Are you considering Spironolactone for Acne? Spironolactone (Aldactone) is one of the most common treatments for hormonal acne, as well as alopecia (hair loss), oily skin, and hirsutism (hair growth on face, chest, or back in women). It effectively lowers testosterone levels by inhibiting the synthesis of this hormone, increasing sex hormone-binding globulin (SHBG), and blocking androgen receptors. It may also reduce an enzyme known as 5-alpha reductase, which is responsible for converting testosterone into a potent androgen called Dihydrotestosterone or DHT.
If you’ve been prescribed Spironolactone for acne or are considering taking it for various hormonal applications, let’s explore the pros, cons, and potential cautions associated with it.
What Type of Drug Is Spironolactone?
Spironolactone is a medication used to treat high blood pressure, acne, hirsutism, and alopecia. Spironolactone is known as a diuretic (a pill to expel water) and is frequently referred to as a potassium-sparing drug because it causes the body to retain potassium while excreting sodium. Its primary function is to remove excess fluids from the body.
Spironolactone also has a testosterone-suppressing effect, so it’s commonly used as an off-label treatment for the following conditions.
Spironolactone is Used to Treat
- Hormonal acne
- Polycystic Ovarian Syndrome (PCOS)
- Premenstrual Syndrome (PMS)
- Hirsutism (unwanted hair growth)
- Hyperaldosteronism, a condition in which the adrenal glands produce excess amounts of the hormone aldosterone and blood pressure rises as a result.
Also, because it’s a diuretic, spironolactone is often used to treat:
- Heart conditions
- High blood pressure
- Cirrhosis of the liver
- Kidney disease
- Hypokalemia (low potassium)
It has also been used as hormone therapy for transgender females because it suppresses testosterone.
How Does Spironolactone Work?
Spironolactone is a medication that competes with a hormone called aldosterone at the receptors within the kidneys to increase sodium and water excretion while causing the body to hold onto potassium. This medication is taken by mouth, in pill form.
Does Spironolactone Work for Acne?
Because spironolactone blocks testosterone receptors and inhibits the body from making androgens, women with elevated androgens often see an improvement in acne, a reduction in oily skin, and they may even see resolution of hirsutism (unwanted hair growth, especially on the face).
In addition, it has also been used for alopecia (hair loss) since it may inhibit the 5-alpha-reductase enzyme, which converts testosterone into DHT, a potent androgen.
Spironolactone may also increase sex hormone binding globulin (SHBG), which will bind excess testosterone. It's for these reasons that your doctor may prescribe Spironolactone for acne.
Some studies have reported a 30-50% reduction in sebum (oil) production, which is beneficial for women struggling with oily skin.
It is important to note that the FDA has not approved spironolactone as a treatment for hormonal acne, alopecia, or hirsutism.
Does Spironolactone Help Acne?
Spironolactone has been used as a treatment for acne, specifically acne vulgaris — the kind associated with hormonal imbalance. The typical dose, which is an off-label use, for women struggling with acne is 50 to 200 mg daily. However, it is recommended to begin with a lower dose as this may be effective for resolving acne with a reduced risk of side effects.
There’s not a ton of reliable data to determine its efficacy when used in this way. Although there are some studies that show dramatic improvement, others have reviewed the data and found a high likelihood of bias in these studies.
As with most treatments, results vary from woman to woman. Plenty of women claim it’s the holy grail of acne healing and others don’t experience much improvement. Some develop headaches or other side effects that make using the medication unbearable.
Who Can Benefit from Spironolactone Treatment?
Doctors tend to consider spironolactone for women who experience moderate to severe acne and haven’t seen an improvement in symptoms using birth control, antibiotics, or isotretinoin. If women want to avoid isotretinoin or Retin A, this is an alternative her doctor may recommend.
Clinically, spironolactone is most beneficial for women with cyclical acne that flares premenstrual or in the luteal phase and during menses and when acne is primarily distributed along the jawline.
Cyclical acne is indicative of a hormone imbalance and can be rooted in estrogen or testosterone excess. Typically, if acne is distributed along the jawline that points towards androgen excess or excess testosterone. Testing is the best way to determine your current hormone imbalance.
As I explain in this article on acne and in Beyond the Pill, hormonal birth control can deplete acne-preventing nutrients, mess with your gut flora, AND once you stop taking it, testosterone can flare up big time, making your acne worse. This is when some women may be prescribed Spironolactone to treat their acne.
