In addition, it is known that safety is very high and the probability of serious side effects is lower than that of general-purpose medicines such as antibiotics and antipyretic analgesics.

As a disadvantage, it takes some time for the effect to appear, and for 30 months after the start of treatment, 30% of patients have a transient exacne exacerbation. On average, from the fourth month, acne gradually improves. Another disadvantage is that the recurrence rate is as high as about 60%. In the event of a relapse, 20% of patients return to the level before treatment.

Even if it becomes symptomatic treatment, it is very important to eliminate all acne once and do maintenance after that in terms of leaving acne scars as much as possible. In addition, by continuing treatment to suppress symptoms, there are also people who reach an age where acne can not occur naturally.

It is often continued even after the skin becomes beautiful, and the treatment period is about 1 year ~ 2 years on average. The biggest merit is that it is very safe, and if side effects are checked properly, it is possible to take it for a long time.

Hormone treatment is recommended for those who want to treat with medicines with as few side effects as possible. In particular, it has a function to improve gynecological diseases and symptoms such as menstrual irregularities, dysmenorrhea, polycystic ovary syndrome, endometriosis, menstrual cramps, etc., so it is also recommended for those who are troubled by these symptoms.

* Regarding the recurrence rate, it is called recurrence when the number of new acne returns to 1/3 or more of the state before treatment after the end of treatment.

あわせて読みたい

Mechanism that works on acne

Even women are made of “male hormones” in their bodies. There are two organs that secrete male hormones: the ovaries and the adrenal glands (cortex). Male hormones have less favorable effects for women, such as thickening hair, enlarging sebaceous glands, and worsening acne.

Women who have an excessive amount of male hormones or even if the amount itself is normal can cause acne to be plagued by women who are highly sensitive to male hormones.

We use pills for hormone treatment at our hospital, and the pills contain trace amounts of female hormones and progestational hormones. Female hormones have actions such as finely finening the texture of the skin, making the pores smaller, and increasing the moisture content of the skin. Depending on the type, there are progestational hormones that strengthen the action of male hormones and those that weaken them, and for the treatment of acne, those that have the power to suppress male hormone activity are used.

In our hospital, spironolactone is also used, but spironolactone has antiandrogenic action and has the function of suppressing male hormones. Safety is very high, and treatment in combination with spironolactone and pills can increase the healing rate of acne.

On the other hand, spironolactone is known to be effective only while drinking and that there is a rebound, and at our hospital, when the effect of the pill comes out, we take a method of gradually reducing weight so as not to rebound.

The Need for a Hormone Test

By examining the levels of male and female hormones, you can see the hormonal balance that a person has. However, we do not actively conduct hormone tests.

The main reasons for this are that treatment is effective for most women even without testing, that hormone levels are normal when sensitivity to male hormones is high, and expensive tests (4 types of female hormones + 9,746 yen for male hormone tests).

On the other hand, women who have been suffering from acne for many years and have symptoms such as menstrual irregularities should undergo a hormone test. This is because a gynecological disease called “polycystic ovary syndrome (PCOs)” may be hidden. Patients with PCOs are characterized by a higher LH than FSH, one of the female hormones, and the androgen level is often elevated.

Since there are fluctuations in hormonal balance, it is necessary to collect blood “in the morning of the 3rd day ~ 5th day of menstruation”. If you wish to have an examination, please make a reservation at the right time (those who are taking hormone medicines cannot be tested).

Case Photos

If you would like to see a case photo of acne treatment with hormone treatment, please click below.

Treatment case 1 (red face and papules)

Background of the visit

A woman in her 20s. Acne began to develop from junior high school, and from the 20s I became able to have red acne all over my face extensively. I had been receiving insurance treatment at a dermatologist for several years, but I did not see any improvement, so I received a treatment called “arc ray” at the orthopedic clinic twice a week, about 50 times in 7 months. However, it did not improve at all, so he came to our hospital.

