Spironolactone (Aldactone) for the treatment of PCOS

by Jesse

DID YOU KNOW? PCOS is a disorder of hormone (dis)regulation. Insulin and male hormones are often seen in much higher levels in women with PCOS than without the disease. The medicinal one-two-punch for this is typically a cocktail of Metformin and Spironolactone. Metformin helps to keep insulin low by limited blood sugar creation in the liver and sensitizing your body to sugars in the blood. Spironolactone, on the other hand, limits the creation of male hormones (androgens) so fewer of them are circulating in your system.

Do you have PCOS? This means you may have hair growth in funny places, painful acne, oily skin (seborrhea), androgenetic alopecia, obesity and, less frequently, acanthosis nigricans (an area of thickened skin, typically behind the neck, that is darkened in appearance and fuzzy soft to the touch).

Spironolactone is the androgen blocking powerhouse pill that can lessen these masculinizing issues for women with PCOS and excessive blood androgen levels.

DID YOU KNOW? Benign cysts that form in the ovaries – often referred to as the PCOS “sting of pearls”- are capable of affecting the production of hormones, such as the androgens Spironolactone is designed to suppress.

Cystic Acne
As if unwanted facial hair wasn’t hard enough to deal with, Mother Nature often throws PCOS patients the potentially disfiguring complication called cystic acne. This isn’t the same as annoying adolescent pimples or outbreaks. Proactiv won’t do anything to get rid of it. This is something much more irritating (literally).

Cystic acne is much more likely to leave scars because the infection often occurs many layers below the skin surface. This is also why topical cleansers and treatments do so little to ease the condition. Treatment has to start below the skin, not on top of it.

Heather from CysterWigs has experienced this symptom her entire adult life. It requires diligence to keeping your skin clean, exfoliated, and well moisturized. In her case, it also required the use of Spironolactone to decrease the hormones responsible for her break outs. She considers this pill her not-so-secret weapon for keeping the dreaded “beard of acne” away!

Androgenic Alopecia
We need to be very specific and state up front that Spironolactone is not a miracle cure for hair loss. It will not make hair grow back if that follicle is already dead. However, this pill can slow or even stop excessive hair shedding in women with high androgen levels. We will discuss testosterone and its role in female hair loss in a later, more detailed installation of this blog series.


DID YOU KNOW? Hirsutism is defined as the excessive growth of body hair in women. It is classified as mild, moderate and severe and is measured by a chart very similar to this one.

The symptoms of hirsutism include excessive growth of hair on the face of a woman or unwanted growth all around the body, especially in the chest and in the back. The hair is usually dark and thick as opposed to the “peach fuzz” one might expect.

Polycystic ovarian syndrome (PCOS) is known to be a frequent cause of hirsutism. According to American Family Physician, PCOS is responsible for three out of four cases of hirsutism.

Spironolactone treatment
What exactly is this pill we’re talking about? It’s another classic example of a medical oops turning into a medical win.

Since its discovery in the 1950s, Spironolactone has demonstrated that it has a curious side effect: it lowers testosterone levels in the people who take it.

DID YOU KNOW? Spironolactone is one of the most common medications prescribed for trans women when they first begin their transitioning process. Spironolactone is either prescribed in combination with estrogen therapy or as a way to suppress androgens before adding more hormones to the mix.

Spironolactone (Aldactone) is actually a diuretic (water pill), normally prescribed to people who have high blood pressure or those who experience swelling due to excess fluids in some areas of their bodies (edema). Most women who this medication to suppress androgen production will get positive results, although it may take up to 6 months to see an improvement in symptoms.

How does Spironolactone work?
Androgens, such as testosterone, are responsible for the growth of hair on the face, chest and stomach that occurs in some women who have PCOS. Spironolactone, when taken, does a great job in decreasing androgen levels in the body, which in turn neutralizes the effect of androgen on the skin, while also improving acne.

