Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder affecting 1 in 10 people who menstruate. Characterized by elevated levels of androgens, a group of sex hormones responsible for male characteristics, PCOS presents with a range of symptoms, including irregular periods, oily skin and acne, weight gain, and hirsutism (excessive hair growth). Furthermore, PCOS stands as a primary contributor to infertility. Given the complexities of PCOS and the increasing popularity of medications like Wegovy for weight loss, it's crucial to examine the potential role, benefits, and drawbacks of these medications for individuals with PCOS.
Understanding PCOS
PCOS diagnosis was challenging because the diagnostic criteria kept changing until an international guideline was established in 2018. Improving diagnosis and treatment for PCOS is important for helping relieve symptoms in the short term, but it’s also essential for improving long-term health outcomes.
Children’s Hospital Colorado endocrinologist Melanie Cree, MD, PhD, has dedicated her research to better understanding this disease and its relationship to the essential hormone insulin. To support providers in making accurate diagnoses, Dr. Cree and her team at Children’s Colorado developed an order set for diagnosis, which is essentially a checklist that outlines the key factors for diagnosing PCOS, including irregular menses (less than 21 or greater than 45 days between periods) one year after menarche. There’s also an order set for treatment and a standardized note template that reminds providers what questions to ask.
The Link Between PCOS and Weight
Weight management is often a central recommendation for individuals with PCOS, as insulin resistance and blood sugar dysregulation are common features of the condition. Dr. Cree’s findings show that weight loss is crucial to improving life expectancy in patients with PCOS, regardless of how that weight loss is achieved. People with PCOS and obesity often have sleep apnea, so they may search for help from a sleep clinic. Or someone experiencing severe acne from PCOS might visit the dermatologist.
Semaglutide: Ozempic and Wegovy
In recent months, medications such as Ozempic and its cousin, Wegovy, have become very popular on social media for their ability to help many people lose weight. In fact, these two medications are the same medication, generically called Semaglutide, with Ozempic being prescribed for managing diabetes and Wegovy being prescribed for weight loss. Semaglutide, the active ingredient in both Ozempic and Wegovy, has gained significant attention for its effectiveness in promoting weight loss. Ozempic was approved by the FDA in 2017 for treatment of diabetes.
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How Semaglutide Works
Research thus far has found that this medication has been shown to increase insulin production, decrease the amount of sugar released by the liver and slow gastric emptying, which can release sugar into the bloodstream more slowly. It has also been shown to reduce weight in many people, which is a huge reason it has become so popular.
Semaglutide and PCOS: Promising Research
So far, studies have shown that it can be more effective than metformin in reducing blood sugar and insulin, and improving regularity of periods as well as improving fertility. I mention metformin because this is a commonly prescribed medication for those with PCOS dealing with blood sugar issues. These medications, however, have not been shown to increase risk of hypoglycemia the way other diabetes medications can.
Dr. Cree’s fifth trial in teens with PCOS and excess weight compared treatment with oral semaglutide, a hormone which stimulates insulin production to reduce blood sugar, against meeting with a dietitian weekly and following a lifestyle food program that reduced simple carbohydrates and fructose. While the patients on semaglutide lost more weight than those on the dietary plan, as expected, the smaller amount of weight loss in the lifestyle-only group still showed a promising improvement in metabolic disease.
Potential Drawbacks and Side Effects
As with any medication, however, there are also important drawbacks to consider. Side effects are one, and may include nausea, vomiting, diarrhea, heartburn, gas, headaches and blurred vision. They may also decrease the effectiveness of birth control methods, requiring additional birth control measures to be taken. There is also concern for thyroid cancer and pancreatitis. As a dietitian, one side effect that comes up a lot in my work with clients is the decrease in appetite. This can make it challenging to eat enough to meet someone’s needs and, in severe cases, could lead to malnutrition. For those looking to improve their relationship with food and/or practice intuitive eating, this can present challenges in being able to connect with one’s body and eat according to its cues. This is especially dangerous in those with eating disorders, whose body cues are often distorted from undernutrition.
Long-Term Considerations
The longest these medications have been studied is 60 weeks. The most common reason I hear from people who are interested in taking these GLP-1 medications is that they are helpful for weight loss. While this may be true, studies show that weight loss plateaus after about 60 weeks, and that when one stops taking the medication, the weight lost is regained. This is true for any weight loss method, and research also indicates that weight cycling itself has negative effects on our health. Weight cycling is the weight loss and regain that occurs over time during repeated attempts at weight loss. Essentially, the more we try to lose weight, the more we are likely to weigh in the long run. While there is nothing wrong with living in a larger body, if one’s goal is to weigh less overall or to improve health outcomes, intentional weight loss attempts do not appear to help people reach those goals.
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Since PCOS is a condition that needs to be managed throughout life, Dr. Currently, Dr. Cree emphasizes the importances of combating the stigma of obesity. “For example, if you've got bad acne and hirsutism and you’re being bullied at school, you have low self-esteem, so you're not going to be able to make lifestyle changes. If you have untreated obstructive sleep apnea, you crave sugary, fatty foods that you cannot overcome with willpower and you're too tired to exercise,” Dr. Cree says.
Access and Availability
Finally, due to the popularity of Ozempic and Wegovy, there are often shortages of these medications, including right now according to the FDA. For my clients who have had diabetes, this made it very difficult for them to manage their blood sugar and had an impact on their health. Additionally, insurance does not always cover these meds, or may stop covering them, which can lead people to be frustrated when they have to stop them and they gain all the weight back.
A Holistic Approach
“In my professional opinion, this is just the newest way that our culture and healthcare system’s obsession with weight actually harms people instead of helping them. There is no evidence of any method of weight loss that works in the long term and, often, the risks can far outweigh the benefits when it comes to medications for weight loss. For those clients who are interested in trying these medications, I like to encourage them to focus on the benefits to their blood sugar and other actual health markers rather than focusing on the effects on their weight. It is important to consider focusing on the benefits to their blood sugar and other actual health markers rather than focusing on the effects on their weight.
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