My journey with acne and Spironolactone is a very long one. I apologize in advance for the extreme length of this review.

First off, I am a 34 year old female and have 4 sons. I started getting mild acne at the age of 13. Very minimal, normal hormonal breakouts that were easily controlled by topicals. In high school I went on a few different antibiotics and also birth control (Ortho-Tri-Cyclin) to help clear it up and those things combined worked for me. My skin generally was clear in my late teens. I went to 1 year of college and during that time I went back on birth control (Ortho-Tri-Cyclin-Lo) and was on that during my engagement and first year of marriage. (Along with topicals; benzoyl peroxide, tretinoin, salicylic acid etc). I used proactive on and off as well. I NEVER had cystic acne. Only surface type; white heads, black heads etc. I went off the pill and at age 21 and I got pregnant and through that first pregnancy my skin was flawless and also while breastfeeding it was beautiful. My second pregnancy (age 24) the same thing; mainly clear while pregnant and throughout breastfeeding. After I was done nursing my second boy my skin started getting gradually worse. (Aug/Sept 2011) I finally went to a dermatologist and he put me on an antibiotic called Cephadroxyl. It worked awesome and my skin cleared up within a few months. I was on that for about 8 months. This takes me to Spring 2012. I wanted to get pregnant again so I weaned off of it. Throughout these years I used cetaphil for face wash and some type of Rx topical benzoyl peroxide. I think I used proactive again too. I got pregnant in May of 2012, had absolutely FLAWLESS skin through that pregnancy, gave birth in February of 2013 and again, while nursing my 3rd son had beautiful skin. (I would occasionally get a zit here or there - I'm talking maybe one a week) Once I was done breastfeeding my 3rd son in Feb. 2014, my skin was great over that spring/summer. Then something happened that fall and once again my acne came back. At this point my husband and I were at peace and knew we didn't want to have any more kids. I had heard about Spiro from my mom (she has also suffered with adult acne and had been on it for a few years and it worked great for her) I was hesitant and afraid to take it because of some reviews I had read. But my skin was getting bad enough I was starting to scar so I decided to go for it. I went on birth control (November 2014) because as we all know Spiro is NOT proven totally safe to take while pregnant and neither my husband or I were sterile yet because we weren't even 30 years old. So I started taking the Spiro in January of 2015 at 50 mg. within 4 weeks I felt like I could see a huge difference in my skin. I was SO SO happy. I had some minor side affects; my period was a bit erratic and I had to pee more. Well............ low and behold in mid-February I find out I am pregnant. (the real reason I had skipped my period!) Birth control did not work for me obviously; despite the fact that I religiously took it, did not skip it or anything. You can imagine my horror because of the fear I had for my precious baby possibly having birth defects from the Spiro etc. I immediately stopped taking it. Fast forward again.... 4th pregnancy was completely normal, and my 4th baby boy (born Nov. 2015) was 100% healthy and whole. Thank you Jesus. It was a VERY emotional pregnancy to say the least. What is odd though is that my skin through that pregnancy was NOT good. I had acne and I had eczema at the same time. After I gave birth and was breastfeeding my skin never cleared up. It wasn't awful but it was not clear like all my previous experiences of pregnancy and while breastfeeding. I was also dealing with the eczema which was very very hard. Understand... I was trying to treat eczema which is dry itchy skin, while treating acne which is caused by greasy oil/dead skin cells. It was a very frustrating time for me. (sorry this review is SOOOO freaking long) Fast forward again to April of 2017. I breastfed my fourth boy for almost 18 months. That summer my skin magically was clear. I was using a brand called Carly's which I heard of on this website and it worked for like 3/4 months. Then...... you can guess. The fall of 2017 all hell broke loose and my skin got horrible again; the worst it has EVER been. I was EXTRA stressed because I was homeschooling my 3 older boys. I do believe this had a huge part to play in my skin. So once again I decided to revisit taking the Spiro. (This time around was a completely different story though because I had my tubes tied when my 4th boy was 8 months old -July 2016-) I didn't have to worry about getting pregnant so I went for it. My doctor was very close to putting my on Accutane because my skin was so bad and he was worried of scaring. I begged him to let me have a chance to take the Spiro and he reluctantly agreed. I started taking it in October 2017 and was on a very low does initially of 25 mg, then gradually worked my way up to 100 mg by January of 2018. My skin took FOREVER to start clearing up. It was absolutely awful. I was so ashamed. Here I am a mom of 4 boys in my mid 30's and I'm still getting acne. Finally, by the spring of 2018 my skin was 80% clear. I still had zits here and there but it was way better then when I started. As time went on I would have weeks where it was totally clear and beautiful; and then I would have weeks where I had a handful of zits. My skin has NEVER been "healed" or consistently clear at all. I always have something going on somewhere on my face. I have messed with the dosage many times, going up to 150 and back down to 125 to see if I just need to find and tweak the "perfect" dosage and it doesn't make a difference. And here I am now, August 2019 and my skin is still not 100% clear. Even today I woke up with 3 new ones and I am taking 125 mg. I am wondering if now being on it for almost 2 years, I am becoming immune to it. I feel very defeated and I am ready to seriously consider Accutane. Thats why I got back on this website; to read (again) the reviews of Accutane because I am afraid of the side affects) BUT I am so sick of having to think about my skin every day. I don't have time to be worrying about my skin and who I am going to see and if I need to wear make up. I want to enjoy just raising my boys and being their mom. If anyone has made it this far in reading my review I thank you for taking the time to listen to me. I don't have any special advice other then just go for it and try it. (oh I forgot to mention that during my 2 years of taking it I have definitely had some crazy issues with my period. I went almost 8 months with no period. Then this past summer I was getting it every 2 weeks! Now it is almost back to normal, every 28 days. Other than that I've not had any serious side affects. Maybe some hair loss/thickness but that is it) If anyone has any advice for me, Id appreciate. Thank you and God bless.