Possible side effects may include:

  • Increased urine frequency (remember this is a diuretic)
  • Weight loss (mostly water weight)
  • Nausea (this generally goes away after a while)
  • Clear skin and easing of other androgen-related issues

Important things to note:

  • In case of liver or kidney problems, inform your doctor before you start taking Spironolactone.
  • Do not take it if you are pregnant or you could get pregnant
  • Spironolactone is best taken along with oral contraceptive pills
  • VERY IMPORTANT: Avoid taking potassium supplements while using Spironolactone! This medication can cause of build-up of potassium in the liver, which can damage the liver over time

Stay tuned for next week’s installment: Birth Control Pills and PCOS

Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!


You can see all of Jesse’s posts here.

Metformin for the treatment of PCOS

DID YOU KNOW? Most people don’t need sugars in their diet to maintain a healthy blood glucose level (unless you are hypoglycemic or diabetic). This is because your liver can create glucose on its own to be released in the blood to keep you healthy. Understanding this concept is essential for understanding the role Metformin plays in your PCOS treatment.

Metformin, also known as Glucophage, is a medication commonly used in the treatment of type II diabetes and blood sugar regulation disorders, such as Polycystic Ovary Syndrome. It inhibits the production of glucose in the liver (glucose = a kind of sugar and the fuel of all your body’s cells) and increases insulin sensitivity (insulin = the hormone that tells your body to open up an accept the fuel; if that fuel can’t be used, this hormone is also responsible for fat storage). Metformin is of great utility in non-diabetic women who have PCOS and has demonstrated long-term improvements in weight loss, ovulation, period regularity, hair loss, and body hair growth. Metformin is also effective at helping ease the intense sugar cravings associated with disorders of insulin resistance, such as PCOS and type II diabetes.

DID YOU KNOW? Contrary to popular belief, Metformin DOES NOT lower the impact foods you eat have on your blood sugar. Instead, Metformin tells your liver to stop making sugar (glucogenesis) in response to your body’s signals related to its insulin resistance. This means that you cannot get away with eating more sugar just because you’re on this pill; taking more of it in response to poor dietary choices will probably only make you feel sicker.

A glucose tolerance test is done before you start metformin. In most patients over 17 years old, the usual starting dose is 500 mg a day, which is increased to twice a day and then increased to 850 mg, twice a day. The first dose is taken in the morning after breakfast and the second at night, after dinner. Doses increase until you reach the maximum dose of 2500 mg per day.

DID YOU KNOW? 2000 mg – 2500 mg a day is considered a prophylactic dosage – meaning it will help prevent PCOS from progressing rather than curing it. This often exceeds the dose given to type II diabetics!

Side effects
Metformin is a modern wonder drug but the side effects can be daunting, particularly when you first start taking it. This is medication women with PCOS stop taking on their own against their doctor’s advice because it is not a pill you can feel working instantly. It is not psychoreactive (there’s no high associated with it) and it prevents the onset of worsened disease rather than curing something. This means that the positive effects are not always obvious to the person taking it, making it often difficult to justify enduring the side effects.

DID YOU KNOW? You need to build up a tolerance to this medication in your liver before the side effects will diminish. If you start and stop only to start again, you will be met head on at every false start with the full impact of these side effects!

The most common side effect that patients experience when they start metformin are stomach upset and diarrhea. These symptoms are most acute when you begin your Metformin regimen and they generally subside when you achieve tolerance to the medication. Tolerance usually sets in about a month after you’ve reached the full prophylactic dosage.

You may experience a relapse of these negative side effects if you eat a meal high in simple sugars or fructose. This is similar to the “dumping syndrome” experienced by bariatric weight loss surgery patients. Believe it or not, this is a signal that your Metformin is doing a good job of sensitizing your liver to the sugars in the food you eat. These foods may also begin to change flavor – and certain hyper sweet foods may even start to taste bad to you!

DID YOU KNOW? Dietary changes are a MUST whenever you start a Metformin regimen to best avoid digestive problems. A low carbohydrate diet low in processed convenience foods, in combination with your Metformin, is generally your best bet for defeating sugar cravings and getting your health back on track.

