Spironolactone for Hormonal Acne
This information explains the benefits and risks of Spironolactone for hormonal acne.
At Midland Skin we offer consultations and treatment for hormonal acne in Birmingham, Solihull, Coventry, Wolverhampton, Worcester and the Midlands.
Quick Facts about Spironolactone
Best for
Hormonal acne in women
Appointment
Initial acne assessment
Treatment
Spironolactone
Course
usually medium to long term
Provider
Consultant dermatologist
Price
See below
What is Spironolactone?
Spironolactone is an oral medication that can help control persistent hormonal acne in adult women, including women in their 20s, 30s and 40s and women experiencing acne during the perimenopause or after the menopause. Spironolactone can help cystic acne, inflamed spots and comedones.
Spironolactone is only available on prescription. Spironolactone tablets are available in three sizes – 25mg, 50mg and 100mg. You should only take Spironolactone for acne if this has been recommended by a doctor with experience in using it for this condition.
We are very experienced in providing treatment with Spironolactone for acne in Birmingham. Spironolactone can be an effective long-term treatment for chronic acne.
How does Spironolactone help hormonal acne?
Androgens are often described as “male” hormones, but they are also present naturally in women. The main androgens in the body include Testosterone and Dihydrotestosterone.
Hormonal acne can occur when the hair follicles and sebaceous glands are particularly sensitive to androgens, even when androgen levels are normal. Hormonal acne can also occur when androgen levels are raised or in association with conditions such as polycystic ovary syndrome.
Spironolactone can help control hormonal acne because it blocks the effects of androgens on the hair follicles and sebaceous glands. This can reduce oil production and the development of inflamed acne lesions.
What conditions can Spironolactone help?
Spironolactone can help with skin and hair conditions influenced by androgens, including:
- Hormonal acne in adult women.
- Acne during the perimenopause or after the menopause.
- Acne associated with HRT or Testosterone used as part of HRT.
- Female pattern hair loss.
- Excessive facial or body hair.
Spironolactone may be used alone or in combination with other treatments for acne.
How may Spironolactone improve the skin?
By reducing the activity of hormones on the hair follicles and sebaceous glands, Spironolactone may provide the following benefits:
- Less greasiness in the skin. The skin may visibly look and feel less oily.
- Fewer inflamed spots, particularly nodules and cysts.
- Fewer comedones. Comedones are skin-coloured bumps beneath the skin that can subsequently become inflamed.
Could Spironolactone be suitable for me?
Spironolactone may be considered for adult women with persistent acne, particularly where the acne has a hormonal pattern, has not responded adequately to standard treatments or repeatedly returns after treatment.
Not every woman with adult acne requires Spironolactone. At an initial acne assessment, the Consultant Dermatologist will consider:
- The type, distribution and severity of your acne.
- Whether your acne is likely to have a hormonal component.
- Treatments you have already tried and how your skin responded.
- Whether Spironolactone, another acne treatment or a combination of treatments may be most appropriate.
- Your medical history, current medication and any relevant risk factors.
- Pregnancy plans and whether contraception needs to be discussed.
- Whether any examination or investigations for an underlying hormonal condition may be appropriate.
The benefits, limitations, monitoring requirements and likely duration of treatment will be discussed before a prescription is provided.
How effective is Spironolactone for acne in women?
Medical studies and our clinical experience show that Spironolactone can be effective for persistent acne in adult women. Overall, our experience is that Spironolactone helps control hormonal acne in approximately 60–70% of women, although some studies have reported higher improvement rates.
The strongest UK evidence comes from the SAFA randomised controlled trial involving 410 adult women with persistent facial acne. The study found that Spironolactone produced better outcomes than placebo, with the difference becoming more noticeable over time.
At 24 weeks, 82% of women taking Spironolactone reported an improvement in their acne compared with 63% taking placebo. No serious adverse reactions were reported during the trial. The researchers concluded that Spironolactone is a useful alternative to oral antibiotics for women with acne.
A separate randomised study published in 2024 compared Spironolactone with Doxycycline in adult women with moderate acne. Spironolactone produced better treatment outcomes by six months and was well tolerated.
