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Q:  Do a lot of women have luck with Spirolactone?? I read your website. Would Yasmin be a good BCP to be on as well, in your opinion?

A: Many people ask about spironolactone. This medication, for which the brand name is Aldactone, was originally introduced to treat high blood pressure. It blocks a hormone called aldosterone which tends to raise blood pressure. It also blocks testosterone and use is made of this action to treat androgenic disorders. These are conditions in women in which testosterone is causing problems, most often oily skin and acne, increased facial and body hair and androgenic alopecia (loss of scalp hair).

Although spironolactone is not labeled for these uses, it is one of the widely used and effective ways of treating these conditions. It does give good results for many women. Here are some things to keep in mind:
1) spirolactone takes some time to start to work: 1 to 4 months for acne, 3-5 months for increased hair and several months for androgenic alopecia.
2) It must be taken in adequate doses. Often when it seems not to be working it is because the dose is too low. 3) Like any medication spironolactone does not work for everyone. An adequate trial is several months, at least.

Many ask me if spironolactone can make androgenic problems, such as hair loss, worse. The answer is no, it cannot. If it is not working completely, the problem may get worse but this is due to the underlying condition, not to the spironolactone.

Spironolactone is one part of treatment for androgenic disorders. Many need other medications in addition to it. A complete work-up should be done first.

Spironolactone raises potassium but this is not usually a problem in people with normal kidneys. It can interact with certain other medications which also raise potassium. It is a prescription medication and consultation with a physician is needed to determine if it is right for you.

Many have also asked about the new oral contraceptive, Yasmin. One of the hormones in Yasmin is similar to spironolactone. However the dose is equivalant to only 25 mg of spiro. If someone is on spiro too, she may get too much from being on Yasmin rather than another OC and Yasmin is not necessary in that case.

There is concern that spironolactone might interfere with development of a male fetus if someone takes it while pregnant. For this reason, spironolactone should not be taken unless effective contraception is being used.

Hope this is helpful.

Geoffrey Redmond, MD

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