Photos before treatment

Countless fine papules are present all over the face, and due to the inflammation and pigmentation of acne, the entire face is reddened.

Red Face and Red Acne
Red Face and Red Acne

Hormonal treatment with a combination of the pill and spironolactone was initiated.

Photos after 8 months

The number of new acne has drastically decreased. In addition, since the inflammation has subsided, the redness of the entire face has also improved. Since the acne got better about 3 months after starting the treatment, salicylic acid macrogol peeling is performed once a month, and the pigmentation of the acne scar has become less noticeable.

Reddened Face and Red Acne After Treatment
Reddened Face and Red Acne After Treatment

Commentary

The patient was treated with pills and spironolactone for about 3 years and then finished. For the next three years, my skin condition had calmed down, but although it did not deteriorate as much as when I first saw him, I confirmed a relapse, so I underwent hormone treatment again.

According to our hospital’s data, the recurrence rate of hormone therapy is 60% or more, and the disadvantage is that it is easy to relapse compared to isotretinoin (Accutane).

Therefore, it is explained that you should drink until the disease (the momentum of the disease) has decreased to some extent. Safety is relatively high, it is an advantage that it can be taken internally for a long time, and it can be taken conservatively in order not to increase acne scars.

Treatment case 2 (multiple papules)

Background of the visit

A woman in her 20s. I have been suffering from acne since I was a junior high school student, and I was treated with herbal medicine and Bepiogel at a nearby dermatologist, and although it improved for a while, it recurred and worsened after becoming a member of society. After that, I did insurance treatment such as topical medicines, herbal medicines, antibiotics, etc. again, but it did not improve, and although I was prescribed a low-dose pill (favoir) by the gynecologist, it did not improve, so I came to our hospital.

Photos before treatment

Small red acne
Small red acne

Although it is not severe, fine white acne and red acne are mixed around the cheek ~ jaw, and the unevenness of the skin is conspicuous due to acne. I changed from the favoir I had been taking at the previous doctor to a type of pill that suppresses the activity of male hormones, and I started treatment by adding spironolactone.

Photos 1 year later

The photo below is taken after 1 year has passed since the start of treatment. The regeneration of acne is gone and it is back to the original clean bare skin.

Small red acne after treatment
Small red acne after treatment

Commentary

Treatment of acne with hormonal drugs requires a period of approximately 3 ~ 4 months to improve. In addition, the initial deterioration is most common in the first month and may last for as long as 3 months.

It is not suitable for those who want to cure quickly, but it is suitable for those who want to choose a treatment with few side effects.

The merit of hormone treatment is that in addition to relatively few side effects, menstrual cramps are lightened and menstrual periods (bleeding) come regularly, so it is easy to use for people with PMS and menstrual irregularities, as well as patients with PCOs (polycystic ovary syndrome).

The disadvantages are that the recurrence rate is high and, although rare, the risk of thrombosis, breast cancer, and cervical cancer must also be noted.

Even if it does not lead to a permanent cure and becomes a symptomatic treatment, suppressing acne is very important for the skin to prevent the formation of acne scars.

Patients who post photos have received consent forms for publication. The photographs taken at the time of examination are for medical records and are protected by the Personal Information Protection Act. Please be assured that we will not post it without your consent.

Side effects of hormone treatment

Side effects of the pill

The pill is used by more than 100 million women worldwide every day and is one of the safest medicines. In Europe and the United States, about half of women in their 20s and 30s use it in some countries (52.6% in Germany and 43.8% in France).

Although it has been prescribed for more than 50 years and recognized as a safe medicine, it changes the hormonal balance at the beginning of the drink, so symptoms such as nausea, headache, breast pain, and swelling may occur. These side effects are almost always mild as you continue to take the medicine.

“Does taking it affect my pregnancy?” There are people who are worried, but there is a contraceptive effect while taking the pill, so there is almost no possibility of getting pregnant. In addition, there is no evidence that it becomes difficult to get pregnant even after stopping taking the pill.

