Taking Ozempic and GLP-1 Receptor Agonists for PCOS

What to know about taking Ozempic and Other GLP-1 receptor agonists for PCOS.

Unless you are living under a rock, you undoubtedly heard about the Ozempic GLP-1 receptor agonist craze. Regular folks to celebrities to billionaires (Hi Elon) are taking prescribed medications originally indicated for diabetes, for weight loss.

So how do Ozempic and other Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RAs) like Wegovy and Mounjaro, work for people with PCOS who struggle with insulin resistance? And what concerns or risks are there for folks with PCOS who are using these medications? Here’s what to know about GLP-1 RAs and PCOS.

What is Ozempic and Glucagon-like Peptide 1 Receptor Agonists?

Semaglutide which is Ozempic or Wegovy, Mounjaro and the newest, Zepbound, are a class of medications called Glucagon-like peptide 1 receptor agonists (GLP-1 RAs). These drugs mimic the action of a signaling hormone called glucagon-like peptide 1 that helps to lower blood sugar levels. This is why these medications are indicated for controlling type 2 diabetes.

There are three main ways that GLP-1s help manage blood sugar:

• Delays stomach emptying. When digestion is slowed, food gets released more slowly, preventing blood sugar from spiking after a meal.
• Increases insulin production to help your body lower glucose that rises after a meal.
• Reduces sugar that gets released from the liver into your bloodstream.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) drugs have been shown to lead to weight loss in some, but not all, individuals. It’s not exactly clear how GLP-1s cause weight loss but it’s suggested that that GLP-1s help curb hunger signals. These drugs also slow the release of food from the stomach into the small intestine. As a result, you may feel full faster and longer, so you eat less.

Along with helping to control blood sugar and helping with hunger cues, GLP-1 RA inhibitors seem to have other major benefits. Research has found that these particular drugs can lower the risk of heart disease, like heart failure, stroke and kidney disease. They may also improve blood pressure and cholesterol levels.

Side Effects from Ozempic and Glucagon-like Peptide 1 Receptor Agonists

Most people who take Ozempic and other GLP-1 RAs report significant GI side effects. These side effects include:

• Nausea
• Heartburn
• Gas
• Vomiting
• Headaches
• Diarrhea
• Blurred vision

Unlike a lot of type 2 diabetes medications, GLP-1s are unlikely to cause low blood sugar.

Note: These medications can reduce the effectiveness of birth control medications so you may want to use a back up method.

There is a concern for pancreatitis and medullary thyroid cancer. Time will certainly tell if people who take GLP-1 RAs develop a higher prevalence for these diseases.

Ozempic for PCOS: Clinical Observations

Compared with weight matched women, PCOS women show higher levels of insulin. Additionally, approximately 70% of women with PCOS struggle with insulin resistance.

Signs and symptoms of insulin resistance include:

• abdominal weight gain
• skin tags
• acathosis nigricans (dark patches behind the neck, groin and armpits)
• increased hunger
• strong cravings for carbohdyrates and sweets, and
• elevated glucose and/or HA1C levels.

In addition, there is a much higher risk for folks with PCOS to develop type 2 diabetes.

Women with PCOS have been shown to have impaired levels of appetite regulating hormones like ghrelin and leptin that could contribute to increased hunger levels.

Many of my patients who take GLP-1 RAs report feeling like a “normal” person does in regard to hunger and cravings. Food that was once so consuming became less often thought of. Many of my patients with PCOS report feeling more regulated blood sugar control with less dips throughout the day. As one patient put it: “these medications have been life changing.”

Some patients who have tried Ozempic for PCOS and couldn’t stay on them for various reasons like cost or side effects, found that any weight lost quickly came back (and more) when they stopped taking it.

Ozempic for PCOS: What the Research Shows

In the past, the only medical treatment options for PCOS were Metformin and Oral Contraceptives. Due to the very limited amount of government funding for research trials, it has been decades since any advancement in PCOS medical treatment has been made. Until now.

The use of GLP-1 RAs alone or in combination with metformin has been studied in women with PCOS. Several studies showed weight loss and testosterone reductions, with mixed results in regards to improvements in insulin resistance and period regularity.

A meta-analysis of 8 randomized trials compared the benefits of GLP-1 RAs versus metformin in women with PCOS. GLP-1 RA was superior to metformin in improving insulin sensitivity and reducing BMI and abdominal circumference. GLP-1 RAs had similar effects on menstrual frequency, total testosterone, free androgen index, SHBG, dehydroepiandrosterone sulfate (DHEA-S), hirsutism, LH, fasting blood glucose, fasting insulin, triglycerides, total cholesterol, and blood pressure when compared with metformin.

Pregnancy rate was studied in a trail involving women with PCOS, who were randomized to receive either the GLP-1 RA exenatide 10 μg twice daily or metformin 1000 mg twice daily for the first 12 weeks. Then all patients were treated with metformin alone during the second 12 weeks. During the second 12 weeks, the rate of natural pregnancy of exenatide-treated patients was significantly higher than metformin-treated patients (43.60% vs 18.70%).

So far the research shows that GLP 1 RAs can help patients with PCOS lower their glucose and insulin as well as improvements to sex hormones and period regularity-if they can tolerate the side effects. Yet, due to limited research, so many more questions remain.

Does Ozempic or Glucagon-like Peptide 1 Receptor Agonists Cause Nutrient Deficiencies?

