Wegovy, Mounjaro, and Ozempic can all be used to treat type 2 diabetes, but they also show promise in treating polycystic ovary syndrome (PCOS). Here's what you need to know.
In this article:
- How do medications like Ozempic work?
- How fast does semaglutide work?
- How Weight Loss Drugs Went Mainstream
- A Note on Eating Disorders & Mental Health
- Using Weight Loss Drugs for PCOS
- FAQs About Ozempic, Mounjaro & Wegovy
- The Downsides of Semaglutide
- Can drugs like Wegovy cause thyroid cancer?
- Alternative Treatment Options
- The Bottom Line
How do medications like Ozempic work?
Injectable medications like Ozempic, Wegovy, Mounjaro, Saxenda, Victoza and others are part of a category of medications called glucagon-like peptide 1 (GLP-1) receptor agonist (RA) based therapies.
They affect glucose control through four main mechanisms:
- Improving insulin secretion: Insulin is released from the pancreas when eating to help blood glucose levels stay stable.
- Slowing gastric emptying: Food stays in the stomach longer and is better absorbed as it moves more slowly through the intestines.
- Lowering glucagon secretion: Glucagon is secreted from the pancreas, which tells the liver to send glucose into the blood. Therefore, reducing glucagon helps keep blood glucose levels stable between meals.
- Promoting a feeling of fullness: Incretin receptors in the brain get a signal that tells the body it has reached a state of fullness, which then leads the person to stop eating.
How fast does semaglutide work?
Every person's body and lifestyle are different, so there will always be some fluctuations in the time frame you can expect medications to take effect. Generally speaking, it takes around 8 to 12 weeks of steady use for semaglutide, liraglutide, tirzepatide or other GLP-1 RA medications to begin working.
The History of GLP-1 Medications
The first GLP-1 RA was exenatide (Byetta), which was approved by the U.S. Food and Drug Administration (FDA) in 2005 for the treatment of type 2 diabetes. It is short acting and taken by twice daily injections.
Daily injectables like liraglutide (Victoza) were then developed.
Tirzepatide (Mounjaro) is the only one of these medications that is both a GLP-1 and GIP agonist, and is the latest drug to hit the market. There is currently only one oral GLP-1 RA, an oral semaglutide marketed under the brand name Rybelsus.
How Weight Loss Drugs Went Mainstream
These medications (particularly Ozempic, Wegovy, and Mounjaro) quickly gained attention after celebrities began using them for cosmetic weight loss. Unfortunately, this has led to an extreme shortage of the drugs for those who genuinely need them.
The media frenzy over these so-called "weight loss drugs" has also resulted in pharmaceutical companies tightening restrictions on who is able to access the medications, leading to rejections of valid prescriptions, delays in treatment, and other issues.
Let's break down how GLP-1 medications can help with weight loss, and which drugs are currently being utilized for weight management.
Is Ozempic approved for weight loss?
While many people have utilized Ozempic off-label for weight loss, it still hasn't been approved for this use by the Food and Drug Administration (FDA). Ozempic is FDA-approved to treat type 2 diabetes.
Is Wegovy approved for weight loss?
Wegovy (semaglutide) was FDA-approved for weight loss in 2021. Wegovy and Ozempic are essentially the same medication - Wegovy is simply available in higher doses than Ozempic.
Is Mounjaro approved for weight loss?
In May 2022, Mounjaro was approved by the FDA for the treatment of type 2 diabetes. While it is not yet approved to treat obesity, it is already being used off-label for weight loss, and is expected to be FDA-approved for this purpose within the year.
A Note on Eating Disorders & Mental Health
It is important to acknowledge that for people with a history of disordered eating, GLP-1 medications may trigger or worsen their illness - primarily due to the psychological side effects that often accompany weight loss and reduced appetite.
In addition, the majority of people who stop taking GLP-1 drugs end up regaining the weight they may have lost. This can lead to weight cycling, which has been shown to cause fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids and insulin.
You should always discuss your full medical history with your healthcare provider to ensure the treatment you are considering will be helpful, not hurtful.
Get support: Working with a counselor and a nutritionist that are familiar with eating disorders can help to mitigate these issues and maintain your mental health. You can also access free, virtual eating disorder resources through the National Eating Disorders Association (NEDA).
Using Weight Loss Drugs for PCOS
PCOS is a condition that affects each individual differently, and doesn't always present the same way. It is important to individualize the treatment of PCOS - always consult with a reproductive endocrinologist to see if GLP-1 medications like Ozempic are right for you.
Since there is no cure for PCOS, the goal is to address the symptoms that an individual is experiencing so that they can live the most full, healthy life possible.
How can these medications help with PCOS?
Many people with PCOS have insulin resistance (IR), which is a health issue involving glucose and insulin metabolism. Medications like Ozempic and Mounjaro work effectively to increase insulin sensitivity and production, and can be an excellent tool for those with PCOS.
In addition to helping with insulin resistance, these medications can benefit those with PCOS in other ways: by promoting weight loss, regulating menstrual cycles, reducing chronic inflammation, and lowering the risk of cardiovascular disease and non-alcoholic fatty liver disease, conditions that can be associated with PCOS.
Irregular Menstrual Cycles & Fertility
Having a higher BMI can contribute to having irregular cycles. As little as 5% body weight loss can sometimes help to regulate those cycles. Since these medications promote weight loss, a person's menstrual cycles may also become more regular as a result.
