Birth control and spironolactone are two different types of medications, but they both directly affect sex hormones.

Spironolactone is a complex drug. It’s commonly used to treat acne symptoms and polycystic ovary syndrome (PCOS) and is used in hormone therapy. Because of its effect on the endocrine (hormone) system, it also affects fertility.

Ahead, we’ll explore the relationship between spironolactone, birth control, and your hormones.

Spironolactone and birth control are safe to take together. They are even used in combination to help treat the symptoms of conditions like acne and PCOS.

In a small study from 2017, researchers explored the use of combination birth control with spironolactone for PCOS symptoms. According to the results, the two medications were more effective than metformin at reducing hirsutism, decreasing testosterone, and relieving menstrual dysregulation in PCOS.

In a large-scale trial from 2023, researchers assessed the effectiveness of spironolactone in reducing acne symptoms in women. They found that against a placebo, spironolactone reduced acne in participants ― especially in longer treatments of 24 weeks.

One of the reasons why spironolactone is often combined with birth control to treat these conditions is because birth control is known to increase blood pressure. Because spironolactone is also a diuretic, it can help decrease high blood pressure levels that may happen with oral contraceptives.

It’s also important to have some form of pregnancy prevention when taking spironolactone because this medication can result in pregnancy complications and birth defects if pregnancy occurs.

Research from 2022 on spironolactone and birth control for PCOS suggests that these two medications can be hugely beneficial for symptoms like acne, excessive hair growth, and even high blood pressure.

In a 2022 research review, researchers explored the literature on the effectiveness of spironolactone versus combination birth control pills in adolescents with PCOS.

Results found that both medications were effective at treating different symptoms of PCOS ― but they were more effective when taken together. For example, when combined with birth control, spironolactone was both safe and effective for treating symptoms like menstrual dysregulation, high testosterone levels, and hirsutism (excessive facial hair).

And when combined with spironolactone, birth control pills became more effective at treating a much wider range of symptoms, like menstrual dysregulation and acne.

Spironolactone is an anti-androgenic drug, which means that it reduces the effects of male sex hormones by preventing them from being able to bind to their receptors. But even though spironolactone can affect sex hormones, it hasn’t been approved as a contraceptive in either males or females.

However, spironolactone is the most common androgen blocker that’s currently used as part of gender affirming care in the United States. It’s known to drastically reduce the sperm count in males, and clinics will typically require you to acknowledge the high chance of reduced fertility as part of this treatment.

Spironolactone suppresses testosterone in the body and so leads to gynecomastia as well as other “feminizing” side effects when used in males as part of gender affirming care.

When used to treat conditions like acne and PCOS in females, the most effective type of birth control is combination birth control. Combination birth control, or combined birth control, is birth control that contains both estrogen and progestin.

According to a 2018 statement by the American Academy of Dermatology (AAD), progestin-only birth control ― such as the mini pill, intrauterine device (IUD), implant, or shot ― is not effective for treating acne.

In fact, research from 2018 suggests that progestin-only birth control may even make acne symptoms worse.

It also appears that the type of progestin in the combined pill matters. For example, the AAD states that third- and fourth-generation pills, which contain progestins like desogestrel, norgestimate, and drospirenone, are preferred for acne treatment. However, they also state that all generations of pills are effective for treatment.

While there are no specific side effects that can happen because of taking both spironolactone and birth control together, each individual medication may cause separate side effects.

Side effects of spironolactone may include:

  • stomach pain
  • diarrhea
  • nausea
  • vomiting
  • muscle cramps
  • headaches
  • dizziness
  • fatigue
  • high potassium levels
  • changes in menstruation

Side effects of hormonal birth control pills may include:

If you are considering taking spironolactone, birth control, or a combination of both medications to treat acne or PCOS, consider talking with your doctor about your risk of side effects.

Other precautions

Some conditions may react poorly with spironolactone. It’s always a good idea to inform your doctor of all your health conditions, but make sure to let them know if you experience:

It’s also not recommended to smoke if you use spironolactone.

Spironolactone and birth control pills are two different classes of medication that can be used to treat various health conditions.

For females that have chronic acne or PCOS, these medications can also help address the symptoms of these conditions ― especially when used together. In males pursuing a gender transition, spironolactone will likely reduce fertility, but it’s not a form of birth control.

If you live with acne or PCOS and other treatment options have not been effective for your symptoms, consider reaching out to your doctor to discuss if these medications may help you manage your conditions.