Side Effects of Spironolactone Therapy in the Hirsute Woman
TLDR Spironolactone can cause side effects like irregular bleeding, but lower doses may reduce these effects and still improve hirsutism.
In a study from 1988, 26 premenopausal women with idiopathic hirsutism were treated with spironolactone, and the side effects were documented. Initially, 16 women were given 200 mg daily, and 68% experienced side effects, leading to a dose reduction or discontinuation for some. The most common side effect was metrorrhagia, affecting 56% of the women on the higher dose. Other side effects included urticaria and scalp hair loss, each in one woman. When the dose was reduced to 100 mg daily for a subsequent group of 10 women, only 2 experienced metrorrhagia, and no other side effects were reported. The study suggested starting treatment at a lower dose of 50 mg twice daily during a specific phase of the menstrual cycle or adding cyclical estrogen/progesterone to continuous spironolactone therapy to mitigate side effects. Despite the side effects at the higher dose, 12 out of the 16 women reported an improvement in their hirsutism symptoms.
