Can GLP-1 Drugs Help Treat PMOS?

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.

How GLP-1s May Help Treat PMOS

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.

“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.

Limitations to Consider Before Using a GLP-1 for 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.

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• 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.

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Could GLP-1 Drugs Replace Current PMOS Treatments?

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.

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.”

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.”