Endocrine disorders -- conditions related to abnormal hormone production -- can be challenging to diagnose and treat. Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders among women. According to a 2009 article in "American Family Physician," PCOS affects 5 to 10 percent of reproductive-age women. There are a variety of effects from PCOS, including infertility and hirsutism, or excess body hair. Spironolactone is often prescribed to treat hirsutism and acne in women with PCOS.
Spironolactone (Aldactone) is most commonly used as a water pill, or diuretic. It is useful in PCOS because it also affects several hormone systems, including sex hormones. Spironolactone acts to block testosterone production and alter its effects in various body tissues. Among women with PCOS, whose elevated testosterone levels contribute to acne and excess body hair, spironolactone can be an effective treatment.
The testosterone-blocking effects of spironolactone make it potentially dangerous during pregnancy, as it may interfere with normal organ development. As of July 2013, spironolactone was ranked an FDA pregnancy category C drug. This means that animal studies have shown the medication is potentially harmful to a developing fetus.
PCOS and Androgens
Polycystic ovarian syndrome affects several body systems and produces a wide range of signs and symptoms, including irregular ovulation, infertility, acne, male-pattern hair growth and/or baldness and insulin resistance. Women with PCOS typically have elevated levels of testosterone and other testosterone-like hormones called androgens.
High levels of testosterone and other androgens are responsible for the acne and excess body hair growth that many women with PCOS experience. Antiandrogens like spironolactone can help limit these symptoms and may aid in restoring regular ovulation and menstrual periods.
Spironolactone versus Metformin
Insulin resistance -- reduced tissue sensitivity to the blood-glucose-lowering hormone insulin -- is a key component of PCOS. Women with PCOS, therefore, tend to have elevated levels of insulin to compensate for reduced tissue response to the hormone. This excess insulin, however, also promotes excess production of testosterone and other androgens. Metformin -- a drug used to treat insulin resistance in type 2 diabetes -- is also effective in reducing insulin resistance among women with PCOS.
Some of the androgen-related symptoms of PCOS, however, are not addressed by the use of metformin. Hirsutism is typically more effectively treated with the antiandrogen spironolactone. The American Association of Clinical Endocrinologists recommends the use of sprionolactone in combination with an oral contraceptive agent to treat skin manifestations of PCOS.
Side Effects and Safety
Spironolactone is primarily used as a diuretic and may cause side effects related to excess water loss or chemical imbalances. Dehydration, dizziness, vomiting, stomach pain and reduced urine production are possible side effects.
Potassium can build up in the blood with spironolactone use, so salt-substitutes and foods high in potassium should be avoided while taking this medication. Talk with your doctor about specific questions related to your diet and other medications while taking spironolactone.
Spironolactone should be avoided by pregnant and nursing women. Reliable birth control should be used while taking spironolactone to treat PCOS. If pregnancy is the goal of your PCOS treatment, your doctor is likely to recommend other medications instead of spironolactone because of the risk for fetal harm.