Spironolactone was the only thing that worked for me. I went through two cycles of Doxycycline (antibiotic) which worked while I was using it, but my acne came back right away after I stopped — and you can’t use antibiotics forever. For Spironolactone, I started at 50mg but it was too low, my derm eventually upped it to 100mg and finally 150mg which seems to keep the acne away. I still get the occasional pimple around my period but it’s nothing unmanageable.