Spironolactone's Role In Treating PCOS

PCOS is among the main causes of female infertility, affecting as many as 6%–12% of American women of reproductive age. If you suffer from PCOS and struggle with excessive hair growth in androgen-dependent areas, your doctor can recommend an effective treatment strategy.¹

Spironolactone is a common medication that doctors issue to treat PCOS. Here is what you need to know about spironolactone's role in treating PCOS in women. 

What is PCOS?

Polycystic ovary syndrome (PCOS) is a condition affecting a woman's hormone levels, where the woman's ovaries can produce an abnormal amount of androgens. 

The exact cause of PCOS is unclear. Most women with PCOS typically have insulin resistance, meaning their bodies don’t respond to insulin properly. Insulin levels then build up in the body and can promote excess ovarian androgen production. 

Excess weight (obesity) can also increase insulin levels, worsening PCOS symptoms. There’s a genetic component to PCOS, meaning it is possible for sisters, daughters, or mothers to develop PCOS during their lifetime if their family members were diagnosed with it. 

Symptoms of PCOS include:

• Infertility

• Male-pattern baldness or thinning of hair

• Acne or oily skin

• Weight gain, especially around the abdomen

• Excess body hair in androgen-dependent places (chest, face, or back). This condition is termed hirsutism.

• Large ovaries or ovaries with cysts

• Missed/ irregular/ very light periods

• Dark/ thick skin patches in the armpits, on the back of the neck, and under the breasts (acanthosis nigricans)

• Skin tags

There is no single test to diagnose PCOS specifically, and the diagnosis is based on Rotterdam criteria. Your doctor may discuss your symptoms, medications, and other conditions with you. They may also ask about your menstrual periods and weight changes. 

The doctor may conduct a physical exam that includes checking for signs of acne, insulin resistance, and excess hair growth. Your healthcare provider may recommend blood tests, a pelvic exam, or an ultrasound to diagnose the matter further. 

PCOS treatment depends on several factors, such as:

• Age

• The severity of the symptoms

• Overall health

• Your intention to become pregnant (If this is the case, treatment options may include changing diet and activity levels and taking medication to cause ovulation.)

If you don't plan to become pregnant, treatment options may include birth control pills, diabetes medication, medication to treat other symptoms (like acne), or a change in diet and activity. Your doctor may also recommend spironolactone to treat your PCOS. 

What is spironolactone?

Spironolactone is a prescription medication termed an aldosterone receptor antagonist. It can treat conditions like heart failure, acne, hair loss, etc. Spironolactone prevents your body from absorbing excess salt and can also increase your potassium levels. 

Spironolactone can help to treat high blood pressure (hypertension) or hypokalemia (low blood potassium). It can also treat fluid retention (edema) in individuals with congestive heart failure, liver cirrhosis, or nephrotic syndrome. 

Spironolactone is also an anti-androgen. This means it can block the effects of androgen, making it beneficial for women diagnosed with PCOS. 

How can spironolactone help treat PCOS?

Although not FDA-approved for PCOS, Spironolactone is often utilized off-label to treat PCOS symptoms. PCOS is characterized by high androgen levels, infertility, ovulation, and menstrual dysfunction. 

In addition, PCOS patients also have high insulin resistance, exposing them to an increased risk of type 2 diabetes. Most PCOS patients struggle with excess weight and can develop high cholesterol and blood pressure. 

Hyperandrogenism — excess androgen levels — is also a key component of PCOS. Despite being male hormones, androgens are also normally present in women, though in limited quantities. Excess androgen levels result in worse PCOS symptoms, like hair loss, acne, and hirsutism. 

As previously mentioned, spironolactone can act as an anti-androgen by blocking androgen receptors, including the receptors on hair follicles. As an anti-androgen, spironolactone hinders testosterone from binding and applying its hirsutism-causing effect. The medication also minimizes androgen production. 

Side effects and adverse reactions to watch out for

Like any medication, spironolactone has potential side effects and adverse reactions among users. Ensure you contact your doctor immediately if you experience one or more of the following possible side effects:

• Dizziness

• Vomiting

• Nausea

• Irregular periods (highly unlikely if you're also on birth control)

• Headaches

• Diarrhea

• Dehydration 

• Breast tenderness

Spironolactone can also affect electrolyte levels in your body. Such electrolytes include potassium. Excess potassium levels can result in heart rhythm problems. Your risks of attaining high potassium levels from spironolactone also increase if you:

• Use potassium supplements/potassium-containing salt substitutes

• Use medications likely to increase potassium levels

• Have diabetes or kidney complications 

Your doctor should assess your potassium levels before and after putting you on spironolactone to treat PCOS. 

Additionally, spironolactone can cause birth defects. If used during pregnancy, spironolactone can result in the feminization of male fetuses. If you want to become pregnant while seeking PCOS treatment, your doctor will advise you on appropriate treatment alternatives.  

