Dr. Ahmed PCOS (polycystic ovarian syndrome) is a common metabolic disorder in women. It is estimated to affect about 10% of women in their reproductive age. Until now, there has been no drug specifically approved for women with PCOS.
Different medications especially those that are associated with weight loss are being investigated to find an effective drug for women with PCOS.
Among the drugs that are associated with significant weight loss, Liraglutide (Victoza or Saxenda) and Semaglutide (Ozempic, Rybelsus, and Wegovy) seem to be the most effective drugs.
Drug treatment of PCOS:
The three cardinal features of women with PCOS are defined by the Rotterdam Criteria:
- Androgen excess
- Polycystic ovaries
- Ovulatory dysfunction
All the medicines that have a role in treating women with PCOS are targeting these three features of PCOS.
For example, women with excessive androgens are primarily treated with OCPs, Finasteride, Flutamide, or Spironolactone.
Women with menstrual irregularities are treated with oral contraceptive pills (OCPs).
In addition, symptomatic treatments for facial hair, acne, and induction of ovulation are given as required.
Here are the different drugs that are used to treat women with PCOS [Ref]:
Features of PCOS | Treatment of PCOS | |
| Androgen excess | First-line treatment | Hormonal contraceptives |
| Alternative treatment | Metformin + antiandrogens (spironolactone, Finasteride, Flutamide) | |
| Acne | First-line treatment | Topical clindamycin and vitamin A derivatives (isotretinoin) |
| Alternative treatment | Oral antibioticsOral isotretinoin | |
| Hirsutism (Facial hair) | First-line treatment | Hormonal contraceptives |
| Alternative treatment | Antiandrogens (Spironolactone)Eflornithine (Vaniqa) + laser therapy | |
| Irregular periods | First-line treatment | Hormonal contraceptives |
| Alternative treatment | Hormonal contraceptives | |
| Infertility | First-line treatment | Clomiphene Citrate |
| Alternative treatment | Metformin + Letrozole | |
| Insulin resistance | First-line treatment | Lifestyle intervention (Low-calorie diet + Exercise) |
| Alternative treatment | Metformin (+/- GLP-1 agonists like Semaglutide and Liraglutide) | |
| Weight loss | First-line treatment | Lifestyle interventions (low-calorie diet and exercise) |
| Alternative treatment | Medical treatment (for example Semaglutide and Liraglutide)Surgical treatment (Gastric Sleeve or Gastric bypass) | |
You can get a copy of the above table in PDF format here [Features and treatment of PCOS]
Victoza and PCOS:
Victoza is a GLP-1 analog that is indicated for the treatment of obese diabetic patients. In higher doses of 3 mg per day (Saxenda), it has been approved by the FDA for the treatment of overweight and obesity.
Victoza (Liraglutide) is not among any of the first-line treatment recommendations mentioned in the above table.
However, Victoza can help women with treatment-resistant PCOs in several ways:
How Victoza may help women with PCOS?
Victoza can help women with PCOS by the following mechanisms:
Improving insulin sensitivity:
The role of Liraglutide (Victoza) in the treatment of insulin resistance is controversial. In the LEAD-3 Trial, insulin resistance as measured by HOMA-IR was significantly reduced by 0.65% and 1.35% in patients who used 1.2 mg liraglutide and 1.8 mg liraglutide.
However, this effect was not observed in patients who used liraglutide in the LEAD-1 and Lead-2 trials [Ref].
It was also observed that the weight loss associated with Victoza is primarily visceral fat loss that is responsible for insulin resistance in women with PCOS.
The effect of Victoza on insulin resistance can be a result of visceral fat loss, direct insulin-sensitizing effect, and overall weight loss.
Weight loss:
Liraglutide in high doses i.e. 3 mg, marketed under the brand name, Saxenda, is an FDA-approved weight loss drug.
It is recommended for obese and overweight individuals who have at least one obesity-associated medical comorbid condition including PCOS.
Even in low doses of 1.2 mg and 1.8 mg, Victoza has resulted in significant weight loss compared to placeboes and other diabetes drugs like glimepiride and glibenclamide.
In the LEAD-3 trial, Victoza in a dose of 1.2 mg and 1.8 mg resulted in a weight loss of 2 kgs (4.4 lbs) and 2.5 kgs (5.5 lbs) respectively versus weight gain with glimepiride [Ref].
Weight loss is one of the key interventions in women with PCOS. Thus, Victoza may help women lose weight and treat PCOS.
Antiandrogenic effects:
Liraglutide has also been studied in women with PCOS who have had higher-than-normal baseline androgens.
Liraglutide intervention resulted in a reduction in the volume of ovaries, increased SHBG, reduced plasma levels of free testosterone, and improved the overall markers of ovarian function [Ref].
The effects of Victoza on body weight in women with PCOS:
Victoza has been associated with significant weight loss in women with PCOS. The weight loss effects could be the result of a direct effect on the stomach as it causes early satiety, and fullness, and may cause nausea, vomiting, and constipation.
Weight loss can also be the result of a direct effect of Liraglutide on the satiety centers in the hypothalamus.
In one trial, Liraglutide in a dose of 1.8 mg subcutaneously daily resulted in a weight loss of 5.2 kgs (11.68 lbs) in women with PCOS compared to the placebo.
The effects of Victoza on menstrual cycles in women with PCOS:
Victoza has been associated with a better outcome in women with menstrual problems and PCOS.
In a clinical trial, Victoza in a dose of 1.8 mg improved menstrual irregularities, amenorrhea, and bleeding ratio in a greater percentage of women with PCOS compared to those who were treated with placebo medicine.
It also improved ovarian morphology and ovarian function in women with PCOS [Ref].
The effects of Victoza on fertility in women with PCOS:
Liraglutide is associated with better hormones and normalization of periods in women. There is very little data on the effects of Liraglutide (Victoza) on fertility.
However, one study evaluated the role of Liraglutide in a dose of 1.2 mg daily plus metformin vs metformin alone in women with PCOS who underwent IVF (in-vitro fertilization).
The pregnancy rates were significantly higher in women with PCOS who received the combination of Liraglutide and Metformin (85.7%) vs those who received metformin therapy alone (28.6%).
In a total span of one year, the PR (pregnancy rates) in the combination group (Victoza plus metformin) was 69.2% vs 35.7% in the metformin alone group [Ref].
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