Can Spironolactone Cause Weight Gain or Water Retention?

Spironolactone has not been shown to cause weight gain in women. In a 3-month study at 100 mg a day, women's BMI stayed essentially the same, and a review of 24 trials found no effect on BMI in women with PCOS. Spironolactone is a diuretic (a water pill), so it pulls fluid out of the body rather than holding it in. None of the studies or the drug label we reviewed link it to cellulite.

Does spironolactone make you gain weight?

No study we reviewed found weight gain. Here is what each one measured.

These studies were small and short, and mostly in women in their 20s. They tell you spironolactone is not known to add pounds. They don't promise your scale will never move.

Does spironolactone cause water retention?

It does the opposite. Spironolactone blocks aldosterone, the hormone that tells your kidneys to hold on to salt and water. That is why doctors use it to treat fluid buildup (edema) in some heart, liver and kidney conditions. The Aldactone label lists it as an aldosterone antagonist for heart failure, high blood pressure, edema in cirrhosis or nephrotic syndrome, and primary hyperaldosteronism.

Because it is a diuretic, you will probably pee more often, especially in the first weeks. The American Academy of Dermatology says to tell your care team if that could be a problem for your day. Across studies of spironolactone for acne, about 13% of women reported peeing more.

Losing fluid can also make you feel lightheaded or dizzy. Lightheadedness, headache and menstrual irregularities are the most common side effects, and they tend to rise with the dose. Tell your clinical team if you feel dizzy when you stand up.

Can spironolactone cause cellulite?

We found no study and no drug label warning that links spironolactone to cellulite. Cellulite is how fat sits under the skin, and the trials above found no weight gain to feed it.

The body changes women do report are in the breasts and the cycle. The AAD lists the most common side effects without a birth control pill as painful periods and cramping, irregular periods, breast tenderness and breast enlargement. Across acne studies, about 21% of women had period changes and about 8% had breast symptoms. Several studies found that taking an oral contraceptive pill at the same time could prevent the period changes.

If your bra feels tighter or your cycle shifts, that is a known spironolactone effect worth telling your clinical team about. It is not a sign the drug is adding fat.

What should I watch for on spironolactone instead?

• Potassium. Too much potassium can be dangerous on spironolactone. The AAD says to skip potassium supplements and coconut water, and the Aldactone label also advises avoiding high-potassium foods and salt substitutes.
• Your age. High potassium is rare in women 45 and under (1.9% of cases in an analysis of FDA reports). In those same reports, women aged 46 to 64 were 13 times more likely to have it than women 18 to 45, and researchers recommend regular blood tests for women over 45. Ask your clinical team what checks fit your age.
• Pregnancy. The AAD says it is essential to use birth control while taking spironolactone if you can get pregnant, because it can cause serious birth defects.
• Other medicines. Tell your clinical team every medicine and supplement you take. Some drugs raise potassium too, including the antibiotic trimethoprim-sulfamethoxazole.

If you take spironolactone for your skin or hair and also want your jeans to fit again, take the quiz to see which weight or skin plan fits your goal. Tell your clinical team you take spironolactone so they can build around it.