Keep reading because we’ll be reviewing spironolactone side effects you should be aware of.
6 Natural Alternatives to Spironolactone for Acne
There are several natural ways to enable your body to clear acne that I like to explore with my patients who have experienced acne after stopping birth control. These tactics work whether you’ve been on birth control or not.
When you understand that acne is multifactorial and often a combination of poor gut health, inefficient elimination of metabolic waste, inflammation, and hormones, these tactics make sense. We have bacteria on our skin as part of our normal flora, but there are certain species that can become problematic, especially when there is excess sebum (oil) production and inflammation. Lowering inflammation by supporting your gut and eating an anti-inflammatory diet can help you clear acne and make it disappear for good.
1. Support Healthy Elimination
This is something your body does every day. When you aren’t getting rid of the waste through your digestive tract and kidneys, your body can try to expel them through your skin. This is when acne can occur. So, what’s the easiest solution to this? Increase dietary fiber.
Aim for 25 grams of fiber daily. If you’re not currently eating that much, start slow and work your way up. I suggest increasing your vegetable intake as a first step. Aim for 6-9 cups of veggies every day. It will do wonders for your skin! How to start? Grab my hormone-balancing meal plan here.
2. Drink Plenty Of Water
Not only will this help remove metabolic waste, but hydration is great for your entire body, and that includes your skin. This study showed that drinking 2 liters per day for just one month significantly impacted participants’ skin.
3. Take a Two Week Detox
Want to fast-track your way to clear, glowing skin? Consider a two-week detox focused on nutrients that aid in elimination and may help support your skin.
Sometimes, simply adding fiber to your diet isn’t enough. And sometimes, you want your skin to look better, like, yesterday. This is why thousands of women turn to detox kits for more complete support and see amazing skin benefits as a result. Learn more about the Paleo Detox and Plant-Based Detox (vegan).
4. Support The Gut Microbiome
Your gut is where the majority of your immune system lives and your immune system is a key player in the health of your skin. In addition, this is where the initial breakdown could happen that leads to food sensitivities.
When your gut microbiome is flourishing, it will take care of those less favorable gut bugs that can exacerbate acne for you! In my naturopathic medical practice I use Gut Rebuild with patients who need extra gut support, and Women's Probiotic to encourage healthy microbial diversity.
5. Balance Your Hormones
As explained above, hormone imbalance like excess testosterone can drive acne and make it a huge problem. In this article on high testosterone in women I talk about how to get testosterone in check, and the steps that I’ve seen have the greatest impact.
If PCOS or testosterone levels are the issue, it’s worth learning about Saw Palmetto Plus formula, which has helped so many women in my clinic get a hold of their painful, cystic acne.
If estrogen excess is your issue, learn about Balance Women's Hormone Support formula for what some women describe as immediate relief.
Not sure which it is? Ask you doctor about hormone testing.
Remember, supplements are designed to support what your body does best and truly work best when diet and lifestyle are dialed in. And as always, supplements are not designed to treat a diagnosed medical condition. I remind you of this because while Spironolactone is not medically necessary when used to treat acne, it is necessary if you’ve been prescribed it for cardiovascular issues like high blood pressure.
6. Increase Omegas
Healthy fats, especially omega-3s, have been shown to have a myriad of health benefits, especially for brain and skin. Try adding chia seeds, walnuts, fatty fish like salmon, or a high-quality omega-3 supplement to your diet. This can impact the quality of the oils your produce on your skin.
PCOS Treatment And Spironolactone
In addition to being a diuretic, spironolactone is also considered an anti-androgen and reduces testosterone. For this reason, many doctors prescribe it for Polycystic Ovarian Syndrome (PCOS).
In fact, in some studies, it has been shown to be more effective and better tolerated than metformin, a common pharmaceutical PCOS treatment that works by improving insulin sensitivity.
But note that Metformin is used to treat pre-diabetes and diabetes and does not work the same way as Spironolactone does. So they are not interchangeable when being used for the FDA approved conditions these medications treat. We’re talking strictly acne here.
Its anti-androgenic effects mean it can help control hirsutism — the unwanted hair growth that can accompany PCOS and help control acne and thinning hair that are also common with the condition.
Is Spironolactone the Best Treatment for Your PCOS?
Look over the side effects, make a note of your symptoms and discuss with your doc if you should do a trial of natural PCOS therapies or go the Spironolactone route. As a naturopathic physician, I’ve treated many women with PCOS using diet and lifestyle therapies alone to regulate their periods, encourage regular ovulation, clear their skin, and ditch the unwanted hair growth.
