Spironolactone and Pregnancy: Risks, Alternatives, and What Doctors Recommend

If you’re taking spironolactone and just found out you’re pregnant-or you’re trying to get pregnant-this isn’t just another medication question. It’s a moment that demands clear, honest answers. Spironolactone isn’t just a water pill. It’s a hormonal drug with real, documented risks during pregnancy. And if you’re relying on outdated advice or vague Google results, you could be putting your baby at risk.

What spironolactone actually does

Spironolactone is a potassium-sparing diuretic, but that’s not why most people take it. It blocks the effects of aldosterone, a hormone that makes your body hold onto salt and water. But it also blocks testosterone and other androgens. That’s why it’s used for acne, hirsutism, and polycystic ovary syndrome (PCOS). In men, it can reduce male-pattern hair growth. In women, it helps with hormonal breakouts and excess body hair.

But here’s the catch: because it interferes with sex hormones, it can interfere with fetal development-especially male reproductive organs. Animal studies show clear signs of feminization in male fetuses exposed to spironolactone. Human case reports back this up. There are documented cases of male babies born with ambiguous genitalia after first-trimester exposure.

The real risk during pregnancy

The FDA classifies spironolactone as Category D: evidence of human fetal risk, but potential benefits may justify use in life-threatening situations. That’s not a warning label you can ignore. It’s a red flag.

According to data from the European Registry of Drug Exposure in Pregnancy and the MotherToBaby database, exposure to spironolactone in the first 12 weeks of pregnancy increases the risk of hypospadias-a condition where the urethral opening is on the underside of the penis instead of the tip. The baseline risk of hypospadias is about 1 in 200 male births. With spironolactone exposure, studies suggest it could rise to 1 in 50 or higher.

There’s also a risk of undescended testicles and underdeveloped genitalia. These aren’t minor issues. They often require multiple surgeries, hormone treatments, and long-term psychological support. And the damage is done by week 10-before many women even know they’re pregnant.

What if you’re already pregnant and taking it?

If you’re in your first trimester and just realized you’ve been taking spironolactone, don’t panic. But don’t wait either. Stop taking it immediately and contact your doctor or OB-GYN. Don’t try to taper it yourself. Abruptly stopping could cause fluid retention or worsen high blood pressure, but continuing it is far riskier.

Your provider will likely order a detailed anatomy scan around week 18-22 to check for genital abnormalities. If you’re carrying a male fetus, they may refer you to a pediatric urologist or genetic counselor. You’ll need to weigh the risks, but the evidence is clear: the earlier you stop, the lower the risk.

If you’re past the first trimester, the risk drops significantly. By week 14, the external genitalia are mostly formed. But spironolactone can still affect fetal kidney function and electrolyte balance. So even later in pregnancy, it’s not considered safe.

Alternatives that are safe during pregnancy

If you’re taking spironolactone for acne or PCOS, there are better options when you’re pregnant.

• Topical treatments: Benzoyl peroxide and azelaic acid are both Category A or B-proven safe during pregnancy. They work well for mild to moderate acne.
• Oral antibiotics: Erythromycin and clindamycin are low-risk options if topical treatments aren’t enough.
• For high blood pressure: Methyldopa, labetalol, and nifedipine are first-line choices. They’ve been used safely in millions of pregnancies.
• For heart failure: If you’re on spironolactone for heart failure, your doctor may switch you to a different diuretic like furosemide, under close monitoring.

Never switch medications on your own. But do ask your doctor: "Is there a pregnancy-safe alternative for my condition?" There almost always is.

Planning a pregnancy? Stop now

If you’re trying to conceive and taking spironolactone, stop at least three months before you stop using birth control. It takes time for the drug to fully clear your system. And even after you stop, your body needs to reset its hormone balance.

Many women with PCOS or hormonal acne feel better on spironolactone and are reluctant to quit. But the trade-off isn’t worth it. You’re trading short-term skin clarity for potential long-term consequences for your child. And if you’re using it for contraception-don’t. Spironolactone is not a birth control pill. It doesn’t reliably prevent ovulation.

Work with your dermatologist or endocrinologist to create a pregnancy-ready plan. That might mean switching to oral contraceptives with anti-androgen effects (like drospirenone) while you’re not trying to conceive, then switching to safer alternatives when you’re ready.

What about breastfeeding?

Spironolactone passes into breast milk in small amounts. There’s no solid evidence of harm to nursing infants, but there’s also no large-scale safety data. Most pediatricians advise against it. The risk of electrolyte imbalance in a newborn-especially low sodium or high potassium-is real, even if rare.

If you’re breastfeeding and need to manage high blood pressure or heart failure, your doctor can recommend safer diuretics like furosemide or hydrochlorothiazide. For acne or hirsutism, topical treatments are still your best bet.

When to call your doctor

Don’t wait for symptoms. Call your provider if:

• You’re pregnant and taking spironolactone, even if you’ve only taken it for a few days
• You’re trying to get pregnant and have been on spironolactone in the past six months
• You’re breastfeeding and your baby seems unusually sleepy, weak, or has poor feeding
• You’ve missed a period and are on spironolactone for acne or PCOS

These aren’t emergencies, but they’re urgent enough to act on within 24-48 hours. Your doctor needs to know so they can adjust your care plan before it’s too late.

Bottom line: Don’t guess. Get clarity.

Spironolactone isn’t the villain. It’s a useful drug-for the right person, at the right time. But pregnancy isn’t the right time. The science is clear. The risks are real. And there are safer options available.

If you’re on this medication and thinking about pregnancy-stop. Talk to your doctor. Switch to something safer. Your future child deserves that much.