Could GLP-1 Drugs Help Women with Common Hormonal Disorder?

Ozempic and similar GLP-1 medications started gaining fame for their remarkable weight loss effects, and they're now showing promise in treating various chronic conditions. Women taking these drugs have also reported unexpected benefits, including some that might not be on pharmaceutical companies' radar. Notably, there's been an uptick in reports of unplanned pregnancies among women on GLP-1 treatments, sparking curiosity among researchers about potential impacts on fertility and hormonal disorders.

Dr. Melanie Cree, a pediatric endocrinologist at Children's Hospital Colorado, is one such researcher. She led a randomized trial examining the effects of semaglutide, the active ingredient in Novo Nordisk’s Rybelsus and Wegovy, on women and adolescents with polycystic ovary syndrome (PCOS). While results from this initial trial are still pending, they were promising enough to initiate a more extensive investigation into how weight loss, metabolic changes, and reproductive functions interplay in PCOS patients.

PCOS is characterized by a hormonal imbalance typically involving excess testosterone, which disrupts ovulation and leads to ovarian cysts. This hormonal disturbance alters menstrual cycles and can cause infertility. Additionally, PCOS often results in insulin resistance, raising the risk of Type 2 diabetes and other cardiometabolic conditions. Diagnosing PCOS is challenging and often delayed, with the World Health Organization estimating that 70% of women with PCOS remain undiagnosed.

Dr. Pardis Hosseinzadeh, an assistant professor at Johns Hopkins School of Medicine, remarks that the root cause of PCOS is still not fully understood, complicating the treatment process as the syndrome affects multiple systems in the body. Treatment strategies vary depending on individual symptoms and may include medications or interventions like weight management and birth control to help regulate ovulation and address mood swings and acne.

Dr. Cree emphasizes the importance of studies like hers, given the lack of FDA-approved medications specifically for PCOS. Weight loss is a critical goal in managing PCOS symptoms, often achieved using diabetes medication like metformin or through lifestyle changes and, in some cases, bariatric surgery. GLP-1 drugs, known for their weight loss benefits, are being explored for their potential in improving menstrual cycles and hormone regulation.

The American Society for Reproductive Medicine updated its guidelines last year to include GLP-1 drugs like semaglutide for weight management in PCOS treatment. This update reflects advances in clinical evidence supporting the effectiveness of GLP-1 medications in this context.

Dr. Cree’s new study seeks to determine whether weight loss, irrespective of method, can alleviate PCOS symptoms or if GLP-1 drugs specifically have a beneficial effect on hormonal disorders. This 10-month trial will recruit 80 females aged 12 to 35 to test the impact of injected semaglutide on ovulation and evaluate how age or metabolic and hormonal changes predict responses to GLP-1 treatment. By examining a broad age range, the study aims to move towards personalized treatment plans for different age groups.

Preliminary findings from a shorter, smaller study using oral semaglutide suggest that the injectable version might help regulate ovulation. Weight loss of as little as 5% can significantly impact menstrual cycles in PCOS patients by promoting regular ovulation, something well-known among endocrinologists and healthcare providers.

Interest in GLP-1 treatment for PCOS is growing, partly due to social media reports of the drugs' effects on fertility. However, the precise relationship between weight loss and fertility remains unclear. Some speculate that GLP-1 drugs might affect the efficacy of oral contraceptives by slowing digestion, potentially leading to unplanned pregnancies.

Wegovy, labeled for obesity, includes a warning to cease use two months before attempting pregnancy. ASRM guidelines also recommend contraception for women on GLP-1s due to limited safety data during pregnancy. Novo Nordisk and Eli Lilly, major manufacturers of GLP-1 drugs, have not conducted extensive studies on their use in PCOS patients and lack immediate plans to do so, given the typical exclusion of pregnant women from clinical trials due to potential risks to the fetus.

The popularity of GLP-1 drugs is particularly notable among women, who receive more prescriptions for these weight loss medications compared to men, despite similar obesity rates. Clinical trials for drugs like Wegovy and Zepbound also saw higher female participation.

While the potential long-term benefits of GLP-1 drugs for PCOS patients are promising, further research is essential to fully understand their impact on fertility and overall health, ensuring safe and effective use across all stages of a woman's life.