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GLP-1 Receptor Agonists and Women’s Health: What You Need to Know

In recent years, medications like Ozempic® (semaglutide) and Mounjaro® (tirzepatide) have made headlines for their impact on blood sugar and weight. Emerging research suggests they may also support PCOS, fertility, and broader cardiometabolic health.


If you're curious about what these medications do, whether they’re right for you, and how to support your body naturally while using them, this post is for you. As a naturopathic doctor, I’m not quick to prescribe GLP-1s, but I do support informed choice and holistic care. Here’s what I want my patients to know.

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1. What Are GLP-1 Receptor Agonists?

GLP-1 (glucagon-like peptide-1) is a hormone your body naturally makes in the gut to help regulate blood sugar and appetite. These medications mimic this hormone, enhancing its effects in the body.


They work by:

  • Enhancing insulin release after meals

  • Slowing stomach emptying

  • Decreasing glucagon (a hormone that raises blood sugar)

  • Suppressing appetite


Common GLP-1 medications include:

  • Semaglutide (Ozempic®, Wegovy®, Rybelsus®)

  • Tirzepatide (Mounjaro®, Zepbound® – a dual GLP-1/GIP agonist)

  • Liraglutide (Saxenda®, Victoza®)

  • Dulaglutide (Trulicity®)

  • Exenatide (Byetta®)


Originally approved for type 2 diabetes, GLP-1 agonists are now also used for obesity and are being studied for other applications in hormone and metabolic health.


2. GLP-1Benefits and Risks: What Does the Research Say?

Benefits:

These medications offer a wide range of benefits, especially for patients with metabolic or insulin-related issues:

  • Weight loss (in clinical trials):

    • Semaglutide (2.4 mg): ~15% body weight loss over 68 weeks

    • Tirzepatide (15 mg): ~21% body weight loss over 72 weeks

    • Liraglutide (3 mg): ~8% body weight loss over 56 weeks

  • Improved blood sugar control:

    • Reduces A1c by ~1.0–2.0% on average

    • Decreases fasting and post-meal glucose

  • Lower blood pressure and triglycerides

  • Reduced cardiovascular risk in people with type 2 diabetes (e.g. heart attack, stroke, cardiovascular death)

  • Improved satiety and reduced binge eating tendencies

  • Better liver markers in people with fatty liver disease (NAFLD/NASH)

  • Improved ovulation, hormone balance, and insulin resistance in PCOS (more below)

💡 Sex differences: Women tend to lose slightly more weight than men (1–1.7 kg more on average in clinical trials). Women are more likely to report feeling full faster and have stronger appetite suppression. Differences between men and women may relate to estrogen-enhanced GLP-1 signaling in the brain.
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General Risks

As with any medication, GLP-1s come with side effects and safety considerations.


Common side effects (especially early on):

  • Nausea (most common, especially in women)

  • Vomiting or early satiety

  • Constipation or diarrhea

  • Fatigue, dizziness, or headaches


Less common but important risks:

  • Muscle loss during rapid weight loss, especially without strength training

  • Nutrient deficiencies from decreased appetite and intake:

    • Iron, B12, magnesium, vitamin D, fat-soluble vitamins (A, E, K)

  • Gallbladder issues (gallstones, especially with rapid weight loss)

  • Pancreatitis (rare, more likely in people with prior history)

  • Possible thyroid C-cell tumors (seen in animals, no confirmed human risk)

  • Appetite dysregulation or disordered eating patterns in sensitive individuals

💡 Sex differences in risk: Women are 2x more likely to experience GI side effects than men. Nausea is often cycle-dependent (worse during high-estrogen phases). Women also have higher discontinuation rates due to tolerability.
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3. GLP-1s in Women’s Health

I care deeply about supporting people with ovaries through the complex transitions of life—from puberty to perimenopause—and helping each person find tools that align with their values and health goals. GLP-1 medications are not a magic fix, and weight loss is not a moral achievement. I also practice from a Health at Every Size and fat-positive framework, meaning I don't use weight as a proxy for health or success.

That said, I want to acknowledge a few specific ways these medications may support some people with hormone-related conditions.


PCOS

PCOS can be a frustrating, complex condition—especially when insulin resistance and hormone imbalances disrupt cycles, cause acne or hair growth, and affect fertility. GLP-1 receptor agonists aren’t FDA-approved for PCOS, but research suggests they may offer support, especially when other approaches haven’t been enough.


Here’s what we’ve seen in clinical studies (particularly with liraglutide and semaglutide):

  • Insulin resistance improves, even when weight isn’t the primary focus

  • Testosterone levels drop (~1.3 nmol/L reduction in some trials)

  • Menstrual cycles become more regular (46–56% of participants)

  • Ovulation resumes in 40–60% of people

  • Best results occur when combined with therapies like metformin or inositol

While weight loss often happens with these medications, it's not the only reason symptoms improve. By shifting metabolic pathways, GLP-1s can help restore hormone signaling and reduce the drive behind irregular cycles or high androgens.


While weight loss may not be the goal for every person with PCOS, addressing insulin resistance and supporting ovulatory function can be meaningful outcomes for those struggling with symptoms.


Fertility & Preconception Support

GLP-1s are not fertility drugs—but they may help people who aren't ovulating regularly due to insulin resistance, PCOS, or metabolic issues.