There are patients who say, “I’m afraid of getting cancer,” but if you take it within 5 years, the risk of breast cancer and cervical cancer will increase, and conversely, the risk of endometrial cancer, ovarian cancer, and colorectal cancer will decrease.

Breast cancer is estimated to affect 1 in 12 people in Japan, but it is considered to be up to 1.2 times the risk. Also, if you stop taking it, the risk will gradually disappear.

The risk of cervical cancer is unlikely to increase with the use of the medicine within 5 years, but there is data that it increases twice with taking it for more than 10 years. Regardless of whether you are taking the pill or not, we recommend screening for cervical cancer once every two years from your 20s and breast cancer once a year from your 30s.

In addition, although it is very rare, liver damage and liver cancer have been reported in people who are taking cyproterone acetate (Diane Souchy) for a long time overseas. In our hospital, we change the type of pill if necessary, so there has not been a single reported case of liver cancer in the past.

The risk of thrombosis caused by the pill (a disease in which blood clots and clogs veins and arteries) can increase from 3 times to up to 7 times, depending on the type of medicine, so care must be taken.

For example, Yaz is known as one of the highest risk of thrombosis among low-dose pills, but three fatal accidents have been reported in the past out of 140,000 patients prescribed in the country. Even if it does not result in a fatal accident, the number of people who developed thrombosis is reported to be 87, which is higher than other pills.

However, 3 out of 140,000 people is 2.1 deaths per 100,000 people. Statistically, it is 1 in 4 than the probability of dying in a traffic accident and 1 in 80 than the probability of dying from smoking.

In our hospital, we check for chronic diseases such as age, blood pressure, weight, smoking history, hyperlipidemia, migraine with omens, etc., and in principle we do not prescribe to those who are at risk of thrombosis. In addition, even young people in their 20s who only smoke one cigarette a day are always asked to quit smoking.

Although it is not possible to completely prevent blood clots 100%, we try to prevent them as much as possible by having them read the conditions and symptoms that increase the risk of thrombosis in lifestyle guidance and detailed side effect sheets.

Side effects of Spironolactone

Spironolactone is also a highly safe medicine, but since side effects such as increasing potassium in the blood and renal dysfunction have been reported in rare cases, blood collection tests are conducted regularly.

Common side effects include irregular bleeding (irregular menstruation) and dry skin, but not dangerous. In addition, diuretic effects and blood pressure lowering may be observed.

There are people who have allergic reactions such as urticaria, rash, and itching of the skin between the time they start drinking and about 4 weeks. Also, although very rare, anaphylactic shock (sudden decrease in blood pressure or difficulty breathing, facial edema) due to severe allergies, toxic epidermal necrolysis and Stevens-Johnson syndrome (high fever, heavy mucous membrane disorders) have been reported, but they are not as frequent as with other medicines.

Hormonal Treatment Rates

項目料金(税込)
スーシー1シート 2,486円
ヤスミン1シート 2,948円
マーシロン(超低用量)1シート 2,486円
ラベルフィーユ1シート 2,178円
スピロノラクトン1錠 33円
  1. Consultation is always required to prescribe medicine.
  2. Tests for side effect checks are required at the first time, once every three months thereafter, and once every six months after entering a stable period.
  3. Our hospital prescribes pills for acne treatment and contraceptive purposes, and since it is an unapproved medicine in Japan, it is not covered by the pharmaceutical side effect damage relief system (guarantee from the pharmaceutical company in the event of serious side effects).

The following rates are examples of the cost of hormone therapy treatment for acne. The price fluctuates depending on the type and amount of medicine used. At the time of the first consultation, it is slightly high because of the initial consultation fee and examination fee, but the price also becomes cheaper because the acne improves from the fourth month and the amount of medicine decreases.

When it comes to the medicine reduction period, the cost per month is about 6,000 yen. After about a year has passed and the acne has completely calmed down and entered the stable period, the treatment will be switched to low-dose pill only, and the average treatment cost per month will be about 3,000 ~ 4,000 yen.

