Taking a GLP-1 for PCOS May Help With Symptoms. Here’s Why and What to Know

This story mentions weight, weight loss, and/or prescription GLP-1 drugs, which are FDA-approved for weight management in adults diagnosed with obesity or with overweight and at least one weight-related health condition. Recently, these medications have become extremely popular, in part due to off-label use. At SELF, our job is to present you—our reader—with science-backed information that you can use to guide the decisions you make about your body, which is why we wrote the article below.

While research suggests having a higher weight may increase your risk for certain conditions, people can be healthy at every size. The categorizations of obesity and overweight can contribute to weight stigma, and they are often based on body mass index (BMI), which is not an accurate measure of health. For some people, pursuing weight loss can be harmful, for instance by leading to weight cycling or increasing the risk of developing an eating disorder; for others, it may be helpful for addressing health concerns or simply having an easier time existing in a world with rampant anti-fat bias. These conversations require nuance, and we hope to provide it. Before taking any medication or making decisions about your health, talk to your doctor or a health care professional.

Postpartum can be an incredibly challenging time point-blank, but for Natalie Nirchi, the physical-emotional wallop of giving birth to her second child also came with a surge in her symptoms of polycystic ovary syndrome (PCOS), a chronic condition that involves too-high levels of sex hormones called androgens. “I had gained 2src-something pounds within a few weeks. My joints were aching. I was not able to sleep, then exhausted all day,” Nirchi tells SELF. She had also spent the previous several years struggling to conceive—a common issue for folks with PCOS because of how the hormonal disorder can futz with ovulation.

The reproductive endocrinologist who had helped Nirchi get pregnant prescribed her a GLP-1 drug to help with the weight gain. But within a few months of taking it, she didn’t just shed pounds; she wound up “feeling the healthiest I’d felt since my symptoms came on,” nearly a decade prior. The fog of pain, insomnia, and anxiety faded away. And her menstrual cycle, previously unpredictable, struck a regular cadence. She even conceived her third child without difficulty within about a month of coming off the medication a year later.

Emerging research on the potential benefits of GLP-1s—which include semaglutide (Wegovy and Ozempic) and tirzepatide (Mounjaro and Zepbound)—for treating PCOS suggests Nirchi may be far from alone in finding this type of drug life-changing. Though these medications are not currently FDA-approved for PCOS, a couple studies have found that in people with the condition who also have a higher weight, the drugs don’t just have a weight-loss effect but can also alleviate PCOS-specific symptoms like cycle abnormalities. In a recent survey of more than 1,7srcsrc people conducted by the birth control app Natural Cycles, 64% of women with PCOS who reported taking a GLP-1 saw more predictable periods, and 2src% said they had shorter bleeding days.

The reason why likely has to do with certain processes in the body that can both increase your weight and toss your hormones off-kilter, and how GLP-1s can affect them. Read on to learn why weight and PCOS can be so intricately intertwined, and how GLP-1 drugs might snap the feedback loop between the two and resolve symptoms along the way.

Weight gain and PCOS can have a tricky bidirectional relationship in some people.

As noted, PCOS symptoms generally happen when your ovaries produce an excess of androgens, or stereotypically “male” hormones like testosterone. The resulting hormonal imbalance can screw with your reproductive cycle, specifically the normal development of egg follicles, and leave you with a bunch of tiny fluid sacs (hence, “polycystic”). It can also make your periods irregular and trigger the hormonal fallout of acne, excess facial hair, scalp hair loss, and mood changes commonly associated with the disorder. Though doctors don’t know what initially causes PCOS, they have pinpointed a few processes that can drive the overproduction of androgens in the condition, one of which can have a simultaneous (and related) effect on weight in certain folks.

