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Polycystic Ovary Syndrome (PCOS) impacts 1 in 10 women in the United States. Many of these women — maybe yourself included — would tell the world that PCOS is as unpredictable as it is stressful. It’s a condition with symptoms that can make managing day-to-day well-being difficult.
PCOS is known for its hormonal imbalance and the trickle-down effect it can have on the rest of your body. It’s not out of the norm for it to impact your self-confidence, fertility, and physical well-being.
For instance, some women may struggle with missing ovulation or periods, which can lead to roadblocks when starting a family. At the same time, others may have to manage one of the more physically visible symptoms like acne or excessive hair loss.
If one of your main gripes with your PCOS comes down to the physical pain or mental exhaustion tied to excessive breakouts — you’re not alone and there may be one way to ask your doctor for extra support.
As Dr. Jessica Ryniec, reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston, explains, it’s never too early or too late in your PCOS journey to ask your doctor for added support.
How PCOS and acne breakouts are connected
Once you’re diagnosed with PCOS, you may start to notice that symptoms you thought were just one-off experiences actually exist under your “PCOS” umbrella.
For instance, those breakouts you get during your period may have more to do with PCOS than you expected.
“You would think acne with PCOS wouldn't necessarily be cyclical because many people with PCOS don't have a regular cycle but there still can be hormonal changes that lead to worse flares and most often that occurs around menstruation,” explains Dr. Ryniec.
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One way your doctor may help manage your acne, especially if they’re tied to a PCOS flare-up, is to prescribe Spironolactone.
“PCOS causes the ovaries to make more androgens (hormones like testosterone), which causes the skin to start producing more oil, leading to clogged pores and breakouts,” adds Dr. Ryniec. “Androgens can also slow down the turnover of skin cells, which worsens pore clogging due to a buildup of dead skin cells.”
A regular Spironolactone prescription helps interrupt those added hormones and breaks the cycle that may be causing your acne.
Spironolactone’s impact on acne and hair loss
While Spironolactone is usually used to treat high blood pressure and heart failure, Dr. Ryniec notes it can help mitigate PCOS-related acne breakouts because it blocks and disrupts hormones to your benefit.
“Spironolactone is actually a diuretic…” explains Dr. Ryniec. “It works by blocking a hormone called aldosterone but it can also block androgen receptors and disrupt androgen production which leads to its benefits for hormonal acne.”
Spironolactone is known for doing its job effectively, but not overnight. Once you start taking it, Spironolactone can take anywhere from 8 weeks to 6 months to clear up your skin. It all depends on your body and how it reacts to the medication. But, no matter how long it takes, it’s helpful to remember that there may be a silver lining on the horizon for you.
“Studies have shown that up to two thirds of people taking spironolactone seeing complete response with up to 85% having a significant improvement >50% of acne symptoms,” explains Dr. Ryniec.
If in addition to acne, you’re also struggling with PCOS-related hair loss, a Spironolactone prescription may also help. According to Dr. Ryniec, Spironolactone’s positive impact on hair loss depends on whether the hair loss is due to elevated androgens. On average, it can take anywhere from 6 months to a year to work.
What to expect after starting Spironolactone for PCOS
Like any new medication you start, there are a host of side effects your doctor may warn you about. According to Dr. Ryniec, some of Spironolactone’s side effects include GI symptoms, breast tenderness, or more frequent urination, which typically goes away within a few weeks.
But don’t worry, Dr. Ryniec adds that only 1 in about 20 people have side effects that lead them to stop the medication altogether.
Before you start taking Spironolactone on a regular basis, your doctor may also run some blood work to ensure that your body can handle the prescription.
“If otherwise healthy, no other lab monitoring may be necessary as long as you are mindful with symptoms and checking in with your doctor about any concerns,” adds Dr. Ryniec. “When starting spironolactone it may be worth having check-ins every 2-3 months to make sure the dose is working and it doesn't need to be increased.”
Vivian Nunez is a writer. Her award-winning Instagram community has created pathways for speaking about mental health and grief. She hosts the podcast, Happy To Be Here, and has been featured by Spotify, Instagram, Netflix, CBS This Morning, Oprah! The Magazine, and more. You can find Vivian @vivnunez on Instagram/TikTok and her writing on vivnunez.substack.com.
