Should you take Ozempic for PCOS?

Despite only being FDA-approved for Type 2 diabetes, Ozempic is increasingly becoming a household name for quick weight loss. With scores of celebrities rumored to have slimmed down quickly thanks to the drug, it’s become a popular topic for both news outlets and social media, undoubtedly aided by the outspoken support of people like Elon Musk, who even posted a photo captioned “Ozempic Santa” on X on Christmas day, 2024. (The post featured a noticeably slimmed down Musk dressed in traditional Santa attire.)

Tech moguls and celebrities aside, Healthline reports that an estimated 13% of all Americans have now tried Ozempic or a similar-acting drug, such as Mounjaro (which is the drug Musk admittedly used for his own weight loss). With Ozempic’s effectiveness in lowering blood sugar and decreasing body fat, some women are also beginning to wonder if this powerful drug could prove to be a tool in treating PCOS.

What is Ozempic?

Ozempic’s active ingredient—the one responsible for its weight loss effects—is semaglutide, a GLP-1 agonist [1]. “GLP-1” stands for “glucagon-like peptide-1,” which is a hormone naturally produced by the small intestine to help regulate digestion. GLP-1 blocks glucagon (a hormone that works to raise blood sugar) and signals to the pancreas to release insulin. This in turn lowers blood sugar by signalling cells to take up glucose (sugar). (The effects on blood sugar are why Ozempic has been approved by the FDA specifically for the treatment of Type II diabetes.) 

GLP-1 also causes the stomach to empty more slowly, and is one of the hormones that lets your brain know you’re “full.” As a GLP-1 agonist, semaglutide activates GLP-1 receptors, increasing the effects of this hormone.

Names to know: Ozempic and Wegovy, Mounjaro and Zepbound

Notably, Ozempic is not FDA-approved for weight loss at this time. A Penn State Health News article helpfully explains the difference between Ozempic and Wegovy, which both contain the active ingredient semaglutide: “Both Wegovy and Ozempic are Semaglutide but at a different dose, with Wegovy being approved by the FDA for treatment of obesity.” 

Two other names to know when it comes to weight loss medications are Mounjaro and Zepbound, which contain the active ingredient tirzepatide. Similar to Ozempic and Wegovy, Mounjaro is only approved for Type 2 diabetes, while Zepbound is approved for weight loss. 

How does Ozempic make you lose weight?

Despite not being FDA approved for weight loss, Ozempic has undeniably become synonymous with slimming down. But how can a diabetes drug make you lose weight? 

People with insulin resistance have cells that are less responsive to insulin. As a result, there is more sugar in their blood than there should be. By activating GLP-1 receptors, food digests more slowly to reduce blood sugar spikes, and more insulin is produced to combat insulin resistance. In addition, slowed digestion contributes to lower appetite and feeling full longer—which means that people on Ozempic end up eating far less than they did prior to starting Ozempic, ultimately leading to weight loss. In other words, Ozempic functions as a powerful appetite suppressant. 

Why Ozempic might be relevant as a PCOS treatment option

Insulin resistance is a common symptom in women with Polycystic Ovary Syndrome (PCOS). Excess blood sugar as a result of insulin resistance contributes to increased fat storage plus increased cravings and appetite, further contributing to easy weight gain. Weight gain, in turn, tends to exacerbate PCOS symptoms, leading to a frustrating, seemingly never-ending struggle with weight management. 

Because of this, a common approach for treating PCOS is to treat it like Type 2 diabetes, with the goal of managing both weight and blood sugar. Until now, this typically meant prescribing metformin to women suffering with PCOS. Now GLP-1 agonists have become a second option, and some preliminary studies suggest that GLP-1 agonists may be even more effective than metformin. 

Ozempic vs. metformin for women with PCOS

A 2017 randomized controlled trial comparing metformin to a GLP-1 agonist found that obese women with PCOS who took the GLP-1 agonist lost an additional 2 kg (4.4 lbs), had more frequent menstrual cycles, and had a higher rate of achieving pregnancy (43.6% vs. 18.7%) over the 12-week treatment course [2].

In a small 2023 study on the effect of semaglutide on obese PCOS patients who did not see improvement with lifestyle changes alone, 80% of participants lost at least 5% of their body weight over three months [3]. The same number of patients also experienced more normal blood sugar and menstrual cycles.

Potential concerns with Ozempic for PCOS

According to the Ozempic website, the most common side effects are nausea, stomach pain, constipation, diarrhea, and vomiting. The less-common (but more serious) side effects listed include pancreatitis, changes in vision, low blood sugar, kidney failure, allergic reactions, gallbladder problems, and thyroid cancer. Although rare, people with pre-existing conditions related to pancreatic, kidney, or gallbladder health may be more at risk of these effects. 

For some people, GI effects like diarrhea and nausea can be severe and make it difficult to continue with Ozempic. However, even if a person is able to physically tolerate Ozempic, the cost alone can be enough to cause an upset stomach. According to Medical News Today, a single dose of Ozempic retails for over $900, meaning that regular injections of the drug can cost patients thousands of dollars per month. While most insurance companies cover GLP-1 treatment for Type 2 diabetes, they may not cover the cost for patients who experience insulin resistance from PCOS, but who do not have a diabetes diagnosis. 

