I am 23 years old and since I started taking spironolactone my period has not come. I am approximately one month late. Could this be related to the treatment? Should I be worried?

Hello, Lucía,

Yes, spironolactone can cause changes to the menstrual cycle, so what you are noticing may well be related to your treatment.

Although spironolactone is primarily a diuretic medication, it also has an important anti-androgenic effect. For this reason, we use it quite frequently in young women to treat conditions such as hormonal acne, excess sebum production, or certain cases of hirsutism.

Precisely because of this hormonal action, some women may experience changes in their menstrual cycle: periods that come earlier or later than expected, light spotting between periods, irregular cycles, and occasionally a temporary absence of menstruation.

This effect may also depend on the dose used and tends to be more common at higher doses.

Therefore, if your period has stopped since starting treatment, spironolactone is a possible explanation and does not necessarily mean that there is a serious underlying problem.

However, there is something we should always check first.

If there is any possibility of pregnancy, please take a test.

In a 23-year-old woman with a one-month menstrual delay, regardless of whether she is taking spironolactone, the first step is to rule out pregnancy if there has been any possibility of this.

This is especially important because spironolactone should not be used during pregnancy due to its anti-androgenic effects.

If the test is negative and your cycles were previously regular, we can monitor how things progress and assess whether the change clearly coincides with the start of treatment or with an increase in dose.

Will my period return to normal?

In many patients, the menstrual changes associated with spironolactone are reversible and may improve over time, with a dose adjustment, or, if necessary, by modifying the treatment.

However, I would not recommend simply waiting indefinitely assuming that everything is due to the medication.

If the absence of menstruation continues, recurs over several cycles, or if other symptoms appear, we should also consider other causes of amenorrhoea: thyroid disorders, polycystic ovary syndrome, significant weight changes, excessive physical exercise, stress, elevated prolactin levels, or other hormonal imbalances.

Should I stop taking spironolactone?

Not necessarily.

If the treatment is working well and there are no other side effects, an isolated menstrual delay does not automatically require it to be discontinued.

The right approach is to review the dose, the reason you are taking spironolactone, your medical history, and what your cycles were like before you started.

Depending on each individual patient, we may maintain the treatment, adjust the dose, or consider other strategies. In some women who also require contraception, certain hormonal contraceptives may help to regulate the cycle; however, this decision must be personalised and they are not recommended simply to correct an irregular period.

Therefore, my recommendation would be simple: take a pregnancy test if there is any possibility, and if it comes back negative, discuss it with the doctor who prescribed the spironolactone so that a proper follow-up can be arranged.

Do not be alarmed by a single missed period, as menstrual changes are a known side effect of this medication; however, we should not automatically attribute every absence of menstruation to spironolactone without first ruling out other causes.

Warm regards,

Doctor Florian A. Vallecillo Cabrera