Spironolactone usage warning

Doctors recommend using spironolactone with caution if you also have Addison's disease, are using eplerenone, or have trouble urinating. Spironolactone can also cause tumors in animals. However, recent retrospective and observational studies have not shown an increased risk of prostate or breast cancer in humans. Avoid using spironolactone for any condition unchecked by your doctor.²

Other uses of spironolactone

Spironolactone has multiple uses besides being an anti-androgen medication to treat PCOS. Generally, spironolactone is a prescription diuretic (medication used to eliminate excess fluid from your body). 

Spironolactone is used alone or with other drugs to treat high blood pressure and heart failure. Reducing blood pressure can minimize the risks of stroke and heart attacks. 

In addition, spironolactone can help treat hyperaldosteronism (where the adrenal gland produces an excess hormone known as aldosterone). 

Spironolactone can be used with other medications to treat some types of precocious puberty. Precocious puberty is a condition causing children to enter puberty too early, leading to the development of sexual traits at the age of 2 to 2.5 standard deviations (SD) earlier than expected, given the population.

Spironolactone can also be used to treat:

Hormonal acne

Though not FDA-approved for acne treatment, spironolactone can be prescribed off-label as a medication to treat hormonal acne. It is an androgen blocker reducing the effects of androgenic hormones. 

These hormones can increase sebum production in the skin, leading to an increased risk of experiencing hormonal acne breakouts. Spironolactone minimizes the impact of androgens in your body, thus reducing sebum levels and the chances of acne breakouts. 

Hair loss

The same hormones (dihydrotestosterone, i.e., DHT) causing hair loss in men can cause hair loss in women. Spironolactone reduces testosterone production, thus indirectly influencing the DHT level your body produces, leading to a reduction in hormonal hair loss. 

Hypokalemia

Spironolactone can also treat hypokalemia — also known as low blood potassium levels — though it is rarely used in this context. This condition happens when your blood pressure drops below 3.5 mEq/L (3.5 mmol/L). The result can be potentially life-threatening if left untreated. 

Hypokalemia can occur due to different reasons, such as losses from diarrhea or diuretic use. Individuals with hypokalemia often experience weakness, fatigue, and other symptoms, such as muscle cramps. 

As a diuretic, spironolactone retains potassium while eliminating excess water and sodium from the body. It is a safe, effective treatment for patients that require diuretics but are prone to hypokalemia.

The lowdown

Spironolactone is an effective treatment medication for several conditions, including PCOS, a condition affecting women of reproductive age. Women with PCOS often have high androgen levels, i.e., male hormones. 

Depending on several key factors, your doctor may recommend spironolactone to treat your PCOS, among other treatment options. Though not approved by the FDA for treating PCOS, spironolactone effectively treats the signs and symptoms of this condition. It is an anti-androgen medication that can help hinder androgen production in women. 

However, despite its effectiveness, spironolactone isn't for everyone. Therefore, before accepting the drug as a treatment option for PCOS, inform your doctor of any possible reasons you shouldn't take spironolactone. These include kidney complications or if you are using medication likely to increase potassium levels. 

If you experience any side effects or adverse reactions to spironolactone, visit your doctor immediately. 

Frequently asked questions

Does spironolactone lower androgen levels?

Yes. Spironolactone works as an effective anti-androgen by hindering androgen receptors. The drug lowers androgen production, thus reducing the effects of androgens (like testosterone) in your body.  

What does spironolactone do to androgens?

Spironolactone inhibits androgens at various physiological levels. This ability has led to its utilization in women with excess sebum production, hirsutism, and androgenic alopecia, with successful outcomes seen in patients. 

Does spironolactone increase facial hair?

No, spironolactone suppresses androgen hormones. Androgen hormones are behind the hirsutism seen in females. It helps hair regrowth on one's scalp since PCOS leads to balding and thinning hair. At the same time, spironolactone also works to reduce excess hair growth on the body and face (hirsutism). 

Does spironolactone help PCOS weight loss?

There is no scientific evidence evaluating spironolactone specifically for weight loss, as this would not be expected. However, it makes sense that spironolactone might reduce weight in some individuals, mostly those with fluid retention. 

The drug functions as a diuretic, meaning it causes the body to expel excess fluid. A reduction in body fluids results in reduced body weight. However, it is worth noting that this type of water-weight loss isn't the same as healthy weight loss due to reduced body fat or body mass. PCOS weight loss requires proper nutrition and regular exercise.

Is metformin or spironolactone better for PCOS?

Yes. There are different treatments for hirsutism besides spironolactone, including metformin. In comparison, spironolactone appears to be better than metformin in treating hirsutism. 

Can spironolactone make your hair grow?

Yes. Spironolactone decreases the production of androgen. Reduced androgen production slows down the progression of hair loss caused by androgenic alopecia. Furthermore, it can encourage hair to regrow. 

Can spironolactone help you lose weight?

Spironolactone helps to reduce fluid retention effectively. Still, it isn't effective in eliminating body fat. It can help you lose weight by eliminating retained fluid. However, it won't help you lose weight from actual body fat.