at a glance
Is Ozempic the next PCOS miracle drug?
The Ozempic Craze
It’s the hottest drug in Hollywood. It’s the “secret” to weight loss. It’s oh oh oh Ozempic! Oh, the diabetes medication?
If you pay attention to pop culture (or watch TV), then you’ve probably heard of Ozempic. Ozempic is trending at the moment because it helps people lose weight. A subject our culture fixates upon.
Social media influencers in the PCOS space are starting to speak out about their experiences with Ozempic to help improve symptoms and lower their weight. You’ve probably also seen it highlighted on shows like Good Morning America or the Today Show.
If you are here for the latest tea or are wondering if Ozempic could help your PCOS: we’ve got you.
What is Ozempic?
Ozempic is an FDA-approved drug, proven to lower blood sugar (along with diet and exercise) and stimulate insulin production in adults with type 2 diabetes. (1)
Ozempic was Originally Designed for Type 2 Diabetes
Insulin is a hormone. Its main job is to help your body move sugar from your bloodstream into your cells. People with type 2 diabetes struggle with this. They make insulin but their cells have stopped responding to it and they can no longer make enough of it.
This means too much sugar can hang out in the bloodstream and cause problems. Drug companies have marketed many solutions to this and Ozempic is one of the newer options.
Ozempic was created to help lower blood sugar levels in diabetics. What they found in clinical trials was it also helped with weight loss: shooting Ozempic into the spotlight.
How does Ozempic work?
Ozempic lowers blood glucose
Most people think to treat diabetes you are injecting yourself with insulin all the time. That is true for Type 1 Diabetes or when Type 2 Diabetes can no longer be managed with less invasive treatment.
Ozempic is a non-insulin medication designed to help the body release its own insulin to lower blood sugar. Ozempic works in three ways to lower blood sugar. (1)
1. Ozempic stimulates insulin production
Ozempic coordinates with the pancreas to produce insulin when blood sugar is too high.
2. Prevents the liver from making and releasing too much sugar
The liver serves as a reservoir for extra sugar tightly bound together in long coiled chains. When blood sugar levels dip it quickly mobilizes sugar when you need it.
The liver is very central to managing blood sugar levels. In people with type 2 diabetes, the liver may be making and releasing too much sugar into the blood. Ozempic helps manage that.
3. Ozempic slows the digestion of food leaving the stomach
This slows down your digestion and access to the energy stored in your food. It gives the pancreas time to release enough insulin, helping to control blood sugar spikes.
How is Ozempic taken?
Ozempic is taken once a week, on the same day every week, exactly as prescribed by your health care provider (1). It is a medicine you inject into your belly.
In clinical trials, it was determined Ozempic should be safe to use for up to 68 weeks. Type 2 diabetes is a long-term (chronic) disease and medications are used for the maintenance treatment.
Ozempic is estimated to cost nearly $1000 per month. Most insurance will not cover it if you do no have diabetes. And if you are reading this and have PCOS, you may not also have diabetes. Be sure to read on though. Your doctor may be able to help support your case to use this drug for PCOS and weight loss and provide documentation to your insurance company.
How does Ozempic Cause Weight Loss?
The question we’ve all been waiting for.
1. Slows digestion
When someone tries to lose weight they often eat less. However, eating less can make you feel hungry. If you can slow down how quickly food empties from your stomach you will feel full for a longer period of time. Feeling full helps you effectively eat less for longer, aiding weight loss (2).
2. Manages spikes in blood sugar
Ozempic also helps to prevent large blood sugar spikes. Have you ever eaten waffles in the morning and been ravenous an hour later? There are a few reasons for this, but the main one is that your blood sugar spiked up and then promptly dropped off a cliff.
Wild swings in blood sugar will make you feel hungry. Ozempic blunts a major shift in blood sugar so you will not have reactive hunger (2).
3. One of the most common side effects is Ozempics ability to lower appetite
One of the ways Ozempic impacts appetite is by causing some nasty side effects: nausea and vomiting. (2)
So, what’s the issue with Ozempic?
1. Off-label drug use
This sounds super shady. It’s not as scary as it sounds. Off-label drug use is when an FDA-approved drug is being prescribed or used for a different condition than what the FDA has cleared the drug for.
Off-label use occurs with many drugs. An example of this is being prescribed Ozempic for weight loss, despite not having type 2 diabetes. Something we are seeing a lot of lately, even among women with PCOS.
So, what does the FDA say about off-label use? The FDA can regulate the approval of a medication but not the practice of prescribing the medicine itself. Meaning, providers can prescribe medications for unapproved uses in patients they deem appropriate.