In particular, up to 7src% of people with PCOS have insulin resistance; that means your cells don’t respond well to insulin, the hormone that tells them to use glucose (a.k.a sugar) from food as energy, Christina Boots, MD, a board-certified reproductive endocrinologist at Northwestern Medical Group and associate professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. When insulin is ineffective, more glucose winds up floating around in your blood, which prompts your pancreas to overcompensate and produce even more insulin, Dr. Boots explains, as it tries to get your cells to pick up and use the excess sugar. All that insulin triggers your ovaries to pump out extra androgens, leading to PCOS symptoms. (High blood sugar levels can also cause prediabetes and up your risk for type 2 diabetes, both of which commonly co-occur with PCOS.) At the same time, your body stores the unused glucose as fat, which can prompt weight gain, Dr. Boots says.

A vicious cycle unfolds from there: Carrying more weight may pump up the size of your fat cells and trigger inflammation, both of which can make it even tougher for your cells to respond to insulin. Which again, spurs the production of excess insulin, and in turn, the surge of androgens that can trigger the full slate of PCOS symptoms. Those extra androgens can also “predispose you to weight gain, particularly the accumulation of fat around your middle,” for reasons we don’t quite understand, Basma Faris, MD, a board-certified ob-gyn at Mount Sinai West, tells SELF. Plus, all these metabolic shifts can screw with the hormones that regulate appetite, she adds, which can keep you from feeling full…and prompt you to eat more, further contributing to weight gain.

That said, it’s important to point out that just because weight gain may exacerbate PCOS doesn’t mean that it is the cause, Dr. Faris notes. Attributing someone’s PCOS solely to their weight creates unfair blame and shame, she says. In reality, there are likely genetic factors that may set you up for both weight gain and PCOS. There are also women with PCOS who do not have a high weight or the above metabolic dysfunction that can worsen the condition, Dr. Boots notes. But again, for those who do have PCOS and a higher weight, plenty of data suggests that the two can fuel and feed into each other.

GLP-1s may help break the vicious cycle of weight gain and PCOS symptoms in people who experience both.

The reason GLP-1s are “really exciting [for people with PCOS]” is because they can remove the barriers to weight loss that can keep people with the condition stuck in the above cycle, Kerry Krauss, MD, a board-certified ob-gyn in Philadelphia and medical director at Natural Cycles, tells SELF. In particular, the drugs can boost insulin sensitivity (in part by slowing the passage of food in the GI tract) and act on parts of the brain that influence appetite and cravings, all of which can reduce that never-quite-full feeling common in folks with PCOS.

These mechanisms help explain why GLP-1s appear to trigger a significant 12% to 18% weight loss on average. And studies have shown that in people with PCOS who have a higher weight, losing some of it can make a big difference. Why? It can kick off the opposite ripple effect as above: Less fat makes your cells more insulin-sensitive, which means your pancreas doesn’t have to produce so much of the stuff. That cuts down on androgen production in your ovaries—which unlocks PCOS relief. Fewer androgens means your ovaries can work how they’re supposed to, Dr. Faris says, which regulates your period. It can also resolve the acne, funky hair growth or loss, and other hormonal issues that can come with PCOS. (By contrast, other PCOS treatments just tackle a single one of these symptoms, Dr. Krauss says—a birth control pill for irregular periods, blood-sugar medication for prediabetes, or spironolactone for acne, for example.)

The GLP-1 effect was transformational for Shealy Long, who has struggled with her weight for much of her life. Her parents, who are both in the health care industry, were puzzled by her weight gain as a kid: “We did not have potato chips in our house; we were a hummus-and-carrots household, and active,” she tells SELF. Years later, a diagnosis of PCOS with insulin resistance would help shed light on why, even after eating a balanced meal, she’d still feel hungry; her A1C, a measure of blood sugar, was also teetering into prediabetic territory. At the urging of countless doctors, Long tried “calorie-counting, a Mediterranean diet, high-intensity workouts—but nothing was working,” she says. At the same time, her hair was falling out, she was constantly depleted of energy, she had irregular cycles, and she felt generally “not right.” But within a year of starting on Mounjaro, not only did she lose about 1srcsrc pounds (and reach a healthy weight for her), but her PCOS symptoms let up, her A1C went down, and the “clarity in my mind” came back, she says.

