Can GLP-1 Drugs Help Treat PMOS?

Woman using GLP-1 pen in her kitcheniStockPolyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), impacts about 1 in 8 women. Despite how common the condition is, the symptoms and health consequences of PMOS can vary. Many types of treatment exist to address the different elements of PMOS, which can include excess androgen hormones, insulin resistance, and infertility.

One emerging treatment for PMOS is glucagon-like peptide-1 (GLP-1) agonist medications. Drugs in this class have been approved by the U.S. Food and Drug Administration (FDA) for weight management, glucose control and kidney protection in people with type 2 diabetes, cardiovascular risk reduction, and sleep apnea. When a GLP-1 is prescribed for PMOS, it is done so off-label, meaning that the drugs are not specifically approved to treat that condition.

However, because these medications treat insulin resistance and help with weight loss, they may help treat PMOS in women who are overweight or have obesity. It's estimated that 70 percent of women with PMOS have insulin resistance, and women with PMOS are also at higher risk of developing type 2 diabetes. What's more, GLP-1s may address other comorbidities that are also common in women with PMOS, such as hypertension and prediabetes.

Weight reduction is one pillar of PMOS management, says obesity medicine-certified physician Samantha Schon, MD, a reproductive endocrinologist and an associate professor in the department of obstetrics and gynecology at the University of Michigan in Ann Arbor. GLP-1s reduce weight by working in the brain to suppress appetite, helping you eat fewer calories, so that you lose weight.

A review that looked at early research on the effects of GLP-1s on body composition in women with PMOS found that adding a GLP-1 to metformin (an existing, common PMOS treatment) improved reductions in measures like body weight, body mass index (BMI), and waist circumference, as well as factors like insulin resistance and glucose control. It also helped with reproductive functions, such as ovulation and menstrual regularity. However, although the research is promising, there's not enough evidence to recommend GLP-1s as an effective singular treatment for women with PMOS.

"GLP-1s work really well for our patients with PMOS with overweight and obesity," says Dr. Schon. For women with PMOS who are not overweight, however, GLP-1 prescriptions are not usually recommended.

Since these medications improve insulin action, they are believed to improve reproductive health as well, with early research suggesting that they may improve ovulation. More research is needed to confirm this connection, however, and women who have been experiencing infertility should take caution and use contraception, as getting pregnant while taking a GLP-1 is not safe.

Typically, the goal for women with PMOS who are overweight or have obesity is to lose 5 percent of their body weight, which has been shown to improve ovulation and insulin sensitivity and regulate androgen hormones. Taking a GLP-1 can result in losing as much as 15 to 20 percent of your body weight, according to clinical trials.

In addition, there are some common comorbidities with PMOS that GLP-1 medications can treat. For example, Zepbound (tirzepatide) is FDA-approved to treat obstructive sleep apnea (OSA). Research suggests that about 1 in 5 women with PMOS also have OSA, which can exacerbate the heightened risk of cardiovascular disease that women with PMOS already have. In this way, a GLP-1 could potentially help treat a range of health conditions affecting women with PMOS.

If a GLP-1 is under consideration as part of your treatment plan, there are a few things to talk to your doctor about first.

Does taking a GLP-1 make sense for you? GLP-1 drugs are not FDA-approved specifically to treat PMOS, and there is currently not enough data to support their use in patients with PMOS who are not overweight or don't have obesity. However, if a patient with PMOS is also overweight and has a weight-related complication such as prediabetes – which is very common – or has obesity, then taking a GLP-1 may be particularly helpful. Talk to your doctor about side effects, such as gastrointestinal distress, as well as cost and any insurance barriers around a prescription.

What is your family plan? "Contraception is important with GLP-1s because you are not supposed to get pregnant while taking them," says Schon. Since none of the medications are approved for use in pregnancy – and fertility may improve when taking one – it's important to discuss the timing of starting and stopping the medication with your clinician. Some medications, like tirzepatide (Zepbound, Mounjaro), may reduce the effectiveness of oral hormonal contraceptives, and prescriber guidelines recommend using a backup birth control method when starting a GLP-1 and after each dosage increase.

What is your long-term plan? GLP-1s are considered long-term medications, as research shows that weight regain occurs after stopping a GLP-1, says Schon.

In short, no. Even if a GLP-1 or similar medication is eventually approved for the treatment of PMOS, it likely would not be a stand-alone therapy. A GLP-1 may not adequately control androgens or regulate menses, for example, or sufficiently improve fertility in all patients.

Other therapies, such as metformin, hormonal birth control, anti-androgen medication, fertility treatments (if trying to conceive), and lifestyle and nutrition counseling remain the bedrocks of PMOS treatment.

When it comes to lifestyle and nutrition changes, there is always a place for healthy habits in PMOS treatment, whether you are taking a GLP-1 or not, says Christa Brown, RDN, a dietitian in private practice in Woodbridge, New Jersey, who specializes in PMOS care as well as support for those on a GLP-1 medication. Nutrition habits like consistent fiber and protein intake to promote insulin sensitivity, exercise in the form of resistance training, adequate sleep, and stress management are all areas she focuses on when working with women who have PMOS.

"The biggest [lifestyle factor where] I see room for opportunity is resistance-based strength training," Brown says. "That muscle growth supports reducing insulin resistance."

What's more, some research shows that 1 in 4 women with PMOS have a normal BMI measure or one that's considered underweight. For these women, a medication that causes weight loss would not be appropriate. "Lean PMOS patients need a different lens entirely, focused on insulin sensitivity over weight [loss]," says Brown.

There are many things to consider when treating PMOS. While weight reduction may be one part, it is not the only therapy. "We still need to treat common symptoms like excess hair growth and acne," says Schon. "Weight reduction can help, but it's still one piece of overall care."

"PMOS is a lifelong reproductive disorder, but treatment goals may vary at different points throughout the reproductive lifespan," she says. "We have to take all of these things into consideration when identifying the right treatments for patients."

PMOS treatment does not look the same in every woman and may be aimed at reducing excess androgen hormones, insulin resistance, or infertility.

Weight loss is a mainstay treatment for PMOS. There's emerging evidence that the addition of a GLP-1 medication may help women with the condition lose weight.

GLP-1s are not FDA-approved to treat PMOS specifically; any use of GLP-1s by patients who are not overweight or don't have obesity is considered off-label.

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Elise-M-Brett-bioElise M. Brett, MDMedical ReviewerCastle Connolly Top Doctor

Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine …

Jessica Migala is a freelance writer with over 15 years of experience, specializing in health, nutrition, fitness, and beauty. She has written extensively about vision care, diabet…

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