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Day 10 On Spironolactone -- Update On Birth Control Hormones



Quick update! Woke up feeling great this morning. Drank a ton of water last night and finally stopped feeling dehydrated. My skin is ehh... I have 4 cysts that will be injected with cortisone later this morning at the derm office, and about 5 other active, smaller pimples (more like clogged pores) around my chin and mouth. It's definitely more than I'm used to having at once, but for some reason I think this was the initial breakout and I'm feeling confident that once these clear up I'll be good! At least that's what I'm hoping. My mood seems to have evened out --- the first few days I was on spiro I felt kind of "off" almost like I was PMSing, my heart was racing, felt mood swings, etc. But today I feel great. I hope that means my hormones are calming down a bit and adjusting.

I've lost 4 lbs in the last 10 days. Nothing in my diet has changed except drinking more water. I'm 5'7" and weighed 115lb on October 23, and currently weigh 111lb. Crazy! It seems to be all water weight, my stomach is soooooo flat. I'm curious to see what will happen when I get my period in the next few weeks, since normally the week before I have major bloating.

I also forgot to mention this in my last post. I researched the different kind of birth control pills because I wanted to better understand the reason for my primary care physician to change me from junel to sprintec. Here's what I found:

There are 2 kinds of birth control pills: combination pills and mini pills.

Combination pills are the most commonly used and contain two active ingredients: ethinyl estradiol (a synthetic estrogen) and a progestin. There are three kinds of combination pills:

  1. Monophasic - the level of hormones are the same for all 21 days of the cycle, then 7 days of "filler" inactive pills. This tends to be a good option for someone who struggles with hormonal acne because it keeps your estrogen levels constant, versus waving all over the place each week. Examples include Levora, Sprintec, Ortho-cyclen, Junel and Ovral.
  2. Biphasic - these have a fixed amount of estrogen, but there are two different strengths of progestin. The first 7-10 days are one level, and the next 11-14 are another. The last 7 days are the "filler" inactive pills. Examples include Jenest-28 and Mircette.
  3. Triphasic - depending on the brand, both the estrogen and progestin levels change throughout the 28 day cycle. The first 7 days are one strength, the next 7 days are another, and the third week is yet another. The final 7 days are "filler" inactive pills. This creates a changing level of hormones each week throughout the month. Examples include Ortho tri-cyclen, Tri-levlen and Tri-sprintec.

So based on that alone, I was excited that my birth control was monophasic. Except then I was even more confused because junel (the "bad" pill for acne according to my doctor) was monophasic, and so was sprintec (the new "good" pill). So what was the difference?

I looked into the active ingredients in both junel and sprintec. It turns out that both pills contain the standard dose of ethinyl estradiol at ~0.03mg. But the progestin ingredient was different. I found this great article (cited by a doctor) that breaks down the 8 different kinds of progestins, and this is what I concluded:

Junel contains norethindrone acetate: low progestational activity and slight estrogenic affects. It is a first-generation progestin. It tends to be less androgenic than the second-generation progestins, but more androgenic than newer progestins, like desogestrel.

Sprintec contains norgestimate: a third-generation progestin that has high progestational activity while showing slight estrogenic effects and tends to be less androgenic. The low androgenic effects of norgestimate have resulted in successful treatment of acne. In fact, birth control pills that contain norgestimate are the only ones FDA approved to help reduce acne.

I was blown away! The key word in those descriptions is androgenic (definition here) -- this is something that you want very little of, as a woman. So "low androgenic effects" is great to see. It's the same reason why doctors believe spiro has such a positive effect on hormonal acne in women -- it stops the absorption of testosterone and androgens. To put it in perspective, spiro is prescribed at very high levels (~250mg+) for men who undergo sex change operations to suppress their male features like hair growth, etc.

Okay this was a little longer than I had planned to write (so much for the quick update) but maybe one of the reasons I feel so positive today is that I finally understand the *reason* behind the science. I think it's really important to understand why a doctor or dermatologist is prescribing something, rather than just taking their word for it. I spent way too many years upset about pimples, and cried too much about my crappy skin, and didn't go swimming because I didn't want my makeup to smear off, to not take advantage of all the resources that are available now to educate myself about what's causing my acne and how to treat it. Granted, every person's body is different and different medications obviously effect them in varying ways, but I feel relieved that I'm on the "right" birth control. Phew! Happy November!

Also, I'm curious if anyone has any comments (positive or negative!) about this treatment. I've read a lot of the reviews on the site but am curious if anyone is in the same exact situation. And also if this info is helpful --- or if it's overload smile.png You can read my first post here.

Another great article I found in a medical journal about spiro. Has a lot of medical terms and I struggled to understand all of it, but in general provides great statistics about the drug: Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris: Practical Considerations for the Clinician Based on Current Data and Clinical Experience


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