These findings support the established clinical experience that Spironolactone can be an effective longer-term treatment for selected women with persistent acne.
Important points to consider if you are thinking about taking Spironolactone for acne
- Spironolactone does not work for everyone but helps approximately 60–70% of women with hormonal acne, and possibly more. It is not possible to predict with certainty who will benefit.
- Some women may clear completely with Spironolactone. In other women, it may reduce the frequency and severity of acne without clearing it completely. This means that you may still need other acne treatments while taking Spironolactone.
- Spironolactone can take three to six months to have its full effect. Waiting for the results can be frustrating.
- Spironolactone usually controls acne only while you are taking it. Your acne may return when treatment is stopped.
- Women may take Spironolactone for one or two years and sometimes for several years.
- Spironolactone can cause side effects. Approximately 1 in 20 women may need to reduce the dose or stop treatment because of side effects.
How long does Spironolactone take to work?
Spironolactone may be started at a dose between 25mg and 100mg per day and increased at intervals until a dose that improves the acne is reached. There are several variations to this regime, and your Dermatologist will decide what is appropriate for you.
Some improvement may be seen after approximately three months, although it can take three to six months to see the full benefit. The usual dose for skin concerns is between 50mg and 150mg per day.
How long is a course of Spironolactone?
You may require Spironolactone for as long as your acne remains a problem. Most women will be on treatment for a year or two, and some women may need treatment for several years.
Once the acne has been fully controlled, it may be possible to reduce the dose or try stopping treatment. This decision should be made with your Dermatologist because acne may return when Spironolactone is reduced or stopped.
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What are the risks of taking Spironolactone?
It is important to consider the risks of taking Spironolactone as well as the benefits. As with any medication, Spironolactone can cause side effects.
Approximately 1 in 20 women may experience side effects that require them to reduce their dose or stop treatment.
Side effects from Spironolactone include:
- There may be a temporary flare in acne, which occurs in approximately 5% of people.
- Passing urine more frequently, particularly during the first few weeks. This often settles within the first month.
- Menstrual irregularities, including heavier or irregular periods, spotting, discomfort or amenorrhoea, when the periods stop altogether. Sometimes the combined oral contraceptive pill may help these side effects.
- Lightheadedness or dizziness, particularly during the first few days or when standing up.
- Breast tenderness or breast swelling.
- Bloating.
- Headache.
- Feeling sick.
- Dryness of the skin.
- Fatigue.
- Reduced libido.
- Raised potassium levels in the blood. This is uncommon in healthy younger women but is more likely in women over 45, those with heart or kidney problems and those taking other medication that can affect potassium.
- Changes in kidney function.
- Reduced sodium levels in the blood.
- Rarely, changes in liver function or blood counts.
- A potential effect on the development of a male baby’s sex organs if Spironolactone is taken during pregnancy.
- Animal studies using extremely high doses suggested a possible association with tumours. This has not been observed with normal medicinal use in humans.
Your Dermatologist will assess your individual risk and arrange monitoring in accordance with Midland Skin’s monitoring schedule.
Pregnancy and breastfeeding
Spironolactone is not usually recommended during pregnancy because it may affect the development of a male baby’s sex organs.
If you could become pregnant while taking Spironolactone, your pregnancy plans and appropriate contraception should be discussed with your Dermatologist. If you become pregnant or think you may be pregnant, stop taking Spironolactone and contact your doctor.
It is usually considered safe to try for a baby one month after stopping Spironolactone.
Spironolactone may sometimes be used while breastfeeding, but this requires individual medical advice. You should discuss breastfeeding with your Dermatologist before starting or continuing treatment.
Spironolactone is not licensed for acne in the UK. What does this mean?
Spironolactone is prescribed “off licence” for acne in the UK. This means that the manufacturer’s UK licence does not specifically include acne as one of the conditions for which the medication is marketed. It does not mean that Spironolactone is an experimental medicine.
Many established medications are prescribed off licence in Dermatological practice when there is evidence and clinical experience supporting their use and the prescribing doctor believes that the likely benefits outweigh the risks.
