Can Ozempic help with PCOS?

Ozempic (semaglutide) can be a game changer in helping people manage their type 2 diabetes and related metabolic issues like overweight and obesity. But the possible health benefits are more than meets the eye as researchers keep discovering new (off-label) uses for the drug, including Ozempic for PCOS (polycystic ovarian syndrome). 

The once-weekly injectable medication is a glucagon-like peptide-1 (GLP-1) receptor agonist. These drugs work for diabetes and weight loss by stimulating the release of insulin, which helps reduce blood sugar, and slowing down digestion, which decreases appetite, increases satiety, and reduces how much sugar gets released into the bloodstream.

So, how does Ozempic work for PCOS? Read on as we explore the potential benefits of taking Ozempic off-label for PCOS, including how it may help manage PCOS symptoms and improve fertility.

Yes, you can take Ozempic for PCOS—that is, of course, as long as it’s under the care of (and prescribed by!) a licensed healthcare provider. Keep in mind, however, that taking Ozempic for PCOS would be an off-label use of the medication. 

Ozempic is currently approved by the US Food and Drug Administration (FDA) to:

• Improve blood sugar control in adults with type 2 diabetes

• Reduce the risk of major cardiovascular events (e.g. heart attack, stroke) in adults with type 2 diabetes and cardiovascular disease

• Reduce the risk of end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease 

While there are some contraindications for Ozempic (including certain thyroid cancers and gastroparesis), PCOS is not one of them. So, if your healthcare provider thinks Ozempic could help you manage PCOS symptoms, they can prescribe it off-label.

What’s more, a growing body of research suggests Ozempic could be helpful in treating PCOS. How come? It helps to start with a basic understanding of the disorder. PCOS is not just a common endocrine condition but rather the most common one experienced by people assigned female at birth (i.e. women). It affects approximately 5%--15% of women between puberty and menopause worldwide.

It’s not clear what causes PCOS, and diagnosis can be a long, frustrating process for many people because the condition can look like many others, which have to be ruled out first. PCOS is also not a disease with a one-size-fits-all cure, and, as such, treatment largely consists of managing symptoms. 

Up to 70% of people with PCOS also have abdominal obesity, and what’s more, PCOS is commonly associated with comorbidities that include type 2 diabetes, cardiovascular disease, and hypertension. This means that some of the conditions commonly associated with PCOS—type 2 diabetes and obesity—are the very conditions that Ozempic is so good at treating. Plus, losing weight is one of the ways people are recommended to manage their PCOS symptoms.

However, it is important to keep in mind that Ozempic isn’t a cure-all for individuals with PCOS. The symptoms of this complex condition can vary from person to person, and not everyone experiences metabolic symptoms like obesity, insulin resistance, and diabetes. 

PCOS symptoms are typically managed with lifestyle adjustments, as no drugs are currently approved to treat PCOS specifically. Lifestyle modifications that can help with symptoms focus mainly on diet and exercise to help people lose weight and regulate their hormones.

Medications can help with some symptoms, too. Depending on the person’s symptoms and health needs, healthcare providers may prescribe some combination of combined oral contraceptive pills, anti-androgen medication (e.g. spironolactone), insulin-sensitizing medication (e.g. metformin), ovulation-inducing drugs (e.g. clomiphene), and even statins.

Many researchers say Ozempic and other GLP-1 agonists like Saxenda (liraglutide) and Byetta (exenatide) could soon be added to that list. By supporting weight loss, Ozempic and other GLP-1s could potentially help treat PCOS indirectly, says Karen Wheeler, MD, FACOG, a reproductive endocrinologist at Reproductive Medicine Associates (RMA) of Philadelphia. “More research is needed to determine the extent and to compare the improvements with standard therapies like oral contraceptive pills.”

