What I Wish I Knew Before Taking Spironolactone for My Hormonal Acne
I was ready to give up. After a year of trying every spot treatment, clay mask, herbal supplement, and a dairy and gluten free diet, I started to accept the fact that I might have to deal with having deep, painful cystic hormonal acne for the rest of my life.
When I hit my late-20s, I learned that acne doesn't automatically stop when you graduate and sign a lease on your own apartment. Up until this point in my life, except getting for the odd pimple around the time of my period, I was that annoying person with clear skin even though my skincare routine was minimalist at best. As soon as I turned 28, I started getting a few hormonal, cystic bumps on my chin and jawline, regardless of where I was in my monthly cycle. This quickly escalated into full-on breakouts that didn't respond to any of the aforementioned acne treatments I tried.
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It was when I finally stopped being stubborn and visited a dermatologist that I seriously considered spironolactone, a prescription drug, as an alternative treatment to the other last resort options I was looking into: birth control or Accutane.
Spironolactone is a pill that's traditionally used as a blood pressure medicine, but it's becoming more and more popular for its use as a hormonal acne treatment for women. "Spironolactone is a high blood pressure medication used off-label at low doses to treat acne — that means it is not officially approved for acne," explains Joshua Zeichner, MD, Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City. "It blocks the effect of hormones like testosterone on your oil glands. If the oil glands are not stimulated as much they do not make as much oil, which means less shine, fewer blockages in the pores, and less food to feed acne-causing bacteria in the skin."
By the time I was first prescribed spironolactone my hormonal acne was beginning to effect my mental health and my self esteem. I was desperate for a solution so I barely asked about any of the pill's side effects.
I'm coming up on my one-year anniversary of being on spironolactone, and my skin is drastically better, though it's not perfect like I was expecting. However, I have no regrets and, overall, I'm happy with my decision to go on it. If you're considering spironolactone for hormonal acne, here are eight things I wish I knew before I started taking it.
1. DON'T EXPECT INSTANT RESULTS
Although I started seeing an improvement in the cystic acne on my chin and jawline after being on the pill for around a week, don't expect that spironolactone will work as quickly for you as it did for me. "It takes about three months at the right dose to get the full effect," says Dr. Zeichner. "If the dose is too low for an effect in you, you may need to increase the dose and need to wait a few months for that dose to kick in."
The writer's skin before taking spironolactone, after two weeks taking the pill, and four weeks after taking it.
2. IT MIGHT NOT WORK FOR YOU
If you've been taking the pill past the three-month mark and your hormonal acne situation isn't any better, it might be time to try a new dose or another treatment option all together. "When using it to treat acne, spironolactone is only used in women and tends to work best for women with hormonal acne, menstrual flares, adult-onset acne, or conditions with hormone abnormalities and acne (e.g. PCOS)," explains Sejal Shah, cosmetic dermatologist and founder of Smarter Skin Dermatology in New York City "It is also often used in women whose acne is resistant to conventional therapies."
"At a high enough dose, it has some effect on all women," adds Dr. Zeichner. "The issue is that at higher doses it may be associated with side effects like breast tenderness or irregular periods, which get in the way with using it."
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3. YOU WILL PEE, A LOT
The pill itself is a diuretic, so frequent urination is an expected side effect. Personally, I peed every 30 minutes the first week or so I was on spironolactone. (I counted.) The interval eventually tapered off, but I still pee more than I did before I started taking the medication.
4. YOUR PERIOD CRAMPS MIGHT GET WORSE
I've had agonizing cramps every month since I started getting my period in middle school, and I didn't think it was possible for them to get worse until I experienced my first period on spironolactone. My cycle also lasts longer, too. (Lucky me.) What I haven't dealt with is spotting, a common side effect of spironolactone.
Dr. Shah says that it's possible that intensified cramps could be caused by hormonal changes from taking spironolactone.
5. YOU CAN FEEL MORE TIRED THAN USUAL
When my body was still adjusting to spironolactone, I was so exhausted I could have easily fallen asleep standing up while in line at Whole Foods—even though I take a very small dose of the medicine. Since then, my energy levels are pretty much back to what they used to be before taking the pill. "Spironolactone blocks the hormone aldosterone, which can lead to fatigue," Dr. Shah explains. "In addition, it can lower the blood pressure, and if this drop is sudden, you may feel tired."
6. IT IS POSSIBLE YOU'LL STILL GET BLEMISHES
The first six months I was on spironolactone, my skin was completely blemish-free. Lately, I've been getting the odd whitehead—usually during weeks when I'm under extreme stress or have had a few too many late-night pizza slices.
When I asked him, Dr. Zeichner said that it's possible to experience mild breakouts after being on spironolactone for a year. "You are not the same person you were a year ago," Dr. Zeichner said. "The hormones and sensitivity to those hormones may change over time, which means you may need to adjust your dose."
Going off birth control can have an effect on your skin, too. "Some birth control pills that contain a progestin called drosperinone (eg. Yaz and Beyaz) offer spironolactone-like benefits," he explains.
7. IT'S SAFE FOR LONG-TERM USE
Sure, the everyday side effects of spironolactone are minimal, but what about the long-term risks of being on it? Breathe a sigh of relief because it falls under "very safe" on the spectrum of medications. Although it's not associated with cancers (including breast or ovarian) in humans, both Dr. Zeichner and Dr. Shah note that spironolactone does have a black box warning because high doses of it caused tumors in rats.
However, if you are planning on getting pregnant, you shouldn't take spironolactone. "Theoretically it can cause birth defects, so you should use contraception if you are on it," says Dr. Zeichner.
8. YOUR ACNE CAN COME BACK
The reality is that spironolactone only works when you're on it. If you do stop taking it, it's possible that your hormonal acne will come back. "If you go off, then the effect of the body's hormones will go back to what it was before you started," says Dr. Zeichner.