Metformin is commonly taken by people with PCOS and is known to affect vitamin B12 levels. It is possible that Ozempic and other GLP-1 RAs could also affect the absorption of vitamin B12 and other vitamins.

Lack of protein is a concern in people taking these medications. A lack of protein can cause muscle loss and slowed metabolim, among other problems. Malnutrition is a big concern as peoples interest in food goes down, so does their overall intake of food. I highly recommend working with a registered dietitian to help you get the right balance and to avoid malnutrition.

What Happens if you Stop Ozempic or other Glucagon-like Peptide 1 Receptor Agonists if you have PCOS?

Insurance can stop paying for these medications. Not everyone can tolerate the GI side effects that come with taking Ozempic or similar medications. GLP-1 RAs should not be taken if pregnant as safety data are lacking. Many people with PCOS who are trying to conceive or get pregnant will need to stop taking these medications. Certainly if someone develops pancreatitis it should be stopped immediately. So, what happens when people with PCOS stop taking Ozempic?

Many of my patients have found that hunger comes right back, right along with weight gain, suggesting GLP-1s will need to be taken forever to avoid this.

Weight cycling, the constant cycle of losing weight and regaining it, has been known to negatively affect health. What impact will weight regain have on the physical and emotional health of people with PCOS?

Do Glucagon-like Peptide 1 Receptor Agonists Increase the Risk for Eating Disorders?

There is a higher prevalence of eating disorders in the PCOS population. Right now, the data doesn’t show it, but I can tell you from clinical practice that Ozempic definitely can lead to eating disorders or cause eating disorders, once resolved, to reemerge.

Ozempic blunts hunger signals. This can result in people not being interested in food or skipping meals because they don’t feel like eating.

Weight loss, a common side effect, can open up a whole can of worms for someone currently in recovery from an eating disorder or who has gone through recovery.

If Ozempic is stopped and weight gain occurs, that too will have a significant psychological impact on people with distorted eating and eating disorders.

Emily, a current patient of mine with PCOS who had anorexia as a young teenager has been taking Ozempic for 3 months. She has lost some weight on Ozempic but is struggling with terrible GI side effects that are affecting her quality of life. She’s refusing to stop the medication out of fear she will gain back the weight lost.

Hannah has PCOS and has been taking Ozempic for 6 months. She currently only eats one meal a day and struggles to eat more out of fear she won’t keep losing weight. Hannah has already passed out once from dehydration and low blood sugar.

I don’t advise taking GLP RAs if you have an eating disorder. If you are struggling with distorted eating or an eating disorder, please consult with your doctor prior to taking these medications. Anyone whose eating behaviors have gotten worse while on GLP-1 RAs should also reach out to their medical providers.

Are There Ways to Improve Insulin Resistance in PCOS Other Than Ozempic?

Absolutely! The first line treatment for PCOS is lifestyle changes. This means nutrition, exercise, stress management and sleep hygiene. Supplements like Ovasitol, Berberine, Resveratrol and CoEnzyme Q10 have all been shown to help improve insulin sensitivity in PCOS. Not sure what supplement is right for you? Take our supplement quiz and get matched!

Tips for Taking Ozempic or Glucagon-like Peptide 1 Receptor Agonists for PCOS:

Start at the lowest dose until your side effects go away or are very minimal. Don’t be in a rush to increase to the next dose. A higher dose will only make side effects worse.

Anti-nausea medications like Zofran may help to reduce nausea. Eat bland foods, such as crackers, or follow the “BRAT diet” (bananas, rice, applesauce, and toast). Small, frequent meals can help reduce nausea as well.

Gas-X or other over the counter medications can help with fullness and gas.

Set a timer if you find yourself forgetting to eat.

Focus on getting in protein at meals to improve overall protein intake. Drinking protein-rich smoothies between meals can help.

Consider taking a multi-vitamin to help optimize nutrient levels.

If you take birth control pills, your doctor will likely recommend that you switch or add a form of birth control. They may advise you to switch to a non-pill form of birth control, such as the patch or vaginal ring.

Bottom Line: GLP-1 medications like Ozempic, Wegovy, and Mounjaro may offer health benefits to people with PCOS, such as lowered glucose and cholesterol levels, and may even help to reduce heart disease risk factors. The disadvantages include significant GI side effects that can affect quality of life, the risk for eating disorders and pancreatitis, and weight regain. So much still remains unknown about the impact of GLP-1 RAs in PCOS. Larger sample sizes and longer-duration randomized designs will help to determine the reproductive and cardiovascular risk reduction impact on PCOS.

Please share with us in the comments! What has your experience with these medications been like?

Angela Grassi, MS, RDN, LDN, is the founder of The PCOS Nutrition Center, for which she has been providing evidence-based nutrition information and coaching to people with PCOS for over 20 years. Angela is the author of several books on PCOS, including PCOS: The Dietitian’s Guide, The PCOS Workbook: Your Guide to Complete Physical and Emotional Health, and The PCOS Nutrition Center Cookbook. Angela is the past recipient of The Outstanding Nutrition Entrepreneur Award, The Award in Excellence in Practice in Women’s Health, and The Award for Excellence in Graduate Research, from the Academy of Nutrition and Dietetics. Having PCOS herself, Angela has been dedicated to advocacy, education, and research of the syndrome. Click here to schedule a session with Angela to learn more about how nutrition coaching for PCOS can help you!