Does Ozempic interfere with birth control?

The popularity of Ozempic for weight loss is increasing and with more people trying the medication, more experiences are surfacing when it comes to the interaction between this class of drugs, known as GLP-1 agonists, and birth control. And while the FDA hasn’t explicitly published any reported interactions between these pound-shedding shots and birth control, the question of whether they may affect each other is a little more complicated.

There are anecdotal reports on social media about people becoming pregnant while taking Ozempic despite taking birth control pills. Could there be an interaction? Continue reading to learn more about what researchers know so far about Ozempic, birth control, and pregnancy.

The bottom line is this: Ozempic works by slowing the passage of everything through the digestive system and that includes any pills taken by mouth. Theoretically, that could mean it would affect the levels of the medication in the bloodstream, potentially affecting the medication’s effectiveness when it comes to preventing pregnancy. But in practice, that doesn’t seem to be true. 

The prescribing information from the manufacturer Novo Nordisk describes Ozempic’s “potential to impact the absorption of concomitantly administered oral medications,” explaining that “in clinical pharmacology trials, semaglutide did not affect the absorption of orally administered medications to any clinically relevant degree. Nonetheless, caution should be exercised when oral medications are concomitantly administered with Ozempic.” 

And in regular words? Trials didn’t show any specific issues with medications taken by mouth among people using Ozempic but doctors should keep the possibility of delayed absorption in mind. 

Beyond that, the manufacturer of Ozempic did studies specifically looking for interactions between semaglutide (the active ingredient in Ozempic) and ethinyl estradiol and levonorgestrel—two common active ingredients in many combined oral contraceptive pills (Seasonique, Sronyx, Lessina, Altavera, and others.). And while the drug’s label showed that semaglutide had a small effect on the levels of ethinyl estradiol/levonorgestrel in patients’ systems, it wasn’t enough of an effect to warrant a dosage change recommendation. 

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Birth control pills are commonly used to prevent pregnancy and studies report 99% effectiveness with perfect use. That means that 1 in 100 people using oral contraceptives will get pregnant each year even if they take their pill religiously at the same time every day. But in reality, the numbers are a little fuzzier and hover closer to 93% effectiveness, meaning 7 out of every 100 people using oral contraceptives will get pregnant in a given year. The reason for the gap? There are a few. First of all, people frequently forget to take their medication. Also, some types of birth control, like the mini pill, have to be taken at the same time every day, making them ripe for misuse. And beyond that, if you throw up after taking your pill, it may make the pill less effective. 

So when isolated social media reports of people on Ozempic and birth control include tales of accidental pregnancy, it can be difficult to understand if there’s any issue here that might affect other people using both medications, or whether these individual experiences were just that—individual experiences. 

No matter what, after drugs go on the market, researchers and pharmaceutical companies continue to evaluate their safety and effectiveness, and that includes interactions with other medications or reported side effects. So as the market for drugs like semaglutide (brand names Ozempic and Wegovy) increases, we may hear more on the subject and guidelines might change.

While no evidence suggests Ozempic interacts with birth control directly, some of its side effects might affect how effective the medication is at preventing pregnancy. Theoretically, vomiting and diarrhea, both of which are side effects of Ozempic and other GLP-1 agonist medications, can reduce the effectiveness of birth control pills. 

In clinical trials, vomiting occurred in 5-9.2% of people who received Ozempic, compared to 2.3% of people who got a placebo. Diarrhea was reported in nearly 9% of Ozempic users in these trials, while just under 2% of placebo users had diarrhea. Fortunately, these side effects usually ease with continued use of the treatment.

Since vomiting shortly after taking a birth control pill can limit its effectiveness, there may be some underlying truth to reports of more contraceptive failure in people using oral contraceptives who are also using Ozempic. 

No matter the source of vomiting or diarrhea, the CDC recommends using a backup contraceptive method (such as condoms) or abstaining from sex for 7 days if you experience continuous vomiting or diarrhea for 48 hours or more after taking your birth control pill. 

So when it comes to birth control methods for people using Ozempic or other GLP-1 agonists, you can continue using oral contraceptives if they’re working for you––especially if you are among the vast majority of GLP-1 users who don’t experience vomiting or diarrhea. If you’re worried, you can talk to your doctor about alternative non-oral contraceptives such as the vaginal ring, the implant, an IUD, or the shot. 

Ozempic and Wegovy are both not recommended for women who are pregnant or actively trying to conceive. Women should stop taking Ozempic at least 2 months before trying to get pregnant in order to reduce the chance that a developing fetus might be exposed to the drug.  

This recommendation is based on animal studies in which semaglutide was associated with harmful effects on animal pregnancies and fetuses, such as fetal abnormalities, pregnancy losses, and growth changes in rats, rabbits, and monkeys. And while these studies don’t directly translate to what might happen in humans, the drugs should not be used during pregnancy in humans. 

If you find out you’re pregnant while using Ozempic, contact your healthcare professional right away. They’ll likely have you stop taking it. Eating a healthy diet and keeping active during pregnancy are good ways to avoid excessive weight gain during pregnancy. 

While the current recommendation is to stop Ozempic before trying to conceive or as soon as you learn you are pregnant, new data could potentially inform a different recommendation in the future. An ongoing study is currently collecting information about the use and safety of semaglutide during pregnancy.

A recent case report showed no harmful effects after a woman with type 2 diabetes took liraglutide (similar to semaglutide) during the first trimester of her pregnancy. The woman gave birth to a healthy child without experiencing any pregnancy complications. However, this is only one example, which isn't adequate to prove the safety of GLP-1 agonists in pregnancy.

Speak with a healthcare professional to discuss the risks versus benefits of taking Ozempic for diabetes or weight loss in consideration of your unique situation.

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Current version

July 26, 2023

Written by

Patricia Weiser, PharmD

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.