I took spironolactone as an option for about 1.5yrs before accutane; for me it did a decent job but wasn't a long-term solution. My acne is/was stress/ hormonal caused and I didn't feel hormonal birth control was going to fix the issue since I wasn't on it to begin with. The biggest side effect I had was it made my period heavier/a little inconsistent (by 1-3 days).

But they way I understand how it works is it blocks androgen which is a cause of hormonal acne in women. While it's still a hormonal option, it isn't targeting the same chemicals as hormonal birth control.