Increased cycle regularity can in turn lead to improved fertility, making it easier for some people with PCOS to conceive.
FAQs About Ozempic, Mounjaro & Wegovy
There's a lot to learn when it comes to understanding GLP-1 medications. Below are some of the most commonly asked questions about this unique class of prescription drugs.
Can you take Ozempic and Metformin together?
Yes, GLP-1 RAs can safely be combined with Metformin. The risk of hypoglycemia with this combination is small.
Is Ozempic safe for pregnancy?
In short, no - Ozempic and other GLP-1 RA medications have not yet been proven to be safe in pregnancy. More clinical trials in humans are needed to properly evaluate the reproductive effects of these drugs.
However, medications like Ozempic and Mounjaro can be helpful in the time leading up to pregnancy, which is the perfect time to optimize your health. These medications could, in fact, improve your fertility, especially if they help restore cycle regularity.
Note: Always discuss any plans to conceive with your physician before beginning any medication, as these medications have shown potential harmful effects in animal studies. It is recommended that these drugs be discontinued at least two months prior to conceiving due to the potential risks of miscarriage and birth defects.
Does semaglutide lower inflammation?
GLP-1 based therapies have been shown to have anti-inflammatory effects in several organs, tissues and cells. These areas include the lung, brain, liver, pancreas, vascular system, kidneys, and others. PCOS has been associated with chronic inflammation, but the evidence for the link is inconclusive and the causal relationship also unclear.
Obesity and insulin resistance are also associated with increased inflammation. Some people with PCOS and high BMI also struggle with lipedema or lymphedema, which have improved in many cases with the use of GLP-1 agonist medications.
The Downsides of Semaglutide
While semaglutide and other GLP-1 RA medications can have many of the positive side effects mentioned above, there are negative side effects that are important to consider as well. Here are some of the most common issues patients encounter:
A 2022 study of semaglutide showed that when participants stopped treatment, they regained ⅔ of their prior weight loss. In addition, their blood pressure increased back to baseline levels and lipid levels increased.
In short, the positive effects of such drugs should only be expected while in use, and lifestyle modifications are essential to sustain these benefits long-term.
Unpleasant Side Effects
The side effects of GLP-1 RAs are primarily gastrointestinal, and often include nausea, vomiting, diarrhea, bloating, and belching. Some people have experienced such severe nausea and vomiting that they became dehydrated and required medical attention.
Less commonly associated side effects include hypoglycemia, acute pancreatitis, increased risk of gallbladder and biliary diseases, renal insufficiency or acute renal failure, retinopathy, and thrombocytopenia (low platelet count).
What is pancreatitis? Pancreatitis refers to inflammation of the pancreas, a gland behind the stomach. The condition occurs when digestive enzymes activate and attack the pancreas, and can lead to organ damage if untreated.
Can drugs like Wegovy cause thyroid cancer?
Research on the topic is still fairly limited, meaning it is unclear whether the same effect is present in humans. However, in rodent studies, some of these medications were associated with both benign and malignant thyroid C cell tumors.
Note: If you have a family history of a certain type of thyroid cancer (medullary thyroid carcinoma), you should not use these medications.
Alternative Treatment Options
While GLP-1 medications can be helpful tools, it's important to understand the potential risks and side effects associated with these drugs. You should always consider all available treatment options and discuss any concerns with your doctor.
Here are some alternative medications and supplements to explore:
Treatments for Diabetes
All GLP-1 RAs are FDA approved for treating diabetes. It is important to note that Ozempic is not used to treat type 1 diabetes, and is not insulin.
However, there are alternative medications to treat diabetes, such as insulin, Metformin, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose co-transporter 2 (SGLT2) inhibitors, meglitinides, thiazolidinediones and alpha-glucosidase inhibitors. A medical endocrinologist specializes in managing the treatment of diabetes.
Treatments for Obesity
Two GLP-1 RAs (semaglutide and liraglutide) have also been approved for the treatment of obesity. Tirzepatide (currently marketed under the brand name Mounjaro) is anticipated to be approved for the treatment of obesity within the year.
Treatments for Insulin Resistance
If insulin resistance is the primary concern, alternative supplements include inositol and berberine. Here's how they can help with symptoms of PCOS.
- Inositol is a sugar made in the body and found in foods (such as citrus fruit, beans, and cantaloupe). D-chiro and myo-inositol may improve reproductive and metabolic abnormalities associated with PCOS.
- Berberine, an alkaloid found in the root, fruit, or bark of plants like barberry, Oregon grape, goldenseal, and tree turmeric may help to lower cholesterol, triglycerides, and blood sugar levels.
The Bottom Line
If you are interested in learning whether you are a good candidate for a GLP-1 RA, and are working with a reproductive endocrinologist (like our team here at Illume Fertility), ask for a referral to a medical endocrinologist they trust. There are even specific centers that focus on medical weight loss. Some primary care providers can also prescribe these medications.
You should carefully consider all available treatments, talk to your doctor, and understand the various risks and benefits of medications like Ozempic, Wegovy, and Mounjaro.
They can be helpful tools for some people with PCOS, particularly when it comes to managing insulin resistance and chronic inflammation, but they aren't your only option.
Dr. Ilana Ressler is a board-certified OB/GYN and reproductive endocrinologist who joined the Illume Fertility team in 2017. Dr. Ressler has a special interest in treating patients with PCOS and advocating for ovarian and breast cancer awareness in the Jewish community through her advocacy work.