Spironolactone for PCOS (now called PMOS): acne, facial hair and hair thinning

Key facts

What it is

An anti-androgen (originally a diuretic, or water pill)

Rx or supplement

Prescription only

Typical PH cost per month

About ₱720 to ₱1,140 (cost example at 2 tablets of 25 mg a day; your doctor sets the amount)

Evidence (2023 Guideline)

●○○Limited evidence

Time to see results

About 6 months

Who prescribes

Dermatologist or OB-GYN

How it works

In PCOS, higher androgensandrogens: Hormones like testosterone. Everyone has them; in PCOS they are often higher. drive oily skin, deep jawline breakouts, coarse hair on the chin and body, and thinning at the crown. Spironolactone sits on the androgen receptors in skin and hair follicles so testosterone has less effect there. It does not regulate your cycle, so doctors usually pair it with a combined pill or other treatment for periods.

Hair and skin change slowly. Hair follicles cycle over months, so most doctors review progress at around 6 months. Laser or IPL hair reduction works better alongside hormonal treatment, and maintenance sessions are often needed in PCOS.

Why you need contraception

This is one reason doctors often combine it with a combined pill, which covers contraception and cycles together. Remember that PCOS itself is not contraception: you ovulate less often, not never. Our sister site birthcontrolphilippines.com compares contraceptive options.

Who it suits

• Women whose acne or unwanted hair has not improved enough after a fair trial of a combined pill
• Women who cannot take estrogen, with another reliable contraceptive in place
• Some women with female pattern hair thinning, sometimes alongside minoxidil (see hairlossphilippines.com)

A user on r/Hairloss wrote that she had “a spiro prescription but I'm scared to start” (thread). That worry is valid. Ask your doctor what to expect, how long to try it, and what happens if you stop. For hair thinning, also ask for ferritin, thyroid and vitamin D checks.

Side effects and fears

Commonly reported effects include needing to pee more, tiredness, breast tenderness, irregular spotting and feeling lightheaded when standing up quickly. Spironolactone can raise potassium, so doctors may check a blood test. [TODO: source: spironolactone product label]

Spiros vs Aldactone: what it costs

Spiros is the cheaper brand of the same medicine. In the same cost example, Spiros works out to about ₱720 a month and Aldactone to about ₱1,140. Ask your doctor if the cheaper brand is fine for you. See the full cost guide.

When to see a dermatologist

PCOS skin and hair problems often sit between specialties. A dermatologist is a good next step if your acne is cystic or scarring, if unwanted hair is affecting your life and you are considering laser, or if your scalp hair is thinning. Bring your OB-GYN's notes and your pill history. Filipinas describe feeling “sobrang nadodown” with daily new breakouts; that is a real burden, and asking for more help is reasonable.

Safety

This guide is for information. Talk to a doctor before starting or changing any treatment.