Examples of treatment at the time of initial consultation

初診時(税込)
初診料3,850円
薬代スーシー1シート
(28日分)2,486円
スピロノラクトン112錠
(28日分)3,696円
検査料血液検査 2,948円
尿検査 1,056円
合計(28日)
14,036円

Examples of treatment in the medicine reduction period

薬剤減量期(税込)
再診料1,650円
薬代
スーシー3シート
(3ヶ月) 7,458円
スピロノラクトン168錠
(3ヶ月) 5,544円
検査料血液検査 2,948円
合計(3ヶ月)
17,600円
*1ヶ月あたり5,866円

Examples of treatment in the stable phase

安定期(税込)
再診料1,650円
薬代マーシロン6シート
(6ヶ月) 14,916円
検査料血液検査 2,948円
合計(6ヶ月)
16,214円
*1ヶ月あたり3,252円

Those who cannot receive hormone therapy

The following individuals may not be able to receive hormone therapy:

  1. Those
    who import medicines privatelyPlease note that our hospital only treats patients who can receive prescription and treatment of medicines under the responsibility of a doctor.
  2. For men
  3. The premenarctal
    epiphyseal may close and the height may stop.
  4. If
    you are under the age of 18 or under the age of 18, you cannot prescribe medication unless you are accompanied by a guardian at the time of the first consultation. At the time of re-examination, it is possible to examine only the person himself.
  5. Because there is an interaction with people
    who smoke cigarettes, we always ask you to quit smoking at our hospital.
  6. 40 years of age or older
  7. Those who are pregnant, breastfeeding, or planning to become pregnant within one year
  8. Those who have a BMI (weight÷height to the power of m2) exceeding 30
  9. Breast cancer, cervical cancer, cervical epithelial tumor, Crohn’s disease, ulcerative colitis, hypertension, hyperlipidemia, diabetes mellitus, severe liver damage, renal impairment, liver tumor, otosclerosis, antiphospholipid antibody syndrome, thrombotic predisposition, pulmonary hypertension, atrial fibrillation, valvular heart disease, endocarditis, porphyria, people with a history of epilepsy
  10. Those who have migraines with omens (darkening in front of the eyes, glittering, narrowing of vision, etc.), those who are over 35 years old and have migraines
  11. Those who have abnormal genital bleeding for which the diagnosis has not been confirmed
  12. Those who had high blood pressure, jaundice, persistent itching, or herpes during pregnancy

Frequently Asked Questions

For about 3 months from the start of hormone treatment with pills and spironolactone, acne may worsen in 30% of patients, but from the 4th month the effect gradually appears, and 90% of patients at 6 months and 95% of patients at 12 months will be cured and improved.

Even after my skin has been cleaned, I continue to receive medication for an average of one to two years until the disease of acne (byosei = momentum of the disease) weakens.

See Side effects of hormone treatment. At the time of examination, we will explain in more detail according to the side effect sheet.

Treatment is possible by visiting the hospital about once every 4 weeks for the first 4 months, once every 2 months after that, and once every 3 months ~ 6 months once if the symptoms have calmed down. If you are far away or have difficulty going to the hospital, it is also possible to prescribe more medicine.

The treatment period is 1 year ~ 2 years as a guide. Since it is a medicine with few side effects, it can be taken for a long time. In fact, there are many patients who have been taking the medicine for more than 5 years.

For patients who are too busy to visit the hospital, telemedicine is also available. For details, please refer to the “Telemedicine” page.

At the time of the first consultation, blood collection test, blood pressure measurement, and urinalysis test (pregnancy reaction test) are always performed on all patients as tests before taking the medicine (urine test is not necessary if you are menstruating).

About 2 ~ 3 months after you start taking the medicine, blood pressure measurement and blood test will be performed. After that, once every three months, blood collection and blood pressure measurement are performed to check for side effects.

