Among my closest group of girlfriends from college, four out of the five of us have taken spironolactone at some point in our lives. When I first mentioned that I was going on it, the resounding response from my friends was, “It’s the best!” This made this wonder if I was the last person to learn about this magical acne-zapping pill. 

I’ve been on spironolactone since 2018 and can’t imagine going off of it unless I decide to become pregnant. Like many people with uteruses, I was first prescribed spironolactone after getting an IUD (Mirena) implanted in 2018. 

Right before my OBGYN shoved a piece of plastic into my cervix, she said to let her know if I started breaking out. Lo and behold, angry cysts cropped up on my face six weeks later, leaving me self-conscious in a way that I hadn’t felt since high school. My OBGYN wrote me a prescription for spironolactone and within a few months, my skin was clearer than it had been before the IUD. 

“Spironolactone is one of my favorite systemic treatments for female acne,” shares Kimberly Shao, MD, a board-certified dermatologist in Dayton, Ohio. “Females with moderate to severe inflammatory acne of any skin tone would be good candidates.” 

With a huge increase in people with uteruses seeking long lasting birth control in the wake of the Roe reversal, demand for IUDs has gone up. A survey conducted by the Harris Poll on behalf of TIME magazine in July found that 21 percent of women “reported changing their primary contraception method” since the June 24 ruling. Seventeen percent of those surveyed said their primary method of birth control was an IUD or implant. 

So it’s not hard to imagine an increased demand for spironolactone, either. That’s because “hormonal IUDs like Mirena, Skyla, and Liletta have been associated with worsening acne, particularly for those who breakout before their period,” Dr. Shao adds. “Some suggest that this occurs mostly in patients who have switched from a birth control pill to an IUD (since the birth control pill had been helping to control acne symptoms). Others suggest that the IUD itself may worsen acne due to the hormone progestin that is released.”

Meet the experts:

What is spironolactone?

Spironolactone was approved by the Food and Drug Administration (FDA) in 1960 to treat high blood pressure and heart failure. For the past two decades, it’s also been prescribed as a treatment for hormonal acne in women. You know the type: it flares up in cadence with your menstrual cycle, often along the jawline. Spironolactone works by blocking androgen hormones from overstimulating your oil glands, leaving your pores unclogged and your face clearer as a result.

Who is spironolactone for?

While most women can tolerate spironolactone well, it’s not for everyone. “It does have a number of potential side effects, including fatigue, increased urination, irregular periods, and breast tenderness,” says Sejal Shah, MD, a board-certified dermatologist in New York City.