There is now good-quality evidence supporting Spironolactone for persistent acne in adult women. The UK SAFA randomised controlled trial found that Spironolactone improved acne outcomes compared with placebo and concluded that it is a useful alternative to oral antibiotics.
Spironolactone is not one of the standard first-line acne treatments listed in NICE acne guidance. However, it is widely used by Dermatologists and is included in patient information produced by the British Association of Dermatologists.
You should only receive Spironolactone for acne following an appropriate medical assessment by a doctor with experience in prescribing it for this condition. The doctor must decide that the potential benefits outweigh the risks in your individual circumstances.
For patients receiving Spironolactone through Midland Skin, prescribing, monitoring blood tests and follow-up consultations must take place through our Clinic unless another doctor has explicitly agreed to accept responsibility for continuing treatment.
NHS GPs are under no obligation to prescribe or monitor medication being used off licence following private treatment. You should not assume that your GP will take over prescribing or monitoring, and you should factor the cost of private consultations, blood tests and prescriptions into your decision.
While we have considerable experience treating patients with Spironolactone, your Dermatologist may not recommend it if they do not believe that it is suitable or that its benefits outweigh the risks in your circumstances.
Spironolactone FAQs
How many appointments are required?
You will require regular consultations and blood tests if you choose to take Spironolactone through Midland Skin.
It is important to factor the cost of these appointments, blood tests and prescriptions into your decision. You should not start treatment if you are unable to follow the required appointment and blood-test schedule.
How often will I be seen?
Follow-up consultations are usually required every six to eight weeks initially while your response, dose and any side effects are assessed.
A consultation may be required sooner or more frequently if you experience side effects or there are concerns about your treatment.
Once your skin and medication are stable, consultations are required approximately every four months.
What blood tests will I need?
Midland Skin uses a structured monitoring schedule for patients taking Spironolactone. Your Dermatologist may alter the schedule according to your age, medical history, other medication, blood-test results and prescribed dose.
As a general guide:
- A blood test is normally required before starting treatment to assess potassium levels and kidney function.
- A blood test will be required two and/or six weeks after starting treatment and after a change in dose.
- For women over 45, blood tests may be required monthly during the first three to six months, particularly after starting treatment or changing the dose.
- Once the dose and blood-test results are stable, blood tests are required every three to four months while you remain on treatment.
- For women under 45 who remain stable without additional risk factors, monitoring may be reduced to every six months during the second year of treatment.
You must attend the required blood tests and review consultations for treatment and prescribing to continue safely.
How do I get repeat prescriptions?
Repeat prescriptions for Spironolactone are provided at a consultation.
Do I need to avoid potassium in my diet?
You should not take potassium supplements or use potassium-containing salt substitutes while taking Spironolactone unless specifically advised to do so by a doctor.
Most healthy women do not need to follow a restrictive low-potassium diet. However, your Dermatologist may advise you to limit unusually large quantities of potassium-rich foods if your blood-test results are raised or if you have other risk factors, such as kidney problems, being over 45 or taking medication that affects potassium levels.
Do not make major dietary changes or follow a low-potassium diet found online without discussing this with your doctor or a registered dietitian.
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Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
Fees
Acne assessment and treatment Show pricing
Book ConsultationInitial acne assessment
Up to 25 minutes
Review consultation
Standard, up to 20 minutes
Blood tests
References used for this article
- Santer M, Lawrence M, Renz S, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial.BMJ 2023;381:e074349. doi:10.1136/bmj-2022-074349.
- Dréno B, Nguyen JM, Hainaut E, et al. Efficacy of spironolactone compared with doxycycline in moderate acne in adult females: results of the FASCE study.Acta Derm Venereol 2024;104:adv26002. doi:10.2340/actadv.v104.26002.
- British Association of Dermatologists. Spironolactone: Patient Information Leaflet. Updated August 2025.
- NHS. Spironolactone. Updated May 2026.
- National Institute for Health and Care Excellence. Acne vulgaris: management. NICE guideline NG198. Updated August 2026.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 26th Sep 2026
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Expert, consultant led care in dermatology, skin surgery, eyelid surgery, lasers and aesthetics.
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