Oral contraceptives can help reduce common PCOS symptoms such as irregular periods, acne, and excess hair growth, Dr. Wheeler says. But some people also struggle with weight gain. That’s because PCOS can affect hormone regulation and insulin sensitivity (i.e. the body’s ability to use insulin, the hormone that regulates blood sugar, efficiently). This can lead to increased appetite, fat storage, and metabolic changes that make weight management more challenging and weight gain a common occurrence. That’s where medications like Ozempic can help. 

Losing weight and regulating blood sugar are considered crucial to managing PCOS. While the exact relationship between PCOS and its associated health problems like obesity and hormonal imbalance is complex, weight loss with PCOS is associated with improvements in many PCOS symptoms. “Weight loss can cause changes in hormone levels,” Dr. Wheeler says. “Adipose, or fat, tissue produces hormones such as estrone, a form of estrogen. So, decreasing adipose tissue can cause changes in hormone levels.” 

Studies have shown that, among women with PCOS, losing weight can:

• Improve reproductive function

• Improve blood sugar regulation

• Reduce excess androgen hormones

• Lower cholesterol

• Improve hypertension

Weight loss may also improve infertility, which affects up to 75% of women with PCOS on some level. “It has been shown in several studies that even modest weight loss (5%--10%) improves fertility in PCOS,” says Neha Lalani, MD, a triple board-certified physician and CEO of Bluebonnet Diabetes and Endocrinology. “Therefore, it can be said—and it is seen in the real world as well—that patients who are treated with Ozempic and similar medications show improvement in fertility.” 

Indeed, a 2023 review of 11 randomized controlled trials found that women who used GLP-1s were 72% more likely to conceive naturally. However, “it is very important to note that GLP-1 agonists should be stopped prior to conception, sometimes up to two months prior to conception, as they have not been studied for use in pregnant women,” Dr. Wheeler adds. “Some animal studies showed decreased growth and fetal malformations when GLP-1 agonists were used during pregnancy.”

PCOS and insulin resistance frequently go hand in hand. Insulin resistance is estimated to affect between 50% and 70% of people with PCOS. 

Insulin resistance is a situation wherein a person’s body can’t use insulin effectively and, therefore, can’t regulate their blood sugar. Insulin, a key hormone created in the pancreas, is responsible for helping move sugar in the body's cells to make energy. With insulin resistance, the pancreas still makes insulin, but the body can’t use it as well to put away excess blood sugar. This means that blood sugar stays high, and much of the excess blood sugar gets stored as fat cells, increasing body weight and the risk of obesity. The elevated blood sugar can have negative effects on other areas of the body, including your nerves and blood vessels.

Not only is it associated with type 2 diabetes, but insulin resistance is also linked to issues such as hypertension, cholesterol, obesity, and liver disease, among others. So, blood sugar regulation is vital for managing insulin resistance with PCOS, improving obesity, and avoiding progression into more serious health problems. Lifestyle changes, including diet and exercise, are common first-line recommendations to help people to regulate their blood sugar. Salma Alsibai, RD, a registered dietitian at Online PCOS Nutritionist, recommends habitual modifications like:

• Having more frequent meals during the day

• Balancing the proportion of carbs and protein in a meal, favoring protein

• Increasing fiber intake

• Taking short walks after meals

Improving blood sugar balance can help lower insulin levels to a “normal range,” Alsibai explains. “This allows our bodies to more easily use our food for energy rather than store it as fat and burn fat stored in the body.”

Sometimes, however, certain lifestyle changes can’t be made or adjustments don’t make enough of a difference in addressing PCOS. In these scenarios, healthcare providers often prescribe a diabetes drug called metformin to regulate blood sugar. 

“Medications such as oral contraceptives, which bind up free androgens, or other medications, are also often necessary [to manage symptoms of abnormal hair growth or irregular cycles],” Dr. Wheeler says. (In case you’re unfamiliar, androgens are male sex hormones that, in excess, can contribute to the aforementioned common PCOS symptoms.)