If spironolactone has resulted in weight loss and has shifted to pill-only treatment, an examination of about once every 6 months will be fine.

There are rare cases where patients are refused blood tests, etc., but please note that if the necessary tests are not performed, we cannot prescribe medicines at our hospital. However, if you are undergoing a checkup or blood test at another hospital, please let us know.

If you are taking the pill for the first time

We recommend starting on Sunday. Sunday start is a way to start taking the pill on Sunday and avoid bleeding on weekends. If you are sure that you are not pregnant, start from the following Sunday. For contraceptive purposes, the first week of drinking should be combined with other methods of contraception.

  • The first sheet begins to be taken from Sunday.
  • It is 1 tablet once a day. Regardless of whether you eat before or after meals, drink at almost a certain time every day.
  • Continue with 1 tablet daily for 21 days, then rest for 7 days.
  • Bleeding begins on the 2nd ~ 5th day of the withdrawal period (often on the 3rd or 4th day).
  • From the 8th day (Sunday), start drinking a new sheet.
  • After that, it is repeated “take for 21 days, rest for 7 days”.

Time of taking

You can set the time of taking the pill at what time. It does not matter before or after meals, but drink it at almost a certain time every day. By taking the pill at a fixed time, it keeps the hormone concentration in the body constant and adjusts the tone of the skin.

If you forget to drink a lot, irregular bleeding is likely to occur, and the contraceptive effect will also fade. Please take it as little as possible so that it does not slip out. If you are concerned about side effects such as nausea, it is a good idea to take it before bedtime or after dinner.

Taking with water

Normally, it is recommended to drink with water, but there is no change in the effect even if you drink it with juice, tea, or alcohol.

Medications that interact with the pill

  1. Tranexamic acid
    is a medicine with anti-inflammatory action. It is also used for melasma treatment purposes. It may be blended into over-the-counter cold medicines.
    Tranexamic acid has the effect of making blood clots less soluble, and it cannot be denied that it may increase the risk when thrombosis occurs, but it is very rare. We ask that you refrain from using it in our hospital just in case, but it is unlikely that it will be a problem in a short period of time. Topical preparations of tranexamic acid are not a problem.
    Representative Product Name: Transamine, Transino, Perak T Tablets, Halleners, Benzablock Cough Medicine, Benza Rhinitis Medicine α, Benzaace A, Lulu Attack EX, Korgenkova IB Tablets
  2. May inhibit the absorption of St. John’s wort
    pill.
  3. May attenuate the action of anti-HIV, anti-tuberculosis medicines, hepatitis C therapeutic pills
    .
  4. May attenuate the action of antiepileptic medicine
    pills.
    Typical trade names: Tegretol, Lamictal, Aleviatine, Hydantol, Phenovar, Primidone, Topina, Depaken, Valerin, Epileoptimal, Zarontin

* As for antibiotics, it was thought that it could attenuate the action of the pill, but it is now denied in Western trials.

Medicines that interact with spironolactone

  1. To the extent that it is ingested from potassium preparations
    food, it does not matter at all.
  2. Tacrolimus
    is an immunosuppressant. Representative Product Names Prograf, Glassepter, Tacrolimus
  3. Eprerenone
    is a diuretic. Representative product name Selara
  4. It is an anticancer medicine for mitotane
    . Representative Product Name Opuprim

In addition, there may be interactions with antihypertensive medicines, so please consult your doctor at the time of examination.

There is no interaction between hormonal medicines (pills and spironolactones) and alcohol, but when taking medicine, drink it with water.

Please refrain from excessive drinking as it will lower blood pressure and put a strain on the liver.

