Hormones can be super annoying when it comes to acne. Any time they change you can get a breakout.

It doesn't make sense that it was the BC that was keeping you clear if you were off it for a whole year and staying clear just on spiro. At least my common sense tells me that doesn't make sense.

So I'm thinking probably it's just hormonal fluctuation. Going off stuff, getting back on it, etc.

While you figure out hormones (along with a doc but be fiercely your own advocate), I would strongly recommend doing The Regimen so you can stay clear as you figure things out. You want to prevent scarring. The Regimen is super powerful, so it can usually handle even the meanest hormonal acne.