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GLP-1 RA medications and PCOS:
What we currently know
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Written on 10/12/23 by Dr. Daisy & Co dietitian, Adrienne Inger
With PCOS, is Ozempic the missing puzzle piece? Despite widespread use and media coverage of GLP-1 RA medications like Ozempic, Wegovy, and Mounjaro, the information we have is limited, and therefore the jury is still out. Here is what we know so far.
GLP-1 RA Potential Benefits in PCOS
Most of the information we have on drugs like Ozempic, Wegovy, and Mounjaro relates to Type 2 Diabetes and/or weight loss.
Existing studies on these drugs in PCOS patients have many differences in their design. The small number of patients studied, differences in medication dose, study length, and outcomes measured all make it difficult to draw conclusions.
However, most trials report superior weight loss effects of GLP-1 RAs compared to lifestyle changes or metformin, with potential for additional metabolic, reproductive, and cardiovascular benefits.
GLP-1 RAs may improve insulin sensitivity in individuals who have PCOS and live in larger bodies. In a meta-analysis that included 8 RCTs, GLP-1 RA drugs had similar favorable effects to metformin on sex hormone levels (testosterone, androgen, SHBG, DHEA-S, LH), fasting blood glucose, fasting insulin, blood lipids, and blood pressure while being more effective than metformin in improving insulin sensitivity and reducing body mass index.
In patients with Type 2 Diabetes, GLP-1 RAs have been shown to significantly reduce cardiovascular events, though most research to date on PCOS and GLP-1 RA drugs has not evaluated cardiometabolic outcomes.
It is not known whether these medications promote menstrual regularity.
Although some research suggests the use of these drugs can improve reproductive outcomes, it is important to note that these drugs are not considered safe for pregnancy due to a lack of data.
Safety Concerns
Pregnancy: Safety data on the use of GLP-1 RA drugs in pregnancy is lacking. It is recommended that individuals have an effective method of contraception in place while taking these medications, and people who are trying to conceive or are pregnant will need to stop taking these drugs.
Gastrointestinal Issues and Eating Disorder Risk: In practice, we are seeing many clients struggle with adverse side effects such as nausea, vomiting, diarrhea, abdominal pain, and constipation. For clients both with and without a history of eating disorder, experiencing these and other symptoms (ie weight loss and diminished appetite) may increase risk for the development or relapse of an eating disorder.
The Evidence Based Guidelines for PCOS recommend gradual dose escalation in order to minimize these unpleasant side effects. However, higher doses of these medications are prescribed for weight loss effects (versus Type 2 Diabetes management), and higher doses may increase the likelihood and severity of these side effects.
Thyroid Cancer, Pancreatitis, and kidney disease: In studies on rats, Ozempic and drugs like it caused thyroid tumors, including thyroid cancer. It is not known if these medications cause thyroid tumors in people. Pancreatitis, gallbladder problems, and decline in kidney function for those with existing kidney problems are all possible side effects.
Weight Regain & other Considerations: There is a high risk for weight regain after discontinuing these medications, and data on the safety of long term use is lacking. This is important to consider when making a decision, in addition to side effects, medication cost, and shortages.
What we currently know about GLP-1 RA drugs and PCOS is tied solely to weight reduction. This is a significant limitation, considering that upwards of 20% of individuals with PCOS do not struggle with weight, yet still experience many of the profound effects associated with the condition.
Though weight loss drugs like Ozempic have become popular among individuals of all shapes and sizes, they are only approved for specific conditions and could be unsafe when used “off-label.”
In Conclusion
We don’t have enough information to know whether GLP-1 RA drugs like Ozempic, Wegovy, and Mounjaro are the miracle drugs they’re touted to be for PCOS or otherwise. We need more (and better quality) research on the subject.
Currently, the use of GLP-1 RA drugs is not widely accepted by the clinical community treating PCOS. According to the Evidence Based Guidelines, GLP-1 RA drugs “could be considered, in addition to active lifestyle intervention, for the management of higher weight in adults with PCOS as per general population guidelines.”
Though we take a nondiet and weight neutral approach to nutrition counseling, our practice is not “anti weight-loss” and our goal is to support you as best we can — whether you want to pursue weight loss or not. If you are currently taking one of these medications, we recommend working with a dietitian who can help to make sure you’re meeting your estimated nutrition needs, and that your relationship with food and body are not compromised.
Evidence Based Guidelines for PCOS:
https://www.monash.edu/medicine/mchri/pcos/guideline
GLP-1 RA verus metformin in PCOS
https://pubmed.ncbi.nlm.nih.gov/31229399/
Therapeutic Potential of GLP-1 RA in PCOS: Current Clinical Evidence