From the Guidelines
Spironolactone commonly causes side effects in women when used for acne treatment, including menstrual irregularities, breast tenderness, and increased urination, as reported in a 2024 study published in the Journal of the American Academy of Dermatology 1.
Common Side Effects
The most frequent side effects of spironolactone for acne treatment in women include:
- Menstrual irregularities, which may be dose-dependent 1
- Breast tenderness or enlargement
- Increased urination (diuresis)
- Fatigue
- Headache
- Dizziness These side effects are often mild and may improve with continued use as the body adjusts to the medication.
Monitoring and Precautions
Potassium monitoring should be considered in older patients, patients with medical co-morbidities, and patients taking medications that affect renal, adrenal, and hepatic function 1.
Pregnancy and Lactation
Spironolactone should not be used in pregnancy due to the potential risk of feminization of a male fetus 1.
Dosage
Typical dosing ranges from 25-200mg daily, with most women starting at lower doses (25-50mg) and gradually increasing if needed 1.
The medication may take 3-6 months to show maximum benefit for acne. Women should be counseled to avoid becoming pregnant while on spironolactone, and regular monitoring of potassium levels and blood pressure is recommended, especially during the initial treatment period 1.
From the FDA Drug Label
The following adverse reactions associated with the use of spironolactone were identified in clinical trials or postmarketing reports. Reproductive: Decreased libido, inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding, breast and nipple pain.
Common side effects for women on Spironolactone for acne include:
- Irregular menses or amenorrhea
- Breast and nipple pain
- Postmenopausal bleeding 2
From the Research
Common Side Effects of Spironolactone for Acne in Women
- Menstrual irregularities 3
- Breast tenderness 3
- Dizziness 3
- Hyperkalemia, although this is extremely uncommon in women aged 45 or younger 4
Side Effect Profiles
- A study of low-dose spironolactone (25-50 mg/day) in Thai women with moderate acne found that a small number of participants reported mild and temporary treatment-related adverse events, including menstrual irregularities, breast tenderness, and dizziness 3
- An analysis of adverse event reports to the US Food and Drug Administration found that hyperkalemia was the most common adverse reaction in women taking spironolactone, but this was rare in women aged 45 or younger 4