Other side effects are headache, weakness, intestinal gas and abdominal pain. These symptoms can be relieved by taking the medication with a meal. Talk to your doctor about switching to the time released version of this medication if the symptoms persist after tolerance is reached. The time released version is called Metformin ER and it is often much easier on your digestion than the instant release pill form.

Metformin with other treatments
Metformin can be used successfully in combination with other. Spironolactone (Aldactone) is another medication commonly prescribed in combination with Metformin for the treatment of PCOS. The success of metformin treatment increases when patients follow a healthy diet. Since obesity is a common symptom of polycystic ovarian syndrome, many doctors pair their patients with a nutritionist. Regular exercise helps lose weight and improves overall health because it helps the Metformin do a better job of sensitizing your body to glucose in the blood.

In conclusion, Metformin constitutes a fundamental, almost universally accepted treatment in patients with PCOS in any clinical presentation. Metformin regulates the menstrual cycle and induces spontaneous ovulation, thereby increasing fertility and overall health in the process.

DID YOU KNOW? Metformin presents benefits for improving metabolic syndrome, blood glucose levels, total cholesterol, LDL (bad cholesterol), and blood triglycerides. While you may not see or feel it working for you, you are reducing your heightened risk of cardiovascular diseases and other PCOS complications by taking this pill.

Do you have questions about Metformin or PCOS? We highly recommend talking to your doctor or an Endocrinologist (hormone specialist) to discuss possible diagnosis and treatment options. PCOS is often a diagnosis of exclusion because its symptoms mirror so many other possible conditions – such as Cushing’s Syndrome, hypothyroidism and Hashimoto’s Disease. Working closely with a doctor you trust is an essential part of achieving a correct diagnosis. Your doctor will probably want to rule out these other conditions first before prescribing Metformin or any other treatment to you.

Stay tuned for next week’s installment: Spironolactone

Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!


You can see all of Jesse’s posts here.

Polycystic ovarian syndrome (PCOS): Diagnosis

How do doctors diagnose polycystic ovary syndrome (PCOS)?

Your doctor may suspect you have this syndrome if you have eight periods per year or less, excess body hair, hormonal irregularities, high blood sugar, androgenic hair loss, acne, or irregular periods. After obtaining a clinical history that suggests PCOS, the doctor will rule out other diseases that could cause similar symptoms. Some of these diseases include:

  • Excessive production of hormones by the adrenal glands, called adrenal hyperplasia
  • Problems with the function of the thyroid gland
  • Surplus / over production of prolactin hormone by the pituitary gland, known as hyperprolactinemia

Complete family history

The doctor will ask about your menstrual cycle and about any history of infertility. The doctor will also ask if your mother or sister has PCOS or symptoms similar to yours, since PCOS is usually hereditary.

Complete physical examination

The doctor will perform a physical exam and look for excessive growth of hair, acne or other signs of high androgen levels. He/she will take your blood pressure, measure your waist and calculate your body mass index, a measure of your body fat that is calculated from weight and height.

Blood samples

The doctor will check the levels of androgens, cholesterol and blood sugar.

Pelvic exam or ultrasound to check the ovaries

During the pelvic exam, the doctor will insert two fingers into your vagina and put pressure on your abdomen to feel for ovarian cysts. To help see ovarian cysts, the doctor may recommend an ultrasound, a test that uses sound waves to obtain images of the pelvic area. Your doctor will also check the thickness of the lining of the uterus; If your periods are irregular, the lining of the uterus may be thicker than normal.

A woman who has at least two of the following three problems may have a diagnosis of PCOS:

  • The long-term absence of ovulation (the process of ovum ovule release) that causes menstrual irregularities
  • High levels of androgens that are not the result of other causes or diseases or signs of high androgen levels, such as excess facial or body hair
  • More than 12 cysts of a specific size in one or both ovaries (detected by ultrasound)

Some women with a diagnosis of PCOS have the first two symptoms but do not have ovarian cysts


Stay tuned for next week’s installment: Treatment and Management


Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!



You can see all of Jesse’s posts here.

Polycystic ovarian syndrome (PCOS): Causes and Symptoms


What causes polycystic ovary syndrome (PCOS)?