Now at roughly two and a half years on a GLP-1 (she’s been on a maintenance dose of Wegovy for the past several months), Long says the biggest game changer is the way it’s muted her constant “food noise.” Dr. Krauss, who has PCOS herself, has experienced a similar scenario on a GLP-1. She’s spent her life as “a yo-yo dieter,” she says, trying all of the popular weight-loss programs and even running literal marathons only to come up empty. But on a GLP-1, “all of a sudden…you’re like, ‘I don’t need to constantly be thinking, I’m hungry, but I can’t eat, but I need to,’” she says. “You can eat the amount of calories you need for your body but not feel like you’re depriving yourself.”

All of the doctors also point to a potential mental benefit in people with PCOS who lose weight on a GLP-1, and the positive chain of events that can follow. It can be gratifying to “see your body respond” to the work you’ve been putting in, especially when you feel like you’ve been “fighting a losing battle” against your hormones, Dr. Boots says. That can also be motivation to continue embracing (or start) a balanced diet and exercise routine, Dr. Krauss says. She notes that the majority of people in the Natural Cycles survey who took a GLP-1 also made lifestyle changes that may have played a role in the benefits they reported.

It’s also possible that GLP-1s can lessen PCOS symptoms in ways that aren’t directly tied to weight. For instance, boosting insulin sensitivity may help slow the production of androgens (and in turn, reduce PCOS symptoms) regardless of pounds shed. And that benefit might even extend to people with PCOS who don’t have a high weight but are insulin-resistant, Dr. Faris points out, though there’s scant research on using the drugs in this group. (Some evidence also suggests GLP-1s could influence the hormonal facets of PCOS in the brain too, but more research is still needed on that front.)

Doctors are hopeful that GLP-1s may get FDA approval for PCOS in the future—but these drugs aren’t the right option for everyone with the condition.

As mentioned, the majority of the research on GLP-1s for PCOS has been in folks who have a higher weight, so it’s not clear how much of the benefits would translate to people with the condition who fall at lower weights, nor is it known whether the latter folks can safely take these drugs. Some people might also experience some pretty rough GI-related side effects on them. Both Nirchi and Long point to things like nausea and constipation, particularly when starting the drugs or titrating up to a higher dose (but for them, the benefits have outweighed the downsides). People who are pregnant also aren’t advised to be on GLP-1s—which can be tricky if you’re treating your PCOS with the goal of upping your chances of conceiving, like Nirchi once was. Ultimately, if you’re interested in taking a GLP-1 for PCOS, you’d want to chat through all of these nuances with your doctor.

Both Dr. Faris and Dr. Boots also note that it’s important to pair a GLP-1 with a supportive nutrition and exercise plan (whether you’re taking it to mitigate PCOS symptoms or otherwise) so you don’t wind up nutrient-deficient or losing muscle mass.

Still, the big potential of these drugs to help crack an often debilitating chronic condition has all three doctors eager for FDA approval down the line. Right now, GLP-1s are just being prescribed off-label for PCOS (to people who meet the existing prescription criteria because of their weight and/or another related health condition). But that leaves the insurance landscape a little sticky—Nirchi has lost coverage or struggled to get a doctor to write the script on a couple occasions. “What I’m really hoping is to figure out a way to be on this long-term,” she says. Ever since getting back on a GLP-1 (Zepbound) in November for the third time, her symptoms have been totally under control. “I get to wake up and just worry about the normal daily tasks,” she says, “and not, ‘Am I going to be able to function today?’”

Related:

• 6 Things a Wonky Period Might Be Telling You About Your Health
• What’s Up With the Luteal Phase and Is It the Reason I’m in Hell Right Now?
• So You Just Missed Your Period But You’re Not Pregnant. Here’s What Might Be Going On

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