How Does Ozempic Help With PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine condition characterized by reduced fertility, elevated androgens, multiple cysts on the ovaries, and, in many cases, insulin resistance.

Insulin resistance both causes and is exacerbated by weight gain, and it can often develop into type 2 diabetes. Because of this, metformin has been used as a treatment for PCOS for some years.

But what about Ozempic?

What is Ozempic?

Ozempic is a GLP-1 receptor agonist, specifically semaglutide, that is typically used in patients with type 2 diabetes that are not able to control their condition with diet and exercise. It is usually prescribed to people who cannot take metformin.

It is sometimes taken as a weight loss drug by people who do not have diabetes, and problems can occur if it is used without medical supervision. However, some doctors do prescribe similar medication to treat obesity.

How does PCOS relate to insulin resistance?

While it is often seen as a female infertility syndrome, PCOS is an endocrine disorder that can affect the entire body. Hyperinsulinemia (excessive insulin) induces excess androgen production and also affects other reproductive hormones.

The vast majority of patients with PCOS have insulin resistance, even if they are not overweight or obese. Some experts say that all PCOS patients should be treated for insulin resistance by default. This can help keep insulin resistance from progressing to diabetes and can also help with weight loss, fertility, and protecting the heart.

How is insulin resistance treated?

Insulin resistance is traditionally treated by lifestyle modification, diet, and exercise. The goal is to lose weight. Even a slight loss of weight can dramatically improve PCOS symptoms and increase your chances of getting pregnant. No diet has been shown to be better than another to treat PCOS-related symptoms, and some people may have to try more than one to find what works for them. It is also important to make sure that the lifestyle changes you make are sustainable. 

One diet that does appear to work well for many is the Mediterranean diet, which is also good for your overall health. The best diet, though, is the one you are happy to stick to in the long term. Fad diets, crash diets, and fasting should be avoided, as you tend to put more weight back on once you stop dieting.

Exercise on its own also appears to improve PCOS symptoms. For many people with PCOS, however, diet and exercise are not enough on their own. 

Traditionally, most doctors prescribe the diabetes drug metformin, which has been shown to improve weight loss and enhance ovulation. This makes it an important treatment if you are trying to get pregnant. However, oral contraceptives lower androgens further if you are not seeking to conceive. Metformin is a biguanide medication, which means it works by increasing your body's sensitivity to insulin. It can also help you lose weight.

In some cases, other medications used in the treatment of diabetes might be prescribed, but these are usually second or third-line treatments if metformin does not work. They include gliptins, sodium-glucose co-transporter-2 inhibitors, myo-inositol, and statins. 

Statins are recommended if you also have elevated cholesterol, which is common in patients with PCOS. A weight loss drug, Orlistat, is also sometimes used for people with obesity, but it has significant side effects and is not recommended for everyone. However, it can be an option if you are having significant issues losing weight with diet and exercise.

Where does Ozempic fit in?

The biggest issue with metformin is that it is not well tolerated by everyone. Metformin can have some very annoying side effects, including:

• Nausea

• Diarrhea

• Stomach ache

• Metallic taste

• Loss of appetite

Metformin can also interfere with your ability to absorb vitamin B12, so you may be recommended a B12 supplement. If you exercise too much, drink alcohol on an empty stomach, or fast, you can end up with low blood sugar. Additionally, it is possible to be allergic to metformin. Somebody who is allergic to metformin will need to take an alternative drug.

Ozempic enters the picture as a possible alternative to metformin for people who have difficulty tolerating the drug. Metformin is often the first-line treatment because it is known to be highly effective. However, Ozempic is an option if you cannot tolerate metformin or if metformin is not working well.

It increases pregnancy rates, including for people receiving IVF. This study, however, was for a combination of metformin and Ozempic. The combination worked particularly well, and some of the people in the study became pregnant before their scheduled IVF session or after it failed. If you are trying to conceive and tolerate both drugs well, your doctor may choose to prescribe both to have you benefit from the combination effect.

In other words, Ozempic is another option for people who cannot take metformin and may also work in combination with metformin to further improve fertility outcomes. As it has not been well studied during pregnancy, you should stop taking it if you become pregnant unless your doctor decides the risk of stopping is greater.

How is Ozempic taken?

Ozempic is taken as a weekly injection using a special pen that can be self-administered. There is an alternative drug, Rybelsus, that can be taken orally. This drug has not been as well tested for PCOS as Ozempic but is much easier to deal with. Ozempic can be taken with or without food (unlike oral medications, taking it with food is unlikely to reduce gastrointestinal side effects). You should, however, avoid taking oral medications at the same time, as there is a very slight risk that Ozempic may affect absorption.

If you miss your dose, take it as soon as possible — unless more than five days have passed, in which case, you should skip the dose and administer it on your next scheduled day.

What are the side effects of Ozempic?

Ozempic can have the following common side effects:

• Nausea

• Vomiting

• Diarrhea or constipation

• Stomach ache

These are similar to the side effects of metformin, but having these side effects from metformin does not necessarily mean you will get them from Ozempic. Side effects are more common when you first start taking Ozempic or after increasing your dose. Ozempic can also impact the absorption of oral medications taken at the same time. 

Rarely, Ozempic can cause other gastrointestinal side effects such as flatulence, dyspepsia, belching, gastroesophageal reflux disease, and gastritis. If you have gastrointestinal side effects, especially diarrhea, they typically decline with time. However, it’s important to stay hydrated and talk to your doctor about the side effects.

Very rarely, Ozempic can:

• Cause an injection site reaction, such as discomfort or swelling. To reduce this, you should rotate your injection site with each injection.

• Cause pancreatitis. If you experience pancreatitis, you should stop taking Ozempic and consult your doctor. If you have a history of pancreatitis, Ozempic may be contraindicated. Watch for persistent, severe abdominal pain that may radiate to the back.

• Cause complications for diabetics with a history of diabetic retinopathy.

• Cause hypoglycemia if you are using insulin or an insulin secretagogue.

• Cause acute kidney injury if you have renal impairment.

• Cause fatigue.

• Cause dizziness.

• Increase your risk of gallstones.

• Increase your risk of thyroid cancer. Ozempic has been shown to increase the risk of cancer in rats. If you experience a lump or swelling in your neck, trouble swallowing, hoarseness, or shortness of breath, you should talk to your doctor.

All of these adverse reactions are extremely rare. Ozempic pens are for single-patient use and should not be shared, even if the needle is changed. 

Ozempic is specifically contraindicated if you have a personal or family history of medullary thyroid carcinoma or if you have multiple endocrine neoplasia syndrome type 2. It has also not been tested in individuals younger than 18, so it is not currently available for adolescents with PCOS.

There are no specific drug contraindications with Ozempic.

The lowdown

Metformin is a first-line treatment for most people with PCOS who are trying to get pregnant. Ozempic may be prescribed if metformin makes you sick or does not work, or it may be prescribed alongside metformin. It is harder to take, being an injection, although some people may benefit from an oral alternative, Rybelsus.

Ozempic can help you conceive, but if you are not trying to get pregnant, you should use contraceptives, and you should discontinue Ozempic if you do become pregnant, as it can harm the fetus. It can also help control insulin resistance and prevent it from developing into type 2 diabetes and can help you lose weight. For some patients with PCOS, Ozempic is a highly beneficial drug.