OK, I developed acne about 10 yrs ago when I was around 26 and had no kids. I tried the dianette contraceptive pill with no good result, then tried roaccutane. It was sort of effective though not completely. I hated the side effects - I could hardly smile for 6 months as my lips would split and bleed, and I found my contact lenses really uncomfy. The acne came back gradually, but I never really treated it again for years with any heavy-duty meds as had 3 dcs in succession. Last year (youngest child now 3yo), it got quite a lot worse. I wasn't really getting any spot-free days, though in the summer it cleared up quite well.
Anyway, come autumn, I went to a derm. I didn't really want to take a pill again as suffer from migraine and it's a contraindication. She said that in Europe the pill is the standard treatment for adult cystic acne, but in the US they tend to give spironolactone. It's originally a medicine for cardiac disorders of some kind, but showed quite by chance this beneficial effect for hormonal acne in women and is now quite widely prescribed.
You have to take between 100-200mg per day. I started with 100, taking it in the morning as it's a diuretic. It did make me pee quite a lot. It also gave me an upset stomach and made me feel sick, but I soon realised that taking it with food, not before breakfast sorted that out. I felt like it made me feel quite dizzy too, so in the end I started taking it with dinner, so any dizziness would happen when I was asleep. This was fine, and I didn't need to get up to pee, so all OK there.
The first 4-6 weeks my skin really got much worse, with horrible whiteheads and loads of spots and lumps. Add this to feeling awful as described above and I thought about stopping, but decided to give it 3 months to see. After about 9 weeks, my skin really cleared up a lot, and I was feeling the side effects much less too. I went back to the derm who said to increase to 125mg, and prescribed me erythromicin antibiotic gel to put on top of any whiteheads. I'm now about 11 weeks in, and have had only one spot in the last 2 weeks, and that one doesn't hurt at all.
The drug can cause potassium to accumulate in your blood, which is dangerous for your heart, so you have to check your potassium levels regularly. I'm also not sure of the long-term implications. My plan, as discussed with the doc, is to reduce the dose once my skin is really clear, and see how it goes. The spots might of course all come back with a vengeance, and I don't particularly want to take this drug my whole life, although it is a drug that people do take for years and years. But for now it seems to be a pretty good solution to an unsightly problem.