When we treat hormonal issues with pharmaceuticals, we are only temporarily addressing symptoms, and not getting to the root cause of the problem.
Spironolactone PCOS Side Effects
While spironolactone can be a great relief for some women, others are unable to handle the side effects like headaches or increased anxiety that accompany the use of the medication.
Spironolactone side effects in women with PCOS may include:
- Increased blood sugar
- Frequent urination
- Heart palpitations
- Low electrolytes
Plus, since most doctors require that patients take hormonal birth control while on spironolactone, this can be a potentially dangerous situation for women with PCOS. With spironolactone and oral contraceptives treating some symptoms, the inflammation and insulin resistance that are at the heart of this condition can continue to develop — putting you at further risk of developing heart disease and diabetes.
Furthermore, spironolactone can increase blood sugar levels in some patients.
I go into more detail in this article on treating PCOS symptoms with the pill, but just know: Over 50% of women with PCOS will develop diabetes type 2 before the age of 40.
For this reason, I recommend that patients consider a more natural, root-cause focused approach to managing PCOS.
Addressing PCOS without Spironolactone
Addressing nutrition and exercise is one of the first steps. No, this isn’t a “you just have to eat right and exercise” kind of prescription. Instead, it is about supporting your metabolic health, insulin sentization, reducing inflammation and giving your body the nutrients it needs to get all your hormones in check. I have a fantastic, free recipe guide that will get you started — without feeling like you have to starve or deprive yourself.
Try to get some exercise on most days. You don’t have to overexert yourself at the gym (unless you want to). Just do something to move your body and find what you enjoy as a starting place.
Second, with my patients, I use the PCOS Basic Kit to help patients support thier skin and hair. Some of my patients who have lost their periods even got their period back.
A lot of women can manage PCOS naturally, and without the side effects of anti-androgens and birth control.
Spironolactone For PMS
Since spironolactone can affect hormones and reduce water retention, it has been used as a treatment for PMS symptoms.
According to studies, it can significantly improve bloating, irritability, depression, and breast tenderness that many women experience prior to the start of their period.
However, it can also increase those same exact symptoms in other women. The package insert for spironolactone lists breast and nipple pain, anxiety, and weight gain as possible side effects. Not all medications work the same for all women across the board, which is why you have to monitor what works for you and communicate to your prescribing provider.
5 Natural Alternatives to Spironolactone for PMS
If the idea of taking spironolactone or the pill to regulate PMS sounds a bit risky to you, read on. I’ve got some other options for you to consider instead.
Many times, you can attribute PMS to excess estrogen circulating in the body. It’s essential that if you’re experiencing PMS symptoms that you address this problem. Here are some ways you can assist your body in getting rid of excess estrogen.
1. Nutrition For Estrogen Support
Estrogen is eliminated by our gut and our liver. A poor diet can compromise both. I recommend a diet full of vegetables, fiber, and hormone-supporting fats that make elimination easy and optimize liver function. You can access a free recipe guide here to get you started.
2. Hormone Balance Support
Utilizing ingredients like DIM, broccoli seed extract, and calcium d-glucarate can help the body clear estrogen more effectively.
Other times, low progesterone can be the culprit for PMS. Often, it’s both high estrogen and low progesterone that are causing the mayhem.
I give a lot of pointers on how to increase progesterone in this article.
3. Nutrition to Boost Progesterone
We need to eat healthy fat, and tons of whole food nutrients to get in zinc, vitamin B6, vitamin C, and magnesium to help support progesterone production. Add in olive oil, ginger, dark green veggies, beans, and citrus to your diet in copious amounts.
4. Reduce stress
When your body is stressed, whether from under-eating, over-exercising, or worry, you won’t ovulate. When you don’t ovulate, progesterone isn’t produced. Managing stress levels in any way you can improves your overall health and encourages progesterone production.
5. Supplements for Hormone Balance
Sometimes, all it takes is a little extra support from a targeted supplement formula to get those estrogens out and boost progesterone. Many women in my clinic have seen a big difference after a few months of supplementing with Balance Women's Hormone Support.
Can Spironolactone Make Your Breasts Larger?
Spironolactone is famous for increasing breast size. Unfortunately, this side effect is usually accompanied by breast pain, tenderness, and swelling.
