If you struggle with hormonal acne, then you’re probably no stranger to the cystic bumps that often appear on your jawline around your period (you know, the ones that feel tender to the touch and lurk beneath the skin). These breakouts can make even the stubbornest of blackheads feel like a walk in the park. Maybe you’ve been dealing with chin zits since the days of prom, or perhaps they’ve just started popping up in your 30s. Just like that awkward yearbook picture, hormonal acne can haunt you long after high school graduation, and even make an unwelcome appearance decades later.

Fortunately, there are many ways to treat hormonal acne, from skincare products and birth control pills to certain diets and medications. Spironolactone, for example, is a popular oral tablet medication that’s prescribed for hormonal acne. We sat down with Dr. Katherine Brag, the chief dermatology resident at Tulane University School of Medicine, to learn more about this powerful pill that many claim is their clear skin secret.

Hormonal acne and spironolactone 101
“Women in their teens to early 50s will come in with fairly stubborn hormonal acne — the kind that’s deep, tender, on the lower half of the face, and that may get worse before or during menstruation,” says Dr. Brag. “Interestingly, some of these women may not have had acne during their teenage years.”

Dr. Brag explains that while the cause of hormonal acne is multidimensional, it’s often brought on by excess sebum production and inflammation. Sebum is produced by the the body’s sebaceous glands in a process known as “sebogenesis.” Male hormones called androgens (which both men and women secrete) trigger sebogenesis. But when the body has excess androgens, sebogenesis can go into overdrive. This can result in hormonal acne.

“Spironolactone is a medication that blocks androgen activity in the skin by preventing these hormones from binding to sebaceous glands,” explains Dr. Brag. “In turn, the sebaceous glands produce less hormonally-driven sebum and acne is improved over time.”

A pill with an interesting past
According to Dr. Brag, spironolactone is used across multiple fields of medicine, not just dermatology. It’s a diuretic, meaning it promotes fluid loss through urination. “Spironolactone is used primarily to treat fluid retention for heart failure or liver disease,” says Dr. Brag. “It’s a mainstay treatment that has been shown to decrease both morbidity and mortality in certain patients with these conditions.”

How did the medical community figure out that a pill for heart disease can also help hormonal acne? Dr. Brag explains that in the 1980s, physicians noted an unexpected and favorable effect of spironolactone on women who were taking it to help with heart or liver conditions: decreased hormonal acne. “Since then, the use of spironolactone has increased, and it’s now widely prescribed by dermatologists across the country to treat hormonal acne,” she adds.

Spironolactone side effects
Since spironolactone is a diuretic, Dr. Brag notes that those who take it may notice themselves taking more frequent trips to the bathroom. “More commonly, patients may feel a little lightheaded, especially when going from lying or sitting to standing, as a result of slightly decreased blood pressure,” she says. “I advise that patients drink water throughout the day and change positions slowly if this is an issue.”

Dr. Brag says that because of spironolactone’s anti-androgen impact, it can influence your menstrual cycle and related issues, in the form of irregular periods, light spotting, and slight breast tenderness or enlargement. However, spironolactone does not reduce the efficacy of hormonal contraceptive methods like the pill or an intrauterine device (IUD).

Let’s talk results
“Results are usually not seen until at least two to three months after starting spironolactone, but some patients see benefits within days to weeks of starting,” says Dr. Brag. “I urge patients to take the medication consistently without giving up or getting discouraged until we have fully assessed if the medication is helping. In general, spironolactone is very well tolerated and hormonal acne improves.”

Dr. Brag emphasizes that spironolactone is not a silver bullet, however. Maintaining an effective skincare regimen that includes a cleanser, toner, sunscreen, facial moisturizer, and eye cream is also essential.

A few things to keep in mind
While spironolactone offers many women clear and confidence-boosting results, it’s not for everyone. “Pregnant patients should not take spironolactone,” says Dr. Brag. “The medication can cross the fetal placental barrier and feminize a male fetus.” As previously mentioned, spironolactone can cause some mild lightheadedness. Because of this, it’s not appropriate for those who suffer from chronic low blood pressure and associated symptoms like dizziness or fainting. Spironolactone could make things worse by further lowering blood pressure.

If you’re interested in trying spironolactone for hormonal acne, make an appointment with a dermatologist. They can determine if spironolactone is a good fit for your skin, decide what dose is appropriate and at what frequency it should be taken, and write you a prescription.

English Taylor is a San Francisco-based women’s health and wellness writer and birth doula. Her work has been featured in The Atlantic, Healthline, Refinery29, NYLON, and Modern Fertility. Follow English and her work at https://medium.com/@englishtaylor or on Instagram at @englishtaylor.