Research suggests:

  • Ovulation often resumes within 2–4 months of starting a GLP-1

  • Some people conceive spontaneously, even before trying

  • Those undergoing IVF see better outcomes when weight and insulin sensitivity improve

  • Live birth rates increase when patients lose 5–10% of body weight beforehand

  • No increased miscarriage risk has been shown with preconception GLP-1 use


GLP-1s may also help people navigate fertility care gatekeeping. Many IVF clinics require a BMI under 35 (or even 30) to proceed with treatment, regardless of a person’s overall health. While I don’t agree with those policies, I understand the desire to access care and for some, a GLP-1 can be a tool to move forward.

✅ May be used as a preconception tool to improve ovulation and access to IVF (many clinics have BMI cutoffs). ❌ Not safe to use during pregnancy or while actively trying to conceive.

The goal isn’t just pregnancy—it’s a body that feels supported, balanced, and yours every step of the way.

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Obesity and Metabolic Health

While GLP-1s are often promoted for weight loss, I believe weight is not the problem, stigma is. I don’t recommend GLP-1 medications purely for weight loss. But for patients dealing with type 2 diabetes, insulin resistance, fatty liver, cardiovascular disease, or PCOS, I’m open to considering GLP-1s as part of a larger plan to support metabolic and reproductive health—if and when that feels aligned for the patient.


Other Women’s Health Considerations

  • Postpartum weight retention: Early studies are exploring GLP-1s in postpartum people at risk for diabetes, especially after gestational diabetes

  • Perimenopause/menopause: May help with insulin resistance, weight gain, and inflammation—though not studied specifically for vasomotor symptoms

  • Disordered eating concerns: Caution is needed for anyone with a history of binge/restrict patterns or body image struggles


  1. Are GLP-1s safe in Pregnancy and Breastfeeding?

This is where I urge extra caution. GLP-1 receptor agonists are not safe during pregnancy or lactation, and planning matters.


Pregnancy: Why We Avoid It

  • Animal studies show fetal growth restriction and skeletal malformations

  • Human registry data is limited but has not shown a clear pattern of birth defects—still, the data is early


Guidelines recommend stopping:

  • Semaglutide: at least 2 months before conception

  • Tirzepatide: at least 1 month before conception


Key concern:

  • Rebound weight gain after stopping GLP-1s can increase pregnancy complications (GDM, hypertension)

I work with patients to transition off slowly, often supporting with:

  • Metformin or inositol

  • High-protein, anti-inflammatory diets

  • Lifestyle interventions that preserve ovulatory cycles


Breastfeeding: Emerging but Limited Data

  • One study of semaglutide in breastfeeding showed no detectable levels in breast milk and no infant harm→ However, current guidance still recommends avoiding use while nursing

My perspective: Let’s prioritize milk production, maternal energy, and blood sugar stability in early postpartum. If weight support is needed, we can revisit GLP-1s after weaning
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Final Thoughts

GLP-1 receptor agonists are powerful tools—and like all tools, they can be used wisely or overprescribed. They are not my go-to medication, and I do not believe they’re right for everyone. But for the right person, at the right time, with the right support, they can offer meaningful improvements in metabolic, hormonal, and reproductive health.


If you're on a GLP-1 medication—or considering one—know that I’ll meet you where you are, without judgment, and with a plan to support your body as a whole. Your health is not defined by your weight. You deserve care that sees your full story.


Thinking about GLP-1s or navigating PCOS, fertility, or metabolic health?

Let’s talk! Schedule an appointment to explore your options in a supportive, holistic setting.


References

  1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183

  2. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038

  3. Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11-22. doi:10.1056/NEJMoa1411892

  4. Jensterle M, Kravos NA, Pfeifer M, Kocjan T, Janez A. Short-term intervention with liraglutide improves menstrual cycle regularity in women with polycystic ovary syndrome and obesity. Eur J Endocrinol. 2015;173(4):499-505. doi:10.1530/EJE-15-0376

  5. Salama AA, Elsayed M, El-Tawil M, et al. Liraglutide versus metformin for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Gynecol Endocrinol. 2021;37(3):231-237. doi:10.1080/09513590.2020.1848113

  6. Kahal H, Halama A, Aburima A, et al. Effects of semaglutide on metabolic and reproductive parameters in obese women with polycystic ovary syndrome: a randomized controlled pilot study. J Clin Endocrinol Metab. 2022;107(4):1173–1182. doi:10.1210/clinem/dgab839

  7. Elkind-Hirsch KE, Bellanger DE, Bhushan M. Liraglutide use in women with polycystic ovary syndrome and infertility: a clinical case series. Fertil Steril Rep. 2023;4(1):42-47. doi:10.1016/j.xfre.2022.10.007

  8. Ramos-Rincon JM, Belda-Iniesta C, Rubio MA, et al. Semaglutide and breastfeeding: a case report. Diabetes Ther. 2023;14(3):669-674. doi:10.1007/s13300-023-01387-2

  9. Ryan DH, Lingvay I, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in people with overweight or obesity. N Engl J Med. 2023;389(3):222-233. doi:10.1056/NEJMoa2307563

  10. Lundgren JR, Janus C, Jensen SBK, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med. 2021;384(18):1719-1730. doi:10.1056/NEJMoa2028198

  11. Gallo LA, Wright EM, Macintyre AN, et al. GLP-1 receptor agonists in pregnancy and breastfeeding: a review. J Clin Endocrinol Metab. 2021;106(10):2892-2901. doi:10.1210/clinem/dgab314

  12. Kim SH, Abbasi F, Lamendola C, et al. Effect of GLP-1 receptor agonist therapy on muscle mass in type 2 diabetes: a randomized trial. Diabetes Obes Metab. 2022;24(1):119-126. doi:10.1111/dom.14563

 
 
 

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