Beyond weight loss: Exploring the impact of weight loss medications on female reproductive health
It’s been less than two years since weight loss medications Wegovy and Mounjaro were approved in the UK to treat obesity. The GLP-1 receptor agonists work by reducing appetite and lowering blood sugar levels, to support weight loss.
Now, with nearly half a million people using them, there’s a continuous flow of research into their effectiveness, as well as how their use can affect other current and future health conditions.
The metabolic effects of weight management medicines extend beyond appetite regulation. Still, with more questions about their impact on the body asked every day, more in-depth analysis is being done. The impact on female reproductive health is one area being discussed that remains largely unexplored.
Last year, several articles were published where women on GLP-1 agonists believe they had gotten pregnant despite taking oral contraception, and the benefits of semaglutide for women with Polycystic Ovary Syndrome (PCOS) are being investigated.
In this article, I will discuss several evolving areas of research in this space, such as PCOS, menstrual regularity, ovulation, fertility, and sexual health.
The role of GLP-1 agonists in PCOS treatment
Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age, with approximately one in five women in the UK experiencing symptoms. Given the strong association between PCOS and insulin resistance, the potential role of GLP-1 receptor agonists in its management is now being actively explored.
GLP-1 medications enhance insulin sensitivity, reducing hyperinsulinemia – a key driver of androgen excess in PCOS. By improving metabolic function and promoting reduced body weight, these treatments may help to normalise hormonal imbalances, restore ovulatory function, and improve fertility outcomes.
Early clinical trials suggest that semaglutide may be a valuable addition to existing PCOS treatment options, particularly for patients who also struggle with their weight. However, as these medications were not originally designed for this indication, research is ongoing and it’ll be a while before we understand dosing regimens, long-term safety, and patient suitability.
I’m keeping my eyes peeled for PCOS being one of the next indications to be licensed for GLP-1s.
Disruptions in menstrual cycles
The menstrual cycle is a finely tuned process regulated by hormonal signalling between the hypothalamus, pituitary gland, and ovaries. Significant changes in energy balance, like restrictive dieting, intensive exercise, or medical intervention, can disrupt this cycle.
GLP-1 receptor agonists influence metabolic and neuroendocrine pathways, leading to fat loss and changes in energy availability. This can, in some individuals, result in menstrual irregularities, including delayed or missed periods. While clinical data remains limited, real-world evidence suggests that some women using these treatments experience a change in cycle length or intensity.
Our teams must monitor for any changes. While in many cases menstrual irregularities may resolve as the body adjusts to a new metabolic state, persistent disruptions require further assessment.
The impact on ovulation and fertility
The ovulatory function is closely tied to metabolic health. A significant caloric deficit can alter gonadotropin-releasing hormone (GnRH) secretion, reducing levels of luteinising hormone (LH) and follicle-stimulating hormone (FSH). This hormonal shift can lead to irregular or absent ovulation, potentially reducing conception rates.
In cases of substantial weight loss, usually meaning more than 10% of total body weight, studies suggest a 30-40% decline in fertility rates, largely due to anovulation.
For individuals using weight loss medications who wish to conceive, it is generally advised to discontinue treatment at least two months before attempting pregnancy. This supports resumption of normal ovulatory function as well as following the medicine’s licence. In clinical settings, this guidance should form part of a structured preconception care plan.
Libido and sexual wellbeing
Weight loss, achieved through metabolic regulation, rather than restrictive dieting, can positively affect self-perception, confidence, and overall wellbeing. For some individuals, this can translate into increased libido and improved sexual satisfaction, particularly where weight-related concerns have previously been a barrier to an enjoyable sex life.
However, not all patients report positive effects on sexual function. Some experience a transient decrease in libido, possibly linked to neurohormonal adaptations, stress responses, or reduced energy availability in the early stages of treatment. In clinical practice, these fluctuations should be acknowledged as part of our patient counselling.
As more patients choose a healthier future with the support of GLP-1 receptor agonists, a proactive approach to sexual health counselling is important when we review them.
Looking ahead
As the pharmaceutical industry continues to expand the indications for GLP-1 receptor agonists, their impact on reproductive health will be up for discussion.
Ongoing research will help inform our future treatment options around fertility, menstrual health, and long-term reproductive outcomes. For now, we must continue to provide a patient-centred approach, balancing the metabolic benefits of weight loss drugs with the potential implications for hormonal and reproductive function.
As demand for these treatments continues to rise, the role of pharmacists and our wider professional teams in educating and guiding patients will be more important than ever. By staying informed on the latest evidence and emerging therapeutic applications, the health community can ensure safe and effective use of weight loss medicines, delivering health benefits for so many in our population.
About the author
Kiran Jones is clinical pharmacist at Oxford Online Pharmacy. Jones is an experienced pharmacist with a passion for helping others. Her broad professional background includes hospitals, prisons, NHS, and private healthcare. Most recently, she was seconded to a professional sports team, advising on safe medicines for athletes and during 2021 she volunteered her time as a clinical lead administering COVID-19 vaccinations.
