Blog/If I have PCOS, can I take medical weight loss medication?
Jennie Stanford, MD | 7/2/2024 | 4 min read

If I have PCOS, can I take medical weight loss medication?

Taking weight loss medication for PCOS may be a good solution

overweight woman smiling and sitting on yoga mat looking out a window

Polycystic ovary syndrome (PCOS) is a frequent hormone and metabolic disorder affecting women. Within PCOS, not only is weight gain common, but the metabolic changes of PCOS also make it more difficult to lose weight. We’ll dive into the effects of PCOS on weight and how you can avoid some of the negative consequences of PCOS.

What is PCOS?

PCOS is a common endocrine disorder, affecting as many as 5–10% of women. PCOS involves elevated testosterone levels, which often leads to oligomenorrhea (less frequent menstrual periods) or amenorrhea (no menstrual periods) and other effects of elevated testosterone. This often includes acne and male-pattern facial and body hair.

PCOS includes several metabolic effects as well. Insulin resistance is common in patients with PCOS who are at a healthy weight and those who are overweight. PCOS also leads to a higher risk of metabolic syndrome, which includes overweight or obesity, high blood pressure, dyslipidemia, and impaired fasting glucose. Metabolic syndrome elevates the risk of cardiovascular disease, heart attack, stroke, and diabetes mellitus.

How does PCOS affect weight?

It is common for weight gain to occur in PCOS, and it is also common to have a harder time losing weight. PCOS weight gain has a number of different causes. PCOS causes hyperinsulinemia (elevated levels of insulin in the blood) in about 50% of patients. Insulin promotes energy storage, including stored glucose and stored fats, so high insulin levels lead to an increase in adipose (fat) tissue and promotes weight gain. In addition, elevated insulin levels decrease the amounts of stored fat and glucose that are broken down for energy, making it more difficult to lose weight. 

Insulin is also proinflammatory, so high levels of insulin encourage dysregulations of metabolic and stress hormones, like ghrelin, cortisol, glucagon-like peptide-1, somatostatin, and others. This often results in increased hunger, slower metabolism, and weight gain.

How can I lose weight naturally with PCOS?

Healthy Diet

Consuming a poor diet consisting of high-glycemic, proinflammatory foods increases the risk of developing insulin resistance. Consuming large amounts of refined carbohydrates and simple sugars causes rapid rises in blood sugar. Blood sugar spikes not only cause the pancreas to release more and more insulin, but they also cause oxidative stress and damage to cells of the pancreas, which can worsen insulin resistance. 

In contrast, an anti-inflammatory diet, low in processed foods, added sugars, and refined carbohydrates, is the cornerstone of natural weight loss with PCOS. An insulin resistance diet should include these foods:

  • High-fiber foods; apples, berries, broccoli, and leafy greens

  • Complex carbohydrates, such as whole grains, quinoa, sweet potatoes, and legumes

  • Lean proteins, including chicken or turkey breast, eggs, nuts, dairy

  • Healthy fats, monounsaturated fats and polyunsaturated fats, emphasizing omega-3 fatty acids in fatty fish, extra virgin olive oil, and avocado.

Regular Exercise

Regular physical exercise in PCOS, including cardiovascular exercise and strength training, helps improve insulin sensitivity and achieve a healthy weight. 

By increasing glucose uptake and utilization in muscles, physical exercise helps lower blood sugar levels and helps improve insulin sensitivity. Regular physical exercise leads to more lean body mass, and it increases resting energy expenditure (or resting metabolism). More lean body mass and a higher resting metabolic rate help promote a healthy weight and insulin sensitivity.

Supplements

There are many supplements that can help improve insulin sensitivity. 

It’s important to consult with your healthcare provider before adding any supplements to your diet.​​ They can offer more insight into which ones may be the most beneficial to you.

Can I take weight loss medication with PCOS?

If you are wondering, “how can I lose weight with PCOS?”, chances are, you’ve heard about weight loss medication. There are several medications that have been shown to help individuals lose weight with PCOS. 

Metformin is recommended in most cases of PCOS, based on its ability to improve insulin levels and restore ovulation. While glucagon-like peptide-1 (GLP-1) receptor agonists are only FDA-approved for the treatment of diabetes mellitus and obesity, data suggests that they also may be helpful for the hyperinsulinemia associated with PCOS.

Metformin

Metformin is an insulin-sensitizing medication that has been used for the anovulation associated with PCOS for quite a while. Not only does metformin improve insulin resistance in PCOS, but it is effective at producing a mild weight loss. Metformin is recommended in most patients with PCOS, with or without obesity.

Semaglutide

Semaglutide has been studied in people who have both obesity and PCOS. In this study of patients with obesity and PCOS, after 6 months of taking lower-dose semaglutide, the average weight loss was about 12 kilograms (about 26 pounds). At least 80% of the study participants who had elevated fasting blood sugar improved to normal blood sugar levels after 6 months of taking low-dose semaglutide.

Tirzepatide

With its demonstrated results in improving glycemic control and delivering weight loss, tirzepatide is an obvious choice to treat the hyperinsulinemia, abnormal lipid metabolism, metabolic syndrome, inflammation, weight gain, and obesity associated with PCOS. While additional studies are needed regarding tirzepatide’s improvement in PCOS alone, tirzepatide has proven to demonstrate as much as 20% weight loss in patients with obesity. 

Semaglutide to Metformin

This recent study looked at patients with PCOS and obesity who took semaglutide for 16 weeks and then transitioned to metformin for the next 2 years. During the 16 weeks of semaglutide treatment, patients lost about 20 pounds. While taking metformin for the next 2 years, they regained about 30% of their weight, for a net weight loss of about 13 pounds.

While this regimen may be promising, additional study is necessary to look at the optimal time of taking semaglutide and how to successfully transition off of it once weight loss goals are achieved, versus continuing semaglutide indefinitely. Another promising potential treatment regimen for the weight gain and metabolic dysfunction associated with PCOS is using semaglutide and metformin simultaneously, which also needs more study.

What you need to know

PCOS is a complex condition that requires a multifaceted treatment approach. Weight loss medication for PCOS can be an important part of a successful treatment plan, which may include semaglutide or other GLP-1 receptor agonists. If you would like to find out more, take a look at Agile Telehealth’s weight loss program and connect with a knowledgeable physician!

Disclaimer: The content provided in our blogs is for informational purposes only and is not intended as medical advice. Readers should consult their primary care physician for guidance on treatment options and personalized medical advice.