Ozempic shares this side effect with bariatric surgery

Interestingly, the significant weight loss many people experience with Ozempic may lead to some of the same complications as bariatric (weight loss) surgery. One such complication is loss of muscle mass (not just fat) as part of total weight loss. A 2024 analysis in The Lancet Diabetes & Endocrinology found that of the total weight lost on GLP-1 receptor agonists over 36-72 weeks, 25-39% represented lost muscle mass (rather than fat loss) [4]. 

Ozempic may also lead to bone density loss, which is a key concern for women, who naturally lose bone density as they age. (It should be noted, however, that muscle and bone density loss are possible with any significant, rapid weight loss, not just weight loss caused by drugs like Ozempic.) Increasing protein intake and physical activity are two ways to counteract the effects of the significant, potentially rapid, muscle and bone density loss associated with rapid weight loss. 

Women with lean PCOS should use caution with Ozempic

In addition, while the majority of women with PCOS have a higher-than-normal BMI, 1 in 5 women with PCOS do not. For women with “lean” PCOS, while Ozempic can help to regulate blood sugar, the appetite suppression that occurs with GLP-1s may contribute to being underweight.

Health is more than a number

Overall, GLP-1s can be very effective in reducing blood sugar and helping to shed some pounds. However, one of the primary ways GLP-1s reduce weight is by suppressing appetite and helping people to eat less food. In eating less food, it becomes even more important to pair GLP-1 treatment with lifestyle changes to ensure that less food doesn’t equate to malnutrition. 

Especially since anti-inflammatory diets have been shown to have a positive impact on PCOS symptoms, choosing the right kinds of food can make a big difference in treating PCOS at a fundamental level. Exercise, aside from being important in weight management, is also a key mechanism for further reducing inflammation–and regular exercise is also known to improve insulin sensitivity and blood sugar levels. 

Eating habits also tend to be intertwined with stress management, body image, and a person’s relationship with food, all of which need to be addressed when setting goals around such a fundamental activity as eating. 

Rebound weight gain is likely if Ozempic is discontinued

Many people may wonder if they can take Ozempic short-term to lose a certain amount of weight, and then stop it. Short-term Ozempic may only be able to offer temporary weight improvements, as “rebounds” are common after discontinuing treatment. A 2022 study following 327 patients one year after discontinuing semaglutide treatment found that participants regained an average of two-thirds of the weight lost during treatment [5].

Biologically, our bodies tend to resist efforts at weight loss and hold onto the weight we have gained (as many people can attest to from personal experience) [6]. Lifestyle changes are still important because they help prevent further complications, but research to date suggests that diet and exercise modifications alone are often insufficient to keep the weight off once a person has already struggled with obesity, and this is especially the case if 60 or more pounds were lost. For this reason, those experienced in obesity management increasingly refer to obesity medications like Ozempic as lifelong medications, similar to maintenance medications people take for heart disease, diabetes, and other chronic conditions. 

Takeaways for Ozempic and PCOS

Easy weight gain and insulin resistance are two of the most common symptoms of PCOS, symptoms that Ozempic directly counteracts. For women who have not seen results with lifestyle changes alone or who are looking for an alternative to metformin for blood sugar management with PCOS, Ozempic may be a promising option–although as of this writing, using Ozempic to manage PCOS is an off-label use (i.e., the drug is not yet approved by the FDA for this purpose).

While Ozempic could prove to be an effective treatment option for women with PCOS, it must be paired with a healthy diet and lifestyle to maintain overall health and further minimize PCOS symptoms–and if one has any hope of ever discontinuing the drug without seeing rebound effects. As with any drug, the potential risks and benefits must be weighed for each person and their unique medical history and situation. 

What’s more, Ozempic and metformin are not the only treatment options for PCOS, nor will they necessarily deal with every issue caused by PCOS. Supplementing with myo-inositol may improve insulin sensitivity and there are also surgical options available for treating PCOS. Finding a healthcare professional trained in restorative reproductive medicine can help you understand and navigate the treatment options available to you.

References:

[1] Campbell JE, Drucker DJ. Pharmacology, physiology, and mechanisms of incretin hormone action. Cell Metab. 2013 Jun 4;17(6):819-837. doi: 10.1016/j.cmet.2013.04.008. Epub 2013 May 16. PMID: 23684623.

[2] Liu X, Zhang Y, Zheng SY, et al. Efficacy of exenatide on weight loss, metabolic parameters and pregnancy in overweight/obese polycystic ovary syndrome. Clin Endocrinol (Oxf). 2017 Dec;87(6):767-774. doi: 10.1111/cen.13454. Epub 2017 Sep 13. PMID: 28834553.

[3] Carmina E, Longo RA. Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. J Clin Med. 2023 Sep 12;12(18):5921. doi: 10.3390/jcm12185921. PMID: 37762862; PMCID: PMC10531549.

[4] Prado CM, Phillips SM, Gonzalez MC, Heymsfield SB. Muscle matters: the effects of medically induced weight loss on skeletal muscle. Lancet Diabetes Endocrinol. 2024 Nov;12(11):785-787. doi: 10.1016/S2213-8587(24)00272-9. Epub 2024 Sep 9. PMID: 39265590.

[5] Wilding JPH, Batterham RL, Davies M, et al. STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.

[6] Müller MJ, Enderle J, Bosy-Westphal A. Changes in Energy Expenditure with Weight Gain and Weight Loss in Humans. Curr Obes Rep. 2016 Dec;5(4):413-423. doi: 10.1007/s13679-016-0237-4. PMID: 27739007; PMCID: PMC5097076.