Does Ozempic Really Help With PCOS?

GLP-1 medications like Ozempic have exploded in use over the last few years for a range of health conditions. While Ozempic is only FDA-approved for use in type 2 diabetes, research on the potential benefits for other conditions continues to grow─including polycystic ovary syndrome (PCOS).

PCOS is an endocrine (hormonal) condition that impacts 6 to 20% of women of reproductive age.¹ It’s characterized by a range of symptoms, including irregular periods, excess hair growth, weight gain, and difficulty getting pregnant, primarily caused by high androgens like testosterone.² 

People with PCOS are more at risk for weight loss resistance, higher waist circumference, insulin resistance, and metabolic syndrome, with an increased risk for heart disease and type 2 diabetes.³ Since Ozempic is used for some of the same health concerns, it's now considered a potential tool for managing PCOS symptoms.

This article will explore the use of Ozempic for PCOS, including its mechanism of action, potential benefits and risks, and what to consider before using it.

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Understanding How Ozempic Works

Ozempic (semaglutide) is in a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. Other GLP-1s include brand names like Wegovy, Mounjaro, Saxenda, and Victoza.

GLP-1 is a hormone produced and released by your body after eating. It boosts insulin secretion from the pancreas (the hormone that lowers blood glucose), delays gastric emptying (how quickly food moves through digestion), and helps you feel satisfied after meals.⁴

GLP-1 receptor agonists act like this hormone by binding to GLP-1 receptors in the body to bump up insulin secretion while lowering glucagon (a hormone that raises blood sugar levels when they get too low). These medications also slow gastric emptying, making you feel full longer and less likely to overeat. They may also impact hormones that influence appetite in the brain.⁵ 

Ozempic is approved by the Food and Drug Administration (FDA) for type 2 diabetes but is still prescribed off-label for weight loss (other GLP-1s have FDA approval for both T2D and weight loss). Off-label means a drug is used for a purpose that the FDA hasn't approved. While off-label use is legal, it may not be covered by insurance.

Does Ozempic Really Help With PCOS?

Ozempic is not FDA-approved for PCOS, but it’s sometimes used off-label. Since many risk factors and symptoms of PCOS are related to insulin resistance and blood sugar dysregulation, it's possible that Ozempic could have similar benefits for PCOS. 

Studies on PCOS suggest that losing weight can help with insulin resistance and improve androgen levels. Weight loss is also associated with improved fertility and ovulation.⁶

Ozempic may help by supporting weight loss, ovulation, and menstrual irregularities in women with PCOS.⁷ Fertility and Ozempic are tricky topics, however, because Ozempic is not safe for pregnancy, and it’s recommended to stop taking the medication before you try to become pregnant.

Other studies suggest GLP-1 drugs could help with weight loss and blood sugar for women with PCOS.⁸ A meta-analysis revealed that GLP-1s significantly enhance insulin sensitivity, BMI, and abdominal circumference more effectively than metformin, a medication often used for PCOS. The study also found that GLP-1s were equally effective as metformin in improving menstrual cycles, androgens, hirsutism (excessive hair growth), blood sugar, and other cardiometabolic markers.⁹ 

Another small study found that women who were unresponsive to lifestyle modifications experienced significant weight loss, lower BMI, and minimal side effects when taking GLP-1s. They also saw better-fasting blood sugar, and 80% of the participants who responded to the medication also normalized menstrual cycles.¹⁰ 

PCOS is also linked to inflammation and increases the risk of cardiovascular disease. GLP-1s have been shown to have anti-inflammatory effects in the body and could help improve markers of inflammation and blood vessel function.¹¹

While this is all good news, it's important to remember that PCOS looks different for every woman, and GLP-1 medications like Ozempic aren’t for everyone. Most of the studies focus on those with obesity, so it’s not clear if GLP-1s can benefit those at a lower weight with insulin resistance or menstrual irregularities.

Ozempic vs Metformin for PCOS: Which Is Better?

Metformin is a medication used for PCOS for those with impaired blood sugar. It works by decreasing the liver's glucose production, reducing sugar absorption from food, and increasing insulin sensitivity. Along with lifestyle changes, metformin has been shown to lower BMI and body fat while improving inflammation and blood sugar.¹² 

Research on GLP-1s vs. metformin is still very limited for PCOS. Still, as you read above, one meta-analysis did find evidence that GLP-1s may be more effective in improving insulin sensitivity and BMI than metformin. However, the two medications performed the same for other outcomes like cholesterol, blood pressure, androgen levels, and menstrual cycle regularity. ⁹ One interesting study that looked at weight regain following GLP-1 use found that using metformin after 16 weeks of GLP-1 helped minimize weight regain after two years, so it could be that the two medications may complement each other.¹³

Metformin is not a weight loss drug, so Ozempic may be preferred if that is the goal. Both medications have side effects, and although metformin has been around longer and is considered safe, more research is needed to determine whether metformin or Ozempic is better for PCOS (and it likely depends on each person’s individual health history and needs).

Side Effects of Ozempic

Ozempic and other GLP-1’s have some significant side effects, although they appear generally tolerated in clinical trials.¹⁴ Your doctor can help you determine if these side effects outweigh the benefits for you (and some people, like those with a family history of certain thyroid cancers, aren't candidates for GLP-1s). Some of these side effects may be more pronounced when starting the medication but tend to decrease over time.

Mild side effects include (although these can be severe if dehydration occurs):¹

• Abdominal pain
• Nausea
• Vomiting
• Constipation
• Bloating
• Diarrhea
• Injection site reactions

More severe but also less common side effects include:

• Pancreatitis
• Gallbladder disease
• Acute renal failure 

<p class="pro-tip"><strong>Learn More: </strong><a href=ozempic-nausea-relief>How to Relieve Ozempic Nausea</a>.</p>

Ozempic for PCOS: What to Consider

Despite all the buzz and potential benefits seen in research, not everyone is a candidate for Ozempic or other GLP-1s. Some people don’t respond to the medication, so working closely with your healthcare provider is essential to decide if it’s a good choice for you.

Another consideration is the relationship between GLP-1s and eating disorders. Women with PCOS are already at higher risk of having an eating disorder, which is especially challenging when weight loss is the most common recommendation.¹⁵ Using these drugs can either trigger or worsen eating disorder behaviors. Some women with PCOS may even be scared to stop taking the drugs, even if they aren't a good fit due to side effects, because of a fear of weight regain. 

It's also important to keep in mind that taking Ozempic or other GLP-1s may mean a long-term commitment to the medication. Weight regain is common, so while these drugs can be a valuable tool in managing PCOS symptoms, they're not a magic fix.

Even with GLP-1s, lifestyle changes are considered the first line of treatment for PCOS, according to updated guidelines.¹² GLP-1s may have a place in treatment consideration, especially for those who have tried lifestyle changes and aren’t seeing significant changes, but they should not be seen as a standalone solution. 

Finally, if you are someone with PCOS who wants to become pregnant, it's important to understand that GLP-1s are not currently recommended for use during pregnancy. While research is ongoing, it may be best to discuss alternative treatment options with your healthcare provider or endocrinologist if you are planning or trying to conceive.

Do Health Insurance Companies Cover Ozempic for PCOS?

Since using Ozempic for PCOS is considered off-label, health insurance coverage may vary. A lot of people report challenges getting GLP-1s covered by insurance for off-label use, and it's possible that insurance companies may not cover the medication for PCOS treatment.

If you have PCOS and type 2 diabetes, your insurance may cover the cost of Ozempic for diabetes treatment, but not specifically for PCOS. It's essential to check with your insurance provider to understand their coverage policies and any potential out-of-pocket costs.

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