Take note, this can happen to men who take the medication as well. It’s known as gynecomastia.
Can Spironolactone Make You Lose Weight?
While spironolactone can’t make you lose body fat, it can help with fluid retention. Because it’s a diuretic, it can eliminate excess water weight rather quickly.
As the Mayo Clinic warns, however, the loss of too much water can cause dehydration and low blood pressure. If you’re taking this medication and sweating a lot, be sure to hydrate.
What are the Side Effects of Spironolactone?
So, this medication can make your breasts bigger, help you get rid of excess fluid retention, clear up acne, stop unwanted hair growth, and help with PMS?
While this may sound like winning the lottery, it is important to bear in mind that this drug only works if it’s appropriate for your unique situation, and so long as you’re on it. Once you stop taking it, the effects do not last. Or in other words, this isn’t going to give you root cause resolution and is instead a drug that is used for symptom management.
Also, as with any pharmaceutical, we have to be aware of the side effects. This medication actually comes with a black box warning from the FDA due to the fact that studies have shown an association between its use and liver cancer, thyroid cancer, and breast cancer.
However, some researchers say these studies have been performed with much higher than typical doses given to humans. And this study concluded spironolactone use resulted in no increased risk for breast, uterine, ovarian and cervical cancer.
Spironolactone Side Effects
Spironolactone is a potent pharmaceutical and can have several side effects, which may include:
- Weight gain
- Menstrual irregularities
- Depletes magnesium, sodium, calcium
- Depletes electrolytes
- Increases potassium and blood sugar
- Low libido
- Excessive thirst
- Breast tenderness or pain
- Muscle pains or cramps
- Gastric bleeding
- Renal failure
In typical doses used for acne, spironolactone rarely produces side effects. Most commonly, you will see spotting or weight gain in lower doses, but even these effects are rare. Still, it is best to first try and find a holistic approach.
While a typical starting dose is 50 mg, you can discuss with your doctor using a trial dose of 25 mg. If it is well tolerated, but you haven’t quite seen the improvement in your skin, then consider increasing to 50 mg.
Spironolactone Interactions And Caution
Spironolactone can cause elevations of potassium in the body. For this reason, there are certain food, drug, and conditions where spironolactone would be contraindicated.
Too much potassium could lead to hyperkalemia (high levels of potassium in the blood) — which leads to muscle weakness, cramps, and potential heart problems.
Spironolactone and Food Interactions
Since spironolactone can increase potassium levels, it’s recommended that you avoid excess consumption of foods containing potassium if you’re taking this medication.
And girl, you know that celery juice craze that swept the internet? Well, it turns out that 16 ounces of celery on the daily is delivering a whole lot of potassium. I counsel my patients to avoid this practice if they are using a Spironolactone or an oral contraceptive that is potassium sparing due to the potential risk.
If you’re one of the gals who swears that celery juice results in clear skin for you then by all means, do you. But you’ve gotta choose—the juice or the meds, especially if you have a pre-existing condition.
Who Should Not Take Spironolactone, and Drug Interactions
Also — anything that also makes you retain potassium (like ACE inhibitors) should be avoided.
Do not take spironolactone with other medications like non-steroidal anti-inflammatory drugs (NSAID), lithium, digoxin, or oral contraceptives that contain the progestin drosperinone. As I explain in Beyond the Pill, contraceptives with this progestin like Yaz, Yasmin, and Ocella, also cause the body to retain potassium, which can increase cardiovascular issues in some women.
Spironolactone should never be taken by anyone with kidney issues, or Addison’s disease (adrenal insufficiency).
Also — if you have diabetes — monitoring blood sugar levels even more closely is essential if you take spironolactone, as it can increase blood sugar levels.
Is Spironolactone Safe To Use While Pregnant or Breastfeeding?
First things first, this medication is not recommended to take while pregnant or breastfeeding.
Spironolactone does cross the placenta, and if you get pregnant while taking it, the American Academy of Dermatology warns, serious birth defects can result.
For this reason, doctors usually require that their patients take hormonal birth control while using spironolactone. Often, oral contraceptives are used as a means to mitigate hormonal acne and PMS as well, so sometimes, doctors prescribe both medications in conjunction with one another in order to “fix the cycle” and reduce acne.
Let’s be clear, hormonal birth control does not balance hormones, fix periods, regulate cycles or cure acne. Hormonal birth control shuts down your ovarian function so you don’t make your own hormones. It is a symptom management tool, not a root cause solution.