This is actually quite common in the PCOS population. As I can’t think of one single prescription medication that has been designed specifically for PCOS. I can think of many that are used in PCOS that are used in an off-label manner that can be very helpful
Metformin – diabetes drug
Birth Control – contraceptives
Spironolactone – blood pressure/diuretic
Clomid/Letrozole – breast cancer treatment
Something being used off-label is not necessarily good or bad. It’s just worth noting and discussing with your doctor why this medication is a good fit for you and how it works.
2. Supply and demand: semaglutide
The active ingredient in Ozempic is semaglutide. In the summer of 2021, semaglutide was FDA-approved for weight-loss in people with obesity and sold under the brand name Wegovy (2). High demand for Wegovy combined with off-label use created a shortage. What did everyone do? They were directed to Wegovy’s similar cousin, but lower dose T2D medication, Ozempic. Then, it snowballed.
Both drugs are listed as “currently in shortage” on the FDA’s website (6). The shortage has been difficult for diabetic and obesity patients alike, as both are recognized as chronic health conditions. Patients who need Ozempic and Wegovy for management of their disease are struggling to find it.
While Ozempic might make for a good solution for PCOS, you may not be at the front of the line to get it with a medication shortage.
Can Ozempic be Prescribed for PCOS?
The short answer is yes and no. Your doctor has the ability to write a prescription for anything she or he deems appropriate. Since type 2 diabetes and PCOS both involve a great deal of insulin resistance, it makes sense that your doctor could consider this option for you. However, that doesn’t mean your insurance will pay for it.
Anytime a drug is prescribed in an “off label” manner there is potential for insurance to deny claims.
Polycystic ovary syndrome (PCOS) and type 2 diabetes
Insulin resistance affects moft of us with PCOS. Insulin resistance is also the main cause of type 2 diabetes. You are more likely to develop diabetes if you have PCOS.
It is already regular practice to use medications created to manage diabetes for PCOS patients. Metformin is a prime example of this.
Metformin has been the most used medication to treat metabolic abnormalities, like insulin resistance, in women with PCOS (5). Similarly to Ozempic, Metformin is approved for use in patients with T2D and works to reduce blood sugar levels.
Depending on how PCOS affects the patient, metformin may be prescribed to help manage insulin resistance and blood sugar levels and induce ovulation. As for weight loss, diet has been deemed superior to metformin to promote body fat reduction. However, when combined with diet and exercise, metformin may play a role in a small reduction of BMI (5).
Metformin comes with similar side effects as Ozempic including GI distress, nausea, and diarrhea.
GLP-1 receptor agonists
Whoa, what a mouthful!! A class of drugs known as GLP-1-RAs have been tested in women with PCOS. When compared to Metformin, studies suggest these guys may be more effective in improving HOMA-IR and reducing BMI (5). Ozempic falls in the class of GLP-1-RAs but no studies have looked at Ozempic and PCOS specifically.
Upcoming Clinical Trials In PCOS Patients with Ozempic
There is a new clinical trial comparing the effect of semaglutide (aka Ozempic’s active ingredient) and metformin on weight loss in obese women with PCOS. This study has not yet started, but is expected to be completed early 2024 (4).
Another trial is recruiting women aged 12-21 with PCOS to compare treating PCOS with semaglutide (aka Ozempic’s active ingredient) versus an active lifestyle. It is also expected to be completed in 2024 (7). You read that right, 12-21, girls with PCOS.
So, we will just have to wait to see what the future holds for Ozempic and PCOS, but in the meantime, you can talk with your doctor to see if they think it is right for you.
Side effects for Ozempic may be longer than a line at a Chick-fil-A drive-thru.
The most common side effects include nausea, vomiting, diarrhea, abdominal pain, fatigue, low blood sugars, and an increased risk of pancreatitis. Sounds incredible, right? But the clinical trials did not have non-diabetic participants- so we don’t know the risks or side effects associated with this drug in other populations. I think it’s safe to assume you’ll experience many of them though – and perhaps to an even greater degree.
The Weight Loss Doesn’t Last
What happens when you stop taking Ozempic? As soon as you stop taking the drug, the weight loss can reverse. Many women have shared that the weight they lost, came back (8).
Your appetite is curbed while on the drug, so when you stop taking it – your appetite and hunger signals return. And they may come back larger than life. This is why a healthy diet, exercise routine, and mental health are all important for weight maintenance.
This is true for many major shifts that don’t come with sustainable lifestyle changes. Whether it is a medication, intermittent fasting(time-restricted eating) or a diet.
The Bottom Line
This is not the first medication that has been touted as a weight loss drug. Keep in mind medications like Ozempic are not FDA-approved for weight loss or PCOS – they are approved for type 2 diabetes. That means you should be making decisions based on what’s right for your body, not what’s trending on social media or the red carpet.
Whether you and your doctor determine you should or should not take a medication like this, lifestyle should be modified to promote weight loss