PCOS symptoms like facial and body hair and acne are a result of high levels of male hormones. Spironolactone is believed to be effective against excess male hormones. While the drug has been used for more than three decades for PCOS, it comes with certain side effects.
A major embarrassing symptom of PCOS is “hirsutism,” or the sprouting of hair on the face, chest, and stomach. Excess hair growth in PCOS patients is a result of the high levels of male hormones (androgens) in them. For this reason, the pattern of hair growth is similar to that seen in men. Androgens also cause acne. Doctors often prescribe a drug called spironolactone for the treatment for hirsutism in PCOS.
Spironolactone (Aldactone) is a “water pill,” or diuretic that is usually used to reduce swelling due to excess fluid buildup. It is prescribed for diseases like liver cirrhosis, congestive heart failure and nephrotic syndrome (a kidney disorder). This drug also has an androgen-lowering effect on the body, and hence it is prescribed for PCOS symptoms like acne and hirsutism.
How Spironolactone Helps Treat PCOS Hirsutism and Acne?
The effectiveness of spironolactone to treat moderate to severe hirsutism was reported in 1982. Positive effects were seen within two months of treatment. In 1986, a study was done to assess the efficacy of spironolactone in the treatment of acne in women with PCOS. Spironolactone was found to significantly improve acne by reducing the levels of male hormones.
Spironolactone acts by blocking testosterone receptors as well decreasing the production of testosterone. The drug is a potent antagonist (blocker) of the androgen receptor. It does not allow effective binding of molecules of testosterone to its receptor, and thus stops testosterone from showing its effects on the cells.
Side Effects of Spironolactone
Spironolactone causes side effects that can range from minor ones like headaches to serious complications like stomach bleeding.
The most common side effects of spironolactone are
- Mild nausea or vomiting
- Swelling or tenderness in the breast
- Mild drowsiness
- Cramping in the legs
Other serious side effects can occur with spironolactone use, including
- Stomach bleeding with signs like bloody or tar black-colored stools, coughing up blood or vomit resembling ground-coffee
- High potassium levels. Signs include slow heart rate, weak pulse, limp feeling in the muscle due to too much weakness, tingly feeling in the hands and feet.
- Low sodium with symptoms like slurred speech, confusion, severe weakness, hallucinations, loss of coordination, seizure, feeling unsteady, fainting, and shallow breathing.
- Electrolyte imbalance. This can show up in the form of increased thirst, dry mouth, lack of energy, drowsiness, restlessness, nausea, vomiting, confusion, increased urination, fast heart rate, & muscle cramping, etc.
- Irregular periods
- Severe pain in the abdomen
- Dark urine
- Yellowing of the eyes and/or skin
If you are allergic to spironolactone, you might experience side effects like
- Swelling of the face, tongue & throat
- Severe dizziness
- Trouble breathing
Popular Brands of Spironolactone
The most common and recognizable brand is Aldactone. Another brand available in the United States is CaroSpir.
How and When To Use Spironolactone For PCOS
Doctors often prescribe a dosage of 50 – 200 mg per day, either once or divided into two doses, both 12 hours apart. Spironolactone is usually available in tablet form and has to be taken orally.
Can You Reduce Side Effects of Spironolactone?
Lower dosages of this drug are found to cause milder side effects. However, higher dosages are found to be more effective in reducing hirsutism and acne. Your doctor is the best judge to fix the right dosage for you that will be effective as well as not let you experience too many side effects.
Is Spironolactone Safe In The Long Term?
Spironolactone has been used for more than three decades for the treatment of PCOS hirsutism and acne. A long term study was done to assess the safety of spironolactone. This study found that there were no serious illnesses or health complications that could be attributed to spironolactone use. Apparently, long-term use of spironolactone is safe. Side effects as mentioned above are a problem but they will disappear once you stop using spironolactone.
Precautions While Taking Spironolactone
Spironolactone is a potassium-sparing diuretic. You shouldn’t be taking this medicine if you are allergic to it or suffer from kidney disease, Addison’s disease (a disorder of the adrenal glands), have high levels of potassium in your body, or are taking a drug called eplerenone.
You should consult with your doctor about the safety of spironolactone if you have a liver or heart disease or an electrolyte imbalance. You should not be taking this medication if you are pregnant, plan to become pregnant or if you are breast feeding a child.
Does Spironolactone Interact With Other Drugs?
Spironolactone interacts severely with drugs that weaken the immune system, such as cyclosporine and tacrolimus. When taken together, they will cause a sudden increase in potassium levels. Spironolactone also reacts seriously with the following:
- Aldosterone receptor agonists (used for congestive heart failure)
- Trimethoprim (an antibiotic used to treat bladder infections)
- Mitotane (used for treating adrenocortical carcinoma – a type of cancer – and Cushing’s syndrome – a condition caused by high cortisol levels for a long time)
- Sodium phosphate bowel cleanser (to clean the bowel before a medical procedure)
- Potassium preps (to clean the bowel before a medical procedure)
Other drugs that interact moderately with spironolactone are
- ACE inhibitors, etc.
Storage and Disposal of Spironolactone
Store the medicine in a clean, dry and tightly closed container. Keep it away from humidity, excess light and heat. Do not refrigerate.
Always store medicines away from young children and pets. Unused and expired medicines should be disposed of in ways that they do not get consumed by pets, children and other people. Never flush the medicines. If you are not sure about the disposal of the medicine, take it back to your pharmacist.
Dietary Considerations When On Spironolactone
Since this is a potassium-sparing diuretic, you have to limit potassium-rich foods like bananas, raisins, prunes, and orange juice. Ask your doctor how much of these you can safely consume. You need to strictly avoid potassium-containing salt substitutes while you are on this medication. Reduce your salt (sodium) intake during the course of this medication.
Spironolactone for PCOS Hirsutism and Acne: The Final Verdict
Spironolactone has been used for more than 30 years for treating PCOS hirsutism and acne. A few long-term studies do indicate that this drug is safe. However, it is seen that some women do not complete the treatment course due to the side effects. Side effects are troublesome and a serious cause for concern. But they do resolve once you stop the medication. Because this treatment usually runs for more than 6 months, women face the risks of side effects for a long time. This can create a psychological stress on them. Doctors should weigh the costs with the benefits while recommending spironolactone for PCOS.