It’s totally your call if you want to use it and I support women in making their own decision, but it is important that we be honest about how it works. If you are wanting to start birth control, read this article about how to support your body on birth control.
Is Spironolactone Right for Me?
Only you and your doctor can decide if spironolactone is the right medication for you.
If you’ve been taking this medication and you’re having anxiety, headaches, or increased blood sugar, keep looking for options. Don’t settle until you’ve gotten to the root cause of your issues and healed your body and mind.
And if you have questions along the way, I’m always here to help — no matter what you choose!
If you’re looking for more educational resources, I invite you to join my mailing list, where I share my knowledge about women’s health and hormones every week! I’d love to include you in my tribe and send you my hormone balancing starter kit as a thank you!
KEEPING IT REAL, WHILE KEEPING YOU EDUCATED
Featuring a 28 day plan to take back your cycle and dozens of charts, checklists, and diagrams to help along the way.
- G.D. Searle LLC Division of Pfizer Inc. ALDACTONE- spironolactone tablet, film coated.
- Aldactone® spironolactone tablets, USP.
- Thiboutot D, Chen W. Update and future of hormonal therapy in acne. Dermatology. 2003. 206(1). 57-67.
- Sutaria AH, Schlessinger J. Acne Vulgaris. [Updated 2019 Oct 25]. StatPearls Publishing. Treasure Island (FL). 2019. https://www.ncbi.nlm.nih.gov/books/NBK459173/.
- Charny JW, Choi JK, James WD. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017. 3(2). 111-115.
- Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. Am J Clin Dermatol. 2017. 18(2). 169-191.
- Lídia Palma,1 Liliana Tavares Marques,1 Julia Bujan,2,3 and Luís Monteiro Rodrigues. Dietary water affects human skin hydration and biomechanics. Clin Cosmet Investig Dermatol. 2015. 8. 413–421.
- Khayef G, Young J, Burns-Whitmore B, Spalding T. Effects of fish oil supplementation on inflammatory acne. Lipids Health Dis. 2012. 11. 165.
- Vĕtr M, Sobek A. Low dose spironolactone in the treatment of female hyperandrogenemia and hirsutism. Acta Univ Palacki Olomuc Fac Med. 1993. 135. 55-7.
- Ganie MA1, Khurana ML, Eunice M, Gupta N, Gulati M, Dwivedi SN, Ammini AC. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004. 89(6). 2756-62.
- Lashen, H. Role of metformin in the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2010. 1(3). 117–128.
- Dinh QQ, Sinclair R. Female pattern hair loss: Current treatment concepts. Clin Interv Aging. 2007. 2(2). 189–199.
- Ezeh U, Huang A, Landay M, Azziz R. Long-Term Response of Hirsutism and Other Hyperandrogenic Symptoms to Combination Therapy in Polycystic Ovary Syndrome. J Womens Health (Larchmt). 2018. 27(7). 892–902.
- Falch DK, Schreiner A. The effect of spironolactone on lipid, glucose and uric acid levels in blood during long-term administration to hypertensives. Acta Med Scand. 1983. 213(1). 27-30.
- CDC. PCOS (Polycystic Ovary Syndrome) and Diabetes.
- Wang M, Hammarbäck S, Lindhe BA, Bäckström T. Treatment of premenstrual syndrome by spironolactone: a double-blind, placebo-controlled study. Acta Obstet Gynecol Scand. 1995. 74(10). 803-8.
- Vellacott ID, O'Brien PM. Effect of spironolactone on premenstrual syndrome symptoms. J Reprod Med. 1987. 32(6). 429-34.
- Kim GK, Del Rosso JQ. Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris Practical Considerations for the Clinician Based on Current Data and Clinical Experience. J Clin Aesthet Dermatol. 2012. 5(3). 37–50.
- Mayo Clinic. Spironolactone (Oral Route).
- Harvard Health Publishing. Blood pressure drugs can boost blood sugar. Harvard Medical School.
- Biggar RJ, Andersen EW, Wohlfahrt J, Melbye M. Spironolactone use and the risk of breast and gynecologic cancers. Cancer Epidemiol. 2013. 37(6). 870-5.
- Mayo Clinic. Symptoms: Hyperalkemia. Mayo Clinic.
- US FDA. Aldactone® spironolactone tablets, USP. US Food and Drug Administration Database.
- American Academy of Dermatology Association. Sunburn Acne? Hormonal Therapy May Help. AAD.