How does spironolactone help treat PCOS?

If you have polycystic ovary syndrome (PCOS) and struggle with excessive hair growth in unusual places, you’re not alone—up to 80% of people with PCOS experience this symptom (Spritzer, 2016). Spironolactone is one medication your healthcare provider may prescribe to combat this. Here's what you should know about spironolactone's role in the treatment of PCOS and if it could be an option for you. 

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Spironolactone (brand name Aldactone) is a prescription diuretic—a type of medication that helps remove excess fluid from your body. Healthcare providers use spironolactone to treat several conditions, including heart failure, high blood pressure (hypertension) that doesn’t respond to other treatments, and fluid build-up from liver disease (Pfizer, 2018). 

Spironolactone is also an anti-androgen, which means it blocks the effects of androgens (sometimes called male sex hormones, though they’re present in everyone), including testosterone (Sirmans, 2013). 

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions in women between puberty and menopause. PCOS is characterized by ovulation and menstrual dysfunction, infertility, and high androgen levels. Insulin resistance is also common, putting PCOS patients at increased risk of type 2 diabetes. Many people with PCOS struggle with obesity and can develop high blood pressure and high cholesterol (Escobar-Morreale, 2018). 

A key component of PCOS is hyperandrogenism—abnormally high levels of androgens, including testosterone. Androgens are sometimes referred to as male sex hormones, but females also produce these hormones in small amounts. Elevated androgen levels contribute to many PCOS symptoms, including hirsutism (excess hair growth on the face, chest, and back), acne, and hair loss (Escobar-Morreale, 2018). 

Spironolactone acts as an anti-androgen by blocking androgen receptors, including the receptors on hair follicles, which prevents testosterone from binding and exerting its hirsutism-causing effect. Spironolactone also decreases androgen production from the ovaries and adrenal glands (Sirmans, 2013). 

Spironolactone is primarily used to treat hirsutism in people with PCOS after other treatment options have failed (Sirmans, 2013). Hirsutism is when women experience excessive hair growth in a typical male pattern. Hair is thick, coarse, and dark and often grows on the chin, neck, lower face, and sideburns. Other body areas may also be affected, including the chest and back (Goodman, 2015). 

Hormonal birth control is considered the first-line treatment for hirsutism in people with PCOS. Oral birth control pills (oral contraceptives), patches, or vaginal rings are all effective options. In addition to treating hirsutism, hormonal birth control also helps regulate menstrual cycles and improve acne (Legro, 2013). Because it can take at least six months to see a decrease in hair growth, many people also use other methods for removing unwanted hair, such as laser hair removal, waxing, or tweezing (Sirmans, 2013). 

Unfortunately, not everyone responds fully to birth control. If you haven’t seen the results you were hoping for after six months, your healthcare provider may recommend adding spironolactone to your treatment plan (Sirmans, 2013). You may notice an improvement in your acne after starting spironolactone as well (Goodman, 2015). 

Like any medication, spironolactone has the potential to cause side effects. Be sure to follow up with your healthcare provider if you experience any of the following (Goodman, 2015; Patibandla, 2021):

• Breast tenderness

• Dehydration

• Diarrhea

• Dizziness

• Headaches 

• Irregular periods (unlikely to occur if you’re also taking birth control) 

• Nausea

• Vomiting

Electrolyte imbalances 

Spironolactone can affect the levels of different electrolytes in your body, particularly potassium (Pfizer, 2018). Very high levels of potassium can cause heart rhythm problems (Hunter, 2019).  

You may be at increased risk of developing high potassium levels with spironolactone if you (Hunter, 2019):

• have kidney problems

• have diabetes 

• take other medications that increase potassium levels, like ACE-inhibitors (ex. lisinopril) or ARBs (ex. valsartan) 

• take potassium supplements or use potassium-containing salt substitutes 

Your healthcare provider will likely monitor your potassium levels after starting spironolactone to ensure they don’t become too high.  

Pregnancy

Spironolactone can cause birth defects, preventing the proper development of sex organs in male babies if taken during pregnancy. It is recommended that you take birth control while on spironolactone to ensure you do not become pregnant (Goodman, 2015). If you are planning on becoming pregnant, tell your healthcare provider so they can find a treatment that will be more appropriate for you.

Spironolactone is available in doses of 25, 50, and 100 mg tablets, as well as an oral liquid if you have trouble swallowing pills (CMP Pharma, 2017; Pfizer, 2018). 

The starting dose for the treatment of hirsutism is 50 mg twice per day. Your healthcare provider may increase your dose, depending on your symptoms, up to 100 mg twice per day (Goodman, 2015). 

If your PCOS symptoms are affecting your physical appearance, you may feel uncomfortable or struggle with self-confidence. Don’t hesitate to discuss any concerns with your healthcare provider. Effective treatment options, including spironolactone, are available. Your healthcare provider will likely recommend a combination of medications, lifestyle modifications, and weight loss to help target all of your PCOS symptoms and get you feeling your best.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 18, 2021

Written by

Christina Varvatsis, PharmD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.