Spironolactone and pregnancy: We asked a derm about questions patients have
Get an overview of the most frequently asked questions patients have about using spironolactone in relation to hair loss, hirsutism, pregnancy, birth control, breastfeeding, your menstrual cycle and fertility.
Table of Content:
What is spironolactone? | Spironolactone for hair loss and hirsutism | Spironolactone and pregnancy | Spironolactone and birth control | Spironolactone and breastfeeding | Spironolactone and your menstrual cycle | Spironolactone and constipation | Spironolactone and laser hair removal
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In healthcare, the use of medications during pregnancy is a widely discussed topic. An example of this is spironolactone, a medication widely prescribed to treat hypertension, heart failure, and hormonal imbalances.
As more individuals of reproductive age look to be more informed on their health journeys, the question of spironolactone’s compatibility with topics such as pregnancy, birth control, menstrual cycle and fertility arises.
This article aims to explain the complexities surrounding the use of spironolactone in relation to these topics and shed light on the guidance given by medical professionals.
This article is not a substitute for a medical consultation, our goal is to provide an informed perspective on the intricate relationship between spironolactone and pregnancy, empowering women to make well-informed decisions regarding their health together with their doctor.
What is spironolactone and what is it used for?
Spironolactone is a potassium-sparing diuretic mainly used to treat hypertension and heart failure. It is also used off-label by dermatologists for the treatment of hormonal acne1, hair loss2 and hirsutism (excessive hair growth in areas where women usually do not have hair)3.
Unlike many medications for acne that can only be used short term such as oral antibiotics or isotretinoin, the long-term use of spironolactone is well established and has been approved by the FDA4.
How can spironolactone be used to manage both excessive hair growth and hair loss in women?
According to Dr. Carolina Fernandez, dermatologist, spironolactone can be used to address both hair loss and excessive hair growth in women if these conditions are related to hormonal imbalances, such as it is the case with androgenetic alopecia (female pattern hair loss) and hirsutism (excessive hair growth in women in areas where typically not much hair grows).
Female androgenetic alopecia (female pattern alopecia)
Spironolactone can help treat hair loss in women by blocking the effects of androgens (male hormones) on hair follicles. Androgens, such as dihydrotestosterone (DHT), can contribute to hair thinning and loss in genetically predisposed individuals5.
Spironolactone is often prescribed at lower doses, typically in the range of 25 to 100 milligrams per day, to address hair loss in women. It helps to slow down hair shedding and promote the growth of thicker, healthier hair.
Hirsutism
Hirsutism is characterized by the abnormal growth of thick, dark hair in areas where women typically have fine or no hair, such as the face, chest, and back. This condition is often associated with elevated androgen levels6.
To treat hirsutism, spironolactone can be used at higher doses, typically starting at 100 milligrams per day and then it is adjusted as needed. It works by blocking androgens and reducing hair growth in affected areas 7.
Can you take spironolactone when pregnant?
Spironolactone has been shown to cause feminization of male animals exposed in utero8.
Therefore, due to the potential anti-androgenic effects of spironolactone that can potentially interfere with sexual development of the fetus, it is recommended to avoid using spironolactone during pregnancy9 10 .
Potential risks of using spironolactone during pregnancy
Spironolactone has the potential to affect the sex differentiation of male fetuses during their embryonic development. Animal studies have shown feminization of male fetuses and endocrine disruption in females exposed to spironolactone in utero.11
Where to get a spironolactone prescription online?
You can request a prescription for spironolactone for acne, hair loss or hirsutism by having a photo-consultation with an virtual dermatology provider. This only costs $59 and you will get your prescription (if medically adequate for you) in 1-2 working days.
Can you use spironolactone and birth control at the same time?
Spironolactone and oral contraceptives (birth control pills) are safe to take together12 and since it is not advisable for women to get pregnant while taking spironolactone, they are often prescribed together.
On one hand birth control pills can help regulate hormonal imbalances13, while spironolactone can target excess androgens and help manage symptoms like acne and hair loss14.
If your provider has prescribed spironolactone along with birth control, they will closely monitor your response and potential side effects.
Potential drug interaction between spironolactone and birth control
Spironolactone has over 100 drug interactions15 which means it may not always be taken together with other medications.
Spironolactone is a potassium-sparing diuretic, which means it can lead to an increase in potassium levels in the body. Some birth control pills, especially those with a drospirenone component, can also affect potassium levels16. To avoid this your healthcare provider will prescribe a birth control pill that is not contraindicated with spironolactone.
Acne medication comparison
Can you breastfeed while taking spironolactone?
