PCOS and GLP-1 RA’s

Written By Dan Veranth

GLP-1 receptor agonists (GLP-1 RAs) have shown benefit for individuals with polycystic ovarian syndrome (PCOS) due to their effects on weight management, insulin resistance, and metabolic health, which are common issues in PCOS.  Here’s how they relate:

1. Weight Loss

  • Many individuals with PCOS struggle with obesity or being overweight, which can exacerbate symptoms like irregular menstrual cycles, infertility, and hyperandrogegism.

  • GLP-1 RAs such as semaglutide and tirzepatide, and others, promote weight loss by reducing appetite, slowing gastric emptying and enhancing satiety (feeling full)

  • Weight loss can significantly improve PCOS symptoms and overall metabolic healthIt is known that 10% loss of body weight is linked to return of regular menstrual cycles 80% of the time, ie regular ovulation which enhances fertility

2.  Insulin Resistance

  • Insulin resistance is a key feature of PCOS, leading to hyperinsulinemia and contributing to:

  •  Anovulation (irregular ovulation which leads to irregular menstrual cycles)

  •  Elevated Androgen levels which leads to hair growth - ie chin, areola, upper lip-called hirsutism and leads to worsening acne

  • GLP-1 RAs improve insulin sensitivity and help regulate blood sugar levels, which can address the underlying metabolic dysfunction

3.  Hormonal Regulation

  • By reducing insulin levels, GLP-1 RAs can indirectly decrease androgen production from the ovaries and from adipose tissue (fat tissue). This can help alleviate symptoms like acne, hirsutism (the excess hair growth), and male pattern hair loss in PCOS.

4.  Impact On Fertility

  • Weight loss and improved insulin resistance can restore ovulatory cycles, improving fertility in women with PCOS.  While GLP-1 RAs are not directly indicated for fertility treatment, their metabolic benefits can support reproductive health.

GLP-1 RAs are often prescribed “off label” for PCOS because of their overall benefit with all of the above including but not limited to weight loss, return to regular ovulatory cycles/regular periods, decrease androgen production from ovaries and from less adipose tissue (fat tissue) that comes with the weight loss which helps improve acne and helps improve the hirsutism (hair growth).

-Tyler Handcock MD

Dan Veranth
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