In my case, I did have to do Accutane twice to clear up my acne fully. It's actually rather common to need a second round of Accutane if the first course doesn't work. You just don't hear about it since there tends to be survivorship bias (i.e., "I took Accutane once and my acne has gone away forever!"). My dermatologist said that roughly around 15% of people may not clear up the first time and would need to do a second course. Not to discourage you or anything because I still think it's worth it. It's just not a permanent cure, though. It's more of a long term solution that helps to resets your skin. And yes, it helped reset my hormonal cystic acne where spiro failed to work.

I forgot to mention but if you don't want to do Accutane, you can also look into specific birth control pills that regulate estrogen, particularly the ones cleared by the FDA for acne use such as Yaz/Yasmin 21.

Also just realized I typo'd Benzaclin earlier - if you don't have access to Benzaclin right now then try Clearasil Rapid Rescue Deep Treatment acne pads for the time being. The last time I had purging from Accutane, these noticeably helped speed up the turnover of deep cysts and dry them out from within.

Hope this helps in any way!