According to Dr. Fernandez, spironolactone is a medication that can pass through breast milk. Therefore, it is generally discouraged to breastfeed while taking spironolactone due to potential risks to the baby.
The safety of spironolactone during breastfeeding is not well-established, and among the potential adverse effects it could have on the baby’s development is hyperkalemia (elevated levels of potassium in the blood), which can be dangerous. If you are breastfeeding and are considering taking spironolactone it is important to talk to your doctor.
Does spironolactone affect your menstrual cycle (period)?
Spironolactone may disrupt the menstrual cycle in some women. It may lead to changes such as missed periods, irregular periods, or changes in the flow of menstruation17 18 .
Dr. Fernandez says that spironolactone works as an androgen receptor blocker, reducing the effects of androgens (male hormones) in the body. While this can be beneficial to manage certain conditions such as acne and hair loss, it may also impact the balance of hormones needed for a regular menstrual cycle.
Does spironolactone affect fertility?
Some women who take high doses of spironolactone may experience temporary infertility19, however this effect is typically reversible when spironolactone is discontinued or when the dosage is adjusted. Dr. Fernandez recommends that if you have concerns, you should talk to your doctor.
Does spironolactone cause constipation?
Constipation is one of the potential side effects of spironolactone20. This happens because spironolactone is a diuretic medication that can lead to increased urine production, and in some cases, this can result in dehydration, which may contribute to constipation.
If you experience constipation while taking spironolactone, discuss this side effect with your healthcare provider. They can provide guidance on managing this side effect and potentially adjust your medication dosage, or suggest dietary and lifestyle changes to alleviate the symptoms.
Can you do laser hair removal while taking spironolactone?
A question that frequently arises when taking spironolactone is if you can do laser hair removal at the same time. It depends what you are using the spironolactone for. If you are using it for acne or hair loss, there is no evidence that taking spironolactone interferes with laser hair removal.
According to Dr. Fernandez, it is essential to consult with a doctor for specific information before undergoing laser hair removal while taking spironolactone and to take precautions due to skin sensitivity, as spironolactone can make the skin more sensitive to the sun and, consequently, to the laser, with a relative risk of hyperpigmentation.
What is more effective for hirsutism spironolactone or laser hair removal?
Dr. Fernandez says the main thing before choosing a treatment is to know the cause of hirsutism. Once the cause or triggering factor has been identified, a treatment can be addressed. However, since spironolactone is much more affordable that laser hair removal, you may want to check out if that is effective for you first.
Below you can see a comparison of both treatments to help you understand their effectiveness:
Spironolactone
Mechanism of Action: Spironolactone is an anti-androgen medication that works by blocking the effects of androgens (male hormones) on hair follicles. It can help reduce the growth of excess facial and body hair.
Effectiveness: Spironolactone can be effective in reducing hirsutism by addressing the hormonal imbalances that contribute to excessive hair growth. It often takes several months of consistent use to see noticeable results.
Maintenance: Spironolactone requires ongoing use to maintain the results. If treatment is discontinued, hirsutism can return.
Laser hair removal
Mechanism of Action: Laser hair removal is a cosmetic procedure that uses laser technology to target and destroy hair follicles, reducing hair growth in specific areas.
Effectiveness: Laser hair removal is effective in reducing and even permanently removing hair in treated areas. It can be particularly useful for hirsutism when the goal is to eliminate or significantly reduce hair growth in specific areas.
Number of sessions: Multiple sessions are usually required to achieve lasting results, typically spaced several weeks apart.
Considerations: Laser hair removal is most effective for individuals with darker hair and lighter skin, as the contrast between the hair and skin makes it easier for the laser to target the hair follicles. It may not be as effective for individuals with light-colored or gray hair.
Dr. Fernandez that in some cases, it can be beneficial to combine both approaches to address hirsutism more effectively. Consult with a your online dermatologist so they can assess your specific condition, discuss your goals, and recommend the most appropriate treatment or combination of treatments for your needs.
Article References:
https://pubmed.ncbi.nlm.nih.gov/34250269/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010138/
https://pubmed.ncbi.nlm.nih.gov/2357784/
https://www.sciencedirect.com/science/article/pii/S2352647516300363
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010138/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856356/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884655/
https://www.ncbi.nlm.nih.gov/books/NBK554421
https://www.pfizermedicalinformation.com/en-us/aldactone/population-use
https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy
https://my.clevelandclinic.org/health/drugs/3977-birth-control-the-pill
https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/precautions/drg-20071534?p=1
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/spironolactone
https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/side-effects/drg-20071534