Short-Term, Low-Dose Spironolactone for Treatment of Hyperandrogenic Symptoms of Polycystic Ovary Syndrome: A Systematic Review

November 2025 in “ Clinical Endocrinology ”

Telma Martins Viveiros, Neha Deshpande, Irene Karderinis, Yu‐Shui Ma, Sophie Clarke, Vikram Talaulikar, Bassel Wattar

spironolactone metformin hyperandrogenic symptoms polycystic ovary syndrome PCOS hormonal contraceptives Aldactone Glucophage birth control pills

From the encyclopedia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Metformin →

diabetes drug with anti-inflammatory, immunomodulatory, and insulin-sensitizing properties

Studysummary This analysis reports no significant differences between spironolactone and metformin for managing PCOS, noting spironolactone remains a potential off-label option for patients unable to use hormonal contraceptives, but larger studies are necessary to confirm its efficacy.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

This systematic review analyzed 5 randomized controlled trials with 443 participants to assess the efficacy of short-term, low-dose spironolactone for treating hyperandrogenic symptoms in women with PCOS. The findings indicate that spironolactone, especially when combined with metformin, may help manage symptoms like hirsutism, acne, and alopecia. However, the review notes that spironolactone did not significantly reduce serum testosterone levels or BMI compared to metformin alone, and menstrual irregularities were more common in the spironolactone group. The review emphasizes the need for larger, high-quality trials to confirm spironolactone's efficacy and safety due to the limited number of studies and variations in treatment protocols.

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Research cited in this study

9 / 9 results

Efficacy and Safety of Anti-Androgens in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

research Efficacy and Safety of Anti-Androgens in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

7 citations , August 2023 in “EClinicalMedicine”

This study reported that anti-androgens combined with lifestyle modifications were more effective than metformin and lifestyle in reducing hirsutism and certain hormonal measures in women with PCOS, but they were not more effective than a placebo combined with lifestyle changes.

research Effects of Low-Dose Spironolactone Combined with Metformin or Either Drug Alone on Insulin Resistance in Patients with Polycystic Ovary Syndrome: A Pilot Study

8 citations , March 2022 in “International Journal of Endocrinology”

This study found that combining low-dose spironolactone with metformin improved insulin resistance in PCOS patients more effectively than using either drug alone.

research The Mechanism of Androgen Actions in PCOS Etiology

30 citations , August 2019 in “Medical Sciences”

This review summarizes evidence suggesting that excess androgens play a key role in the origins of polycystic ovary syndrome, highlighting opportunities for developing targeted treatments.

research Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis

67 citations , March 2018 in “The Journal of Clinical Endocrinology & Metabolism”

This study reported that estrogen-progestin oral contraceptives, antiandrogens, and insulin sensitizers are more effective than placebo in treating hirsutism in women, with combination therapies generally proving superior to monotherapy.

research Comprehensive Overview of Polycystic Ovary Syndrome

883 citations , August 2016 in “Nature Reviews Disease Primers”

This review discusses the current understanding of polycystic ovary syndrome, focusing on its epidemiology, pathophysiology, diagnosis, management, and future research directions, but reports no new clinical results.

research Comparison of Spironolactone and Spironolactone Plus Metformin in the Treatment of Polycystic Ovary Syndrome

10 citations , September 2015 in “Gynecological Endocrinology”

In this study, spironolactone and spironolactone plus metformin both significantly reduced hirsutism scores in women with PCOS, but the combination therapy was not more effective than spironolactone alone regarding BMI, hormone levels, or insulin resistance.

research Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

1265 citations , October 2013 in “The Journal of Clinical Endocrinology and Metabolism”

This guideline from the Endocrine Society recommends using the Rotterdam criteria for diagnosing polycystic ovary syndrome and outlines first-line treatments, emphasizing hormonal contraceptives and lifestyle intervention.

Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome: A Six-Month, Open-Label Randomized Study

research Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome: A Six-Month, Open-Label Randomized Study

75 citations , July 2013 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that combining low-dose spironolactone with metformin provided greater clinical benefits and improved treatment compliance in women with PCOS compared to either drug alone.

Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double-Blind, Placebo-Controlled Trial

research Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double-Blind, Placebo-Controlled Trial

94 citations , January 2000 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that spironolactone, flutamide, and finasteride are similarly effective in reducing hair diameter and Ferriman-Gallwey scores in women with hirsutism over a 6-month treatment period.