Ozempic for PCOS: How the new GLP-1 Might Help You

Ozempic is a novel GLP-1 analog. It is the injectable formulation of Semaglutide that is administered once a week.

Ozempic has been approved for the treatment of diabetes patients especially those who are obese. It has not been approved for the treatment of PCOS.

Rybelsus is the oral formulation of Semaglutide that has also been approved for obese diabetic patients.

Wegovy, like Ozempic, is an injectable formulation, administered once a week. However, Wegovy is the high-dose Semaglutide that is only approved for weight loss.

Is Ozempic approved for PCOS?

NO. Clinical trials are underway to assess the efficacy of Ozempic in obese patients with PCOS.

One such study has been registered that aims to assess the role of oral Semaglutide (Rybelsus) in a dose of 3 mg and 7 mg in obese adolescents and young adults who are between 12 and 21 years of age and have PCOS.

The study will primarily assess the role of Rybelsus in new-onset lipogenesis, insulin sensitivity, and the percentage of suppression of fatty acids in women with PCOS [Ref].

The study does not evaluate the effect of Rybelsus (Semaglutide) on androgen levels, weight, or ovarian function.

Other patients with diabetes, obesity, and PCOS have noticed an improvement in their symptoms of PCOS with Ozempic therapy, however, these claims can not be generalized.

Treatment of PCOS:

The three cardinal features of PCOS (Polycystic ovarian syndrome) as per the Rotterdam criteria are:

• Polycystic Ovaries
• Hyperandrogenism, and
• Irregular menstrual cycle

Until now, no drug has been approved for the treatment of PCOS. Treatment is directed towards symptomatic treatment and weight loss.

The following list of medications are being used as off-label medicines for the treatment of PCOS:

• Eflornithine:

  • It is used for the treatment of hirsutism and facial hair
  • Oral contraceptives are used for menstrual irregularities and heavy menstrual bleeding

• Metformin:

  • It is the most common medication utilized in the treatment of PCOS. However, it is not FDA-approved.
  • It may be given to obese or overweight patients with insulin resistance, diabetes, or pre-diabetes.

• Insulin sensitizing agents:

  • These include pioglitazone and rosiglitazone, D-chiro-inositol, and statins.

• Spironolactone:

  • Spironolactone suppresses steroidogenesis and has antiandrogen effects. It is primarily used for the treatment of facial hair and hirsutism.

• Finasteride and Flutamide:

  • It inhibits the enzyme 5-alpha reductase inhibitor which is responsible for converting testosterone into its active form.

• GLP-1 analogs:

  • GLP-1 analogs that have been tried in the treatment of PCOS include Exenatide and Liraglutide.
  • These drugs are used in individuals who have insulin resistance such as those with diabetes, pre-diabetes, and PCOS including lean patients with PCOS.

You can download the first-line and second-line treatment of patients with PCOS in PDF here: Features and treatment of PCOS

Here is a pic of the same PDF file:

How can Ozempic or Rybelsus help PCOS patients?

Most treatment strategies for PCOS are directed toward symptomatic therapies, such as menstrual irregularities, facial hair, and obesity.

Insulin resistance is very common in patients with PCOS. Patients with insulin resistance have hyperinsulinemia.

Hyperinsulinemia in turn leads to androgen production and impairs the release of GnRH (Gonadotropin-releasing hormone).

Because of these pathological processes, some clinicians routinely treat PCOS patients with insulin-sensitizing agents like metformin and GLP-1 analogs like Ozempic.

However, Insulin resistance is not universal and the use of metformin in non-obese individuals without dysglycemia has not resulted in any significant favorable effect in PCOS patients.

Ozempic for PCOS:

Contrary to metformin, GLP-1 analogs (Ozempic, Rybelsus, or Wegovy) might be more efficacious in the treatment of PCOS.

Ozempic and other GLP-1 analogs for the treatment of PCOS could exert their effects via the following mechanisms:

• Improved Insulin Sensitivity
• Reduce weight and insulin resistance
• Reduce abdominal fat
• Improved free androgen index
• Improved and regularized menstrual cycles
• Enhance ovulation

Ozempic and other GLP-1 analogs suppress appetite, reduce emotional eating, and reduce cravings for foods especially food rich in calories.

It has also been found that the levels of endogenous GLP-1 are low in patients with PCOS. Hence, GLP-1 treatment could have a physiological role in maintaining body homeostasis.

Ozempic for PCOS: Effect of Weight loss:

Ozempic, Rybelsus, and Wegovy are the three formulations of Semaglutide. These drugs are considered the most effective drugs for weight loss.

In clinical trials, patients lost up to 16% of their body weight with Semaglutide.

It has been found in clinical trials that 10% of bodyweight reduction is associated with improvement in most of the symptoms of PCOS.

Furthermore, with Ozempic, there is abdominal fat redistribution. This results in a reduction in the levels of adipokines and reduced activity of 5-alpha reductase.

Androgens are not activated to their active form. This improves the menstrual cycle irregularities and facial hair in patients with PCOS.

In conclusion:

Although Ozempic primarily exerts its effect by reducing body weight in patients with PCOS, it also increases insulin sensitivity, reduces androgen activation and biosynthesis, and regularizes menstrual cycles.