The following is my experience. I wish someone would have shared something similar when I was struggling with this, so I hope there's someone out there who will find this helpful!

I've dealt with deep, painful cystic acne since I was 12. It's been normal for me at any given time to have 1-5 big, multi-headed cysts with a maximum base diameter matching the size of a penny and sometimes a nickel. Almost always on my chin, but occasionally elsewhere. I was put on a rotating buffet of antibiotics and topicals from 14-19 with minimal results -- the acne would always come back after a month or two of relative success. Starting at around 17 the acne got progressively better, but not totally controlled. I was put on birth control (the NuvaRing) at 20, which seemed to make matters worse, but I persisted, eventually trying a total of 5 different hormonal pill/ring formulations. None improved the acne, with the exception of Yaz. 

Yaz contains drospirenone, which is a synthetic progestin related to the chemical compound in Spironolactone. after about 5 months of worse acne when I started Yaz, my skin cleared up rapidly, and I had near-perfect skin for a little over a year. Unfortunately, Yaz also gave me painful ovarian cysts for the first time in my life, constantly sore breasts, excessive fatigue, and worst of all, completely unpredictable periods. I stopped it after two years and moved to a different pill (ortho-cyclen) with a less-androgenic progestin than other pills I'd tried. My periods got better but my acne came right back, and so about a year ago I was placed on Spironolactone.

Ah, the miracle that was Spironolactone in my first few months taking it. My skin returned to Yaz-level clarity within a month, and I finally believed my acne was under control. Around this time, I decided to switch to the copper IUD, believing that the Spiro had my hormones under control and wanting a gentler, long-term option for birth control. I began the combo of copper IUD for birth control and Spiro for acne in April of 2017 and felt fantastic about the switch from a general health and personal standpoint.

Unfortunately, my acne came back, despite being on the Spiro. It was gradual at first, but became un-ignorable after about six months. My skin had not been this bad since high school, and it was completely demoralizing. My doctor upped my dose of Spiro to try and control the acne, but it didn't help one bit.My periods also gradually got longer and longer, until I was bleeding all month long. I developed a massive ovarian cyst and would experience bouts of fainting, dizziness, and immobilizing fatigue. I was cold all the time, too, and didn't want to eat. I thought something was seriously wrong. But I wasn't anemic, and my hormone levels tested normal. I had full thyroid panels done, only to have everything come back within healthy ranges. I booked an appointment with a specialist, who told me to take supplemental progesterone to try and control the bleeding. But before I filled the prescription, I remembered that Yaz had caused similar, if less drastic, symptoms for me in the past. I skipped my dose of Spiro that night, and again the next morning, in a last-ditch effort to see if it would change anything for me. 

Within 24 hours of skipping my Spiro doses, my period stopped (after, I kid you not, 44 days of steady bleeding). My energy returned, and the pain in my ovary stopped. My appetite came back, and I could run without feeling like I was going to faint. But most miraculously, all acne production stopped. Every single lurker (how I refer to those bumps you'll get that inevitably turn into a gigantic cyst) began to shrink at once, and in over a month since stopping the Spiro I haven't had a single new pimple. My acne scars are healing, and my skin has remained calm and clear. 

I'm not saying Spiro caused my acne. Hormonal acne, especially in women, is very complex and when even one hormone is out of balance, it can cause a chain reaction. What I suspect happened is that in adolescence, I had typical cystic acne that comes with the territory for some people (every woman in my family, in my case). I went through puberty on the late side, and I suspect that my acne would have resolved itself on its own by the time I was in my early 20s. But being put on androgenic progesterones from the birth control flared my acne up more than it would have otherwise, and put my body into a state of increased androgenic activity. The Yaz, which is known to decrease androgens, brought all of the excessive androgens down so low that it somehow imbalanced my estrogen levels while causing testosterone levels to plummet far below normal ranges (blood tests from this time corroborate this theory), leading to the cycle irregularities, ovarian cysts, and fatigue. From this point on I suspect that the synthetic hormones in the final birth control pill I tried made things worse. Only once I'd gotten off all synthetic hormones and in favor of my plain old, beloved copper IUD, did all of this become apparent. 

Hormones are no joke, and Spironolactone can be an incredible medicine for women with excess androgenic activity. I suspect that during puberty, had I been prescribed this medication, it would have worked like a charm. But unfortunately, I began taking spiro once my androgen levels had already normalized, and without the synthetic birth control hormones to keep my estrogen and progesterone in balance, everything went haywire. 

If any of this sounds familiar to you, you've been on hormonal birth control for more than 3 years, and you're still struggling with acne, I would say this: before you try spironolactone, get off hormonal birth control for two to three full cycles. I would 100% recommend the copper IUD, it's been a literal dream for me. Once you've gotten the synthetic hormones out of your system, get a full panel of hormone tests from a qualified doctor (not just a derm) during the luteal phase of your cycle (just before your period). This will give you a baseline sense of whether you have excess androgenic activity and might be a candidate for Spiro.

TL;DR: Hormones are complicated, and Spiro caused me a full 6+ months of misery that went way beyond acne. If you have hormonally related acne, are a woman, and have been on hormonal birth control for years, do NOT do what I did, taking birth control continuously and stacking medications on top without first re-establishing a baseline of where your body is without synthetic BCP.