Short‐Term, Low‐Dose Spironolactone for Treatment of Hyperandrogenic Symptoms of Polycystic Ovary Syndrome—A Systematic Review
Authors' conclusion
Current evidence does not show any significant difference in the use of spironolactone when compared to metformin. Given its widespread use and limited safety concerns, spironolactone remains an off-label option, especially for those unable to take hormonal contraceptives. However, larger, better quality studies are needed to establish its efficacy in PCOS management.
Study context
- Population
- Patients with polycystic ovary syndrome (PCOS) and hyperandrogenic symptoms; RCTs published in English5 RCTs
- Comparison
- Spironolactone vs metformin monotherapy
- Outcome
- Ferriman-Gallwey scores, total testosterone, BMI
Methodological detailsrandom-effects model, Cochrane RoB 2.0 quality assessment, open-label RCTs
- Random-effects model
- Cochrane RoB 2.0 quality assessment
- Open-label RCTs
Pooled result
As reported in the abstract
- No statistically significant difference in reducing Ferriman-Gallwey scores, total testosterone levels or BMI with spironolactone vs metformin monotherapy
- 3 RCTs in meta-analysis
- SMD with 95% CI
Safety
Side effects of spironolactone
- Side effects included menstrual irregularities, polyuria and gastrointestinal symptoms
Original publication
Short‐Term, Low‐Dose Spironolactone for Treatment of Hyperandrogenic Symptoms of Polycystic Ovary Syndrome—A Systematic Review. Clin Endocrinol (Oxf). Published 24 November 2025. doi:10.
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