Ozempic and other semaglutide-based medications often cause some minor side effects, but most people find that they are manageable and subside with time. Some clinical trials found that less than 4% of people stopped taking Ozempic because of gastrointestinal side effects. Depending on the follow-up time, this number may vary. Side effects also tend to be most noticeable when people increase their dosage and sometimes subside after people get used to the medication. Talk to your healthcare provider if you are experiencing side effects, as there are additional treatment strategies or medications you can take to manage many side effects and help you continue on treatment.

Most Ozempic side effects are gastrointestinal in nature and include:

• Nausea

• Vomiting

• Diarrhea

• Abdominal pain

• Constipation

Given this article’s about Ozempic and PCOS, a condition that affects women, it’s also worth noting that some of the drug’s side effects may be more common in females. While more research is needed, and the majority of what’s been done to date has focused on GLP-1s in general, findings suggest females taking GLP-1s are almost twice as likely to experience GI side effects like nausea and vomiting. 

Currently, Ozempic isn’t approved to treat PCOS, but recent research suggests it may help with symptoms. 

A small study of 27 women with PCOS found that after three months of treatment with Ozempic, they had lost nearly 17 pounds, on average. Nearly 80% of them lost at least 5% of their body weight and had their fasting blood sugar levels return to normal levels. In the 80% of women who lost at least 5% of their body weight, treatment was continued for an additional three months.  By the end of the study, after six months of total treatment, the women had lost an additional 8 pounds, and nearly 80% were experiencing regular menstrual cycles.

One more time for the folks in the back: No, Ozempic is not approved to treat PCOS. So, taking the medication for this reason is considered an off-label use of the drug. Currently, Ozempic is approved for three indications:

• To improve glycemic control in adults with type 2 diabetes, when used in combination with diet and exercise

• To reduce cardiovascular risk in adults with type 2 diabetes and heart disease

• To reduce the risk of kidney decline or failure or cardiovascular death in adults with type 2 diabetes and kidney disease

Will insurance cover Ozempic for PCOS? 

Usually, insurance only covers medication when prescribed for an FDA-approved indication. So, if you have type 2 diabetes and PCOS, you may be able to get insurance coverage for Ozempic. But if you are taking it off-label exclusively to treat PCOS, and you don’t have type 2 diabetes, you may have to pay out-of-pocket to fill your prescription.

Both Drs. Wheeler and Lalani stress the importance of getting regular exercise and following a balanced diet to treat PCOS and support sustained weight loss. Dr. Lalani recommends a diet low in carbohydrates and saturated fats and high in lean protein and fresh fruits and vegetables. 

Regular health checkups are also very important to monitor your symptoms, monitor your blood sugar levels, and screen for other complications such as type 2 diabetes. 

Depending on your condition and overall health status, your healthcare provider might also recommend the following anti-androgen medications (e.g. spironolactone) and/or oral contraceptives (think: birth control pill).

While Ozempic isn’t an FDA-approved treatment for PCOS, emerging research suggests it may help manage symptoms of PCOS, especially those related to weight gain and insulin resistance. Since PCOS is a complex condition with varied symptoms, treatment should always be personalized. If you're considering Ozempic for PCOS, talk to your healthcare provider about the potential benefits and risks.

• Ozempic is not FDA-approved for PCOS, though it can be (and often is) prescribed off-label to treat the endocrine condition, especially for those with common complications like obesity. Ozempic is currently indicated for type 2 diabetes and certain cardiovascular and kidney conditions. 

• Ozempic may help with weight loss, insulin resistance, and infertility in some cases; it can help regulate blood sugar and promote weight loss, which may improve PCOS symptoms. Some studies suggest Ozempic-driven weight loss may improve fertility in women with PCOS, but it should be discontinued prior to getting pregnant if possible.

• Alternatives to Ozempic for PCOS include lifestyle changes (think: diet, exercise), metformin, oral contraceptives, and other medications. All of these remain the primary treatment options for PCOS.

• There are some downsides to taking Ozempic for PCOS, including side effects and limited insurance coverage. Gastrointestinal side effects are common with Ozempic, and insurance may not cover Ozempic for PCOS unless prescribed for an approved condition.