Forgetting to take the pill

If you forget to take the pill
  • If you notice that you have forgotten to take one tablet, take the forgotten tablet as soon as possible and take the remaining pills as scheduled. Normally, the contraceptive effect is maintained, but if you forget to take the first or last pill of the sheet, just in case, use other contraceptive methods such as condoms together until you take at least 7 tablets in a row.
  • If you notice that you have forgotten to take more than one tablet, take the most recent of the forgotten tablets as soon as possible, take the remaining tablets as planned, and use other contraceptive methods such as condoms or other contraceptive methods until you take at least 7 tablets in a row, or avoid sexual intercourse.

* If you forget to drink frequently, the risk of side effects such as irregular genital bleeding increases. The condition of the skin will also become unstable, so please do not forget to drink.

* If you forget to take the pill and have leftovers despite the scheduled end date of the sheet, take all 1 tablet per day, shorten the withdrawal period that is usually 7 days, and match the start date of the next sheet.

If you forget to drink, you don’t have to ignore it and drink it. In order to cure acne quickly, try not to forget to drink as much as possible.

In rare cases, menstruation may not come during the withdrawal period. If there is no possibility that you are pregnant at all, take the next sheet from the 8th day as usual even if your period does not come. If there is even the slightest chance of becoming pregnant, make sure that you are not pregnant with a pregnancy test pill, and then start the next sheet.

Menstruation should come during the withdrawal period, but irregular bleeding may occur at the beginning of drinking. Also, when spironolactone is used in combination, a small amount of bleeding may last for about a month. If you take it correctly, most people will subside, so do not worry. If it does not subside, please consult a gynecologist.

The amount of menstrual bleeding is almost always reduced by the pill. Along with that, menstrual cramps also become lighter. Also, conversely, the amount of bleeding may be slightly larger, but do not worry. The strength of menstrual cramps also depends on the compatibility with the pill.

If you want to delay your period by a week, drink for 21 days and then without taking a break, add 7 days’ worth from the spare sheet. Then take a break for 7 days and then take a new sheet as usual. If you are taking LaBelle Feuille, take 7 days’ worth of yellow medicine.

If you want to accelerate your period by several days, you can shorten your period from 7 days to speed up your period. Even if you want to wake up your period early, if you stop halfway before you finish taking 21 tablets, the hormonal effect will be weakened, it will cause acne, and the contraceptive effect will be lost, so we do not recommend it.

You can take your carry-on baggage or Check in baggage.

If you need a medical certificate or certificate in English, please note that it will cost 5500 yen (tax included) per copy.

pill

Ideally, low-dose pills should be taken in a 24-hour cycle as much as possible, but if they are out of sync within 6 hours ~ 12 hours, you don’t have to worry about it. If there is a time difference, bring a watch or smartphone that shows the time of Japan and drink at the same time as the time you were drinking on the Japan. If you were drinking in the Japan at midnight in the local area, try staggering your drink by a few hours to when you were awake.

Spironolactone

Spironolactone can be taken earlier or later for half a day. Try to drink as if you were drinking in Japan. For example, if you drink after breakfast and dinner on the Japan, you should drink it after breakfast and dinner on board and in the field.

Appointments and Enquiries

For return visits, please inform us of your 'consultation ticket number' when making an enquiry.
●Hada no clinic Koenji (TEL 03-5913-7435)
4F Anfini Building, 4-6-7 Koenji Minami, Suginami-ku, Tokyo
Mon.~Sta. : 10:30 am - 1:30 pm / 3:30 pm - 6:30 pm
Sun. and Public holiday : closed
●Hada no clinic Kojimachi (TEL 03-6261-7433)
B1F Chichibuya Building, 3-7-4 Kojimachi, Chiyoda-ku, Tokyo
Mon.~Fri. : 11:00 am - 2:00 pm / 4:00 pm - 7:00 pm
Sta. and Sun. : 10:00 am - 1:00 pm / 3:00 pm - 6:00 pm
Public holiday : closed
*Full appointments are required.
*We are very sorry, but sometimes it is difficult to get through on the phone due to the high volume of calls. We ask for your understanding as we have a limited number of staff.
*Please note that a separate 'telephone re-consultation fee' will be charged if a doctor responds to medical questions.