Is spironolactone effective for PCOS?

spironolactone for pcos
Medically reviewed by Dr. Marsha Dunkely


Spironolactone can be an effective treatment for Polycystic ovary syndrome (PCOS), particularly in managing symptoms like excessive hair growth (hirsutism). Studies have shown that spironolactone can help reduce unwanted hair growth by blocking the effects of androgens, such as testosterone, which are often elevated in women with PCOS. It works by interfering with the action of androgens at the hair follicle level, leading to slower hair growth and sometimes even hair loss. 

However, it’s essential to note that spironolactone is not a cure for PCOS but rather a way to manage its symptoms. It may take several months to see noticeable results, and it’s important to use it as part of a comprehensive treatment plan under the guidance of a healthcare provider. This blog explores the role of spironolactone in treating PCOS. 

How does spironolactone help treat PCOS?

Spironolactone is a diuretic that prevents the lowering of potassium levels in blood. It is known to block the effect of androgens like testosterone, a primary hormone present in males and serves the purpose of differentiation. Women suffering from PCOS suffer from increased levels of testosterone, which causes symptoms like facial hair growth and acne. 

Versatility in Treatment

Moreover, spironolactone demonstrates versatility in PCOS treatment, as it may also contribute to weight management and cholesterol level improvements in certain cases. Typically prescribed alongside birth control pills or metformin, spironolactone addresses various facets of PCOS symptoms and hormonal imbalances comprehensively.

For Hirsutism Management

Primarily utilized for treating hirsutism in PCOS patients when other therapeutic avenues have been exhausted, spironolactone proves pivotal in alleviating this condition characterized by excessive male-pattern hair growth. Hirsutism predominantly manifests on the chin, neck, lower face, and sideburns, potentially spreading to the chest and back.

As an alternative to hormonal birth control

While hormonal birth control stands as the frontline therapy for hirsutism in PCOS, encompassing oral contraceptives, patches, or vaginal rings, its efficacy extends beyond hair management to regulating menstrual cycles and improving acne. Despite the efficacy of hormonal birth control, patience is paramount, as visible reduction in hair growth may take up to six months. 

Moreover, most patients don’t respond to hormonal birth control, and so in such cases, doctors prescribe spironolactone. However, in cases where the desired outcomes are not achieved with hormonal birth control alone, healthcare providers may recommend incorporating spironolactone into the treatment regimen. Additionally, individuals may experience an amelioration of acne upon commencing spironolactone treatment.

Spironolactone for PCOS – Side effects and Risks

Here are different risk factors and side effects that may occur while taking spironolactone for PCOS:

  1. Dehydration and Common Side Effects

Spironolactone, a diuretic, facilitates urination to rid the body of excess fluids, potentially leading to dehydration. Common side effects associated with spironolactone for PCOS treatment include:

  • Breast pain
  • Dizziness
  • Fatigue
  • Cramps

  1. Electrolyte Imbalance

One of the critical considerations with spironolactone use is its impact on electrolyte levels, particularly potassium. Imbalances in electrolytes can pose risks to heart health and may result in irregular heart rhythms. Specifically:

  • Electrolyte imbalances can occur, notably in potassium levels 
  • Elevated potassium levels may lead to heart rhythm disturbances
  • Risk Factors for Elevated Potassium Levels

Certain factors may increase the likelihood of developing high potassium levels while on spironolactone. These include:

  • Kidney problems
  • Diabetes
  • Concurrent use of medications known to elevate potassium levels, such as ACE inhibitors (e.g., lisinopril) or ARBs (e.g., valsartan)
  • Use of potassium supplements or potassium-containing salt substitutes

Healthcare providers closely monitor potassium levels following spironolactone initiation to prevent excessive elevation.

  1. Pregnancy Precautions

Notably, spironolactone poses risks of birth defects, particularly affecting the proper development of male sex organs if taken during pregnancy. To mitigate these risks:

  • Birth control usage is strongly recommended while on spironolactone to prevent unintended pregnancies.
  • Individuals planning pregnancy should inform their healthcare providers to explore alternative treatment options suitable for pregnancy.

What is the dosage of Spironolactone for PCOS?

Spironolactone comes in 25, 50, and 100 mg tablets and an oral liquid formulation for those with difficulty swallowing pills. The typical starting dose for treating hirsutism (excessive hair growth) is 50 mg twice daily.

Depending on your response and symptom severity, your healthcare provider may adjust your dosage, potentially increasing it to 100 mg twice daily.

Communicating openly with your healthcare provider about your symptoms and concerns regarding physical appearance or self-confidence is essential. Effective treatment options, including spironolactone, can be personalized to address your specific needs. Your healthcare provider may also recommend a combination of medications, lifestyle changes, and weight management strategies to manage all aspects of PCOS symptoms and improve overall well-being.

Long-term Implications of Spironolactone Use

Research indicates that long-term use of spironolactone is generally safe. In some cases, long-term spironolactone treatment, especially when combined with weight loss efforts in overweight individuals with PCOS, may even positively affect glucose and lipid metabolism.

The most frequently reported adverse effects associated with spironolactone use are its diuretic effect and menstrual irregularities. Overall, while spironolactone may cause some common adverse effects, its long-term use is well-tolerated and safe, with potential benefits for managing PCOS symptoms and metabolic health. 

How quickly does spironolactone work for PCOS?

Spironolactone usually takes at least six months of consistent use for its effects to become noticeable. While spironolactone may not produce rapid changes, its effectiveness in reducing symptoms like excessive hair growth becomes more apparent with continued and consistent use. Regular communication with your healthcare provider can help track progress and make any necessary adjustments to your treatment plan.

When should I see a doctor?

It’s important to consult a doctor if you have kidney complications or are taking medications known to increase potassium levels. Spironolactone can affect electrolyte balance, particularly potassium levels, so monitoring by a healthcare provider is essential in such cases.

Moreover, seeking immediate medical attention is crucial if you experience any side effects or adverse reactions to spironolactone. Common side effects such as dehydration, dizziness, fatigue, or menstrual irregularities should be reported to your doctor for evaluation and management.


Can Spironolactone help with weight management in women with PCOS?

Yes, as per research, beneficial effects on glucose and lipid metabolism were observed when spironolactone was given to women suffering from PCOS who were overweight.

Is 50 mg of spironolactone enough for acne?

Yes, your doctor may prescribe spironolactone dosages ranging from 25-50mg for acne lesions as per the severity of the acne outbreaks experienced by the concerned patient. 

Should diabetics take spironolactone for PCOS?

Yes, spironolactone can be used for the management of polycystic ovarian syndrome (PCOS). However, combining this medication with metformin could potentially lead to even better outcomes in managing the symptoms of PCOS, including those related to insulin resistance and diabetes.

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