Spironolactone is a prescription oral medication that's used in PCOS care primarily for its anti-androgen effect — meaning it blocks the action of androgens on the tissues that respond to them, including the skin's oil glands and hair follicles.
A bit of background. Spironolactone was originally developed as a diuretic — a medication that helps the body shed excess fluid — for conditions like high blood pressure and heart failure. It still has that use at high doses. At the lower doses typically prescribed for PCOS, the diuretic effect is minimal and the dominant effect is on androgens.
For women with PCOS or PCOS-pattern hormonal imbalance symptoms, Spironolactone is one of the most commonly prescribed treatments for the symptoms driven by elevated androgens:
- PCOS-pattern acne (cysts on the jawline, chin, and lower face)
- Unwanted facial and body hair (hirsutism on the chin, upper lip, jaw, chest, or abdomen)
- Scalp hair loss (female pattern hair loss, hair thinning at the crown or part line)
Spironolactone is taken orally as a daily tablet. It's prescription-only and isn't available over the counter. Most women take it for several months to a year before evaluating results, because the underlying changes happen gradually — see "How does Spironolactone work?" for the timeline.
A note on use: Spironolactone is FDA-approved for several conditions, but its use for PCOS-related acne, hirsutism, and hair loss is off-label — meaning it's prescribed based on clinical evidence and decades of clinical practice, but it doesn't have a specific FDA approval for these uses. Off-label prescribing is legal, common, and well-established for Spironolactone in PCOS care. Your Oana clinician will determine whether it's appropriate for your specific case.