Researchers and health care providers are aware that there are both environmental and genetic factors that contribute to the development of PCOS, but they do not know exactly what causes the disease.

Since the symptoms of PCOS tend to be hereditary, it is likely that the syndrome is due, at least in part, to a change or mutation in one or more genes. Recent research in animal models suggests that, in some cases, PCOS may be due to genetic or chemical changes that occur in the womb.

What are the symptoms of polycystic ovary syndrome (PCOS)?

Coupled with the 3 features (lack of ovulation, excessive levels of both androgens, and ovarian cysts) used to diagnose or confirm PCOS,  there are several signs and symptoms of PCOS, some of which may seem unrelated to the disease:

  • Menstrual irregularities:
  • Total absence of menstrual periods, called amenorrhea
  • Lack of frequent menstrual periods, called oligomenorrhea
  • Heavy, painful periods
  • Bleeding without ovulation, called anovulatory periods
  • Infertility
  • Excess growth of hair on the face, chest, abdomen or thighs-a condition called hirsutism
  • Severe acne, late or persistent onset that does not respond well to usual treatments
  • Excessive weight gain or inability to shed fat easily, most especially around the waist region.
  • Pelvic pain
  • Oily skin
  • Dark patches of skin, which usually has a thick velvety texture (acanthosis nigricans)
  • Hair loss (androgenic alopecia)


PCOS is a manageable – but not curable – chronic endocrinological disease.

PCOS is the highest single cause of female infertility in the western world. Although PCOS is one of the main causes of infertility, many women with PCOS can become – and remain – pregnant. Pregnant women with PCOS, however, are at higher risk of having certain problems with conception, such as miscarriage.

Since many women may be embarrassed about having hair loss, oily skin, excessive body hair growth, or acne, they may not mention these things to their doctors. As a result, many women are not diagnosed with PCOS until they have difficulty becoming pregnant. This is the biggest reason why women of child-bearing age – 18 to 45 – are the most likely to become first diagnosed with the disorder. However, women who have PCOS will continue to have it their entire lives, even after menopause or a hysterectomy. Mounting scientific evidence also suggests that this illness is something women may be born with, though symptoms may not appear until shortly after the onset of puberty. The first obvious symptoms in young girls are typically uncontrollable weight gain and period irregularity.


Stay tuned for next week’s installment: How to Diagnose PCOS


Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!




You can see all of Jesse’s posts here.

Introduction to Polycystic ovarian syndrome (PCOS)


What is polycystic ovary syndrome (PCOS)?

PCOS is a disease caused by a hormonal imbalance that affects women and girls of childbearing age. Women with PCOS usually have at least two of the following three problems:

  • Absence of ovulation, which causes irregular menstrual periods or absence of periods
  • High levels of androgens (a type of hormone) or signs of high androgen levels, such as excess body or facial hair
  • Cysts (sacs full of fluid) in one or both ovaries – “polycystic” literally means “with many cysts”

A number of women with confirmed cases of PCOS experience the first two problems mentioned above, including other symptoms, but there is an absence of cysts in their ovaries.

Polycystic ovary syndrome is undoubtedly the most common cause of anovulatory infertility, which means that infertility is linked to the absence of ovulation, the process in which the ovary releases a mature egg every month. A great number of women are unaware that they are sufferers of this syndrome until they start experiencing difficulty in conceiving.

PCOS is also capable of causing other issues, like hair growth in unwanted parts of the body, hair loss on the top of the head, presence of dark patches on the skin, excessive weight gain, as well as irregular menstruation.

Women with PCOS are also more at risk of having:

  • Obstructive sleep apnea, which causes breathing pauses while a person is asleep
  • Resistance to insulin
  • Metabolic syndrome, a group of risk factors for heart disease and type 2 diabetes
  • Type 2 diabetes
  • Obesity
  • Heart disease and high blood pressure (cardiovascular disease)
  • Mood disorders
  • Endometrial hyperplasia and endometrial cancer


Stay tuned for next week’s installment: The Causes and Symptoms of PCOS


Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!




You can see all of Jesse’s posts here.