A 27-year-old woman with PCOS is started on spironolactone 100 mg daily for hirsutism. Which counselling point is essential before prescribing?
- A It can be safely combined with pregnancy, so no contraception is needed
- B Effective contraception is mandatory because exposure in a male fetus causes feminisation ✓
- C It increases serum potassium dangerously only in women with renal impairment over 60 years
- D It must be stopped if mild menstrual irregularity occurs
Correct answer: B. Effective contraception is mandatory because exposure in a male fetus causes feminisation
Explanation
Spironolactone is an androgen receptor antagonist and also reduces testosterone synthesis. If taken during pregnancy it can feminise a male fetus, so reliable contraception is essential, and a combined pill conveniently adds endometrial protection. Hyperkalaemia is a real concern in renal impairment regardless of age, making option C wrong. Menstrual irregularity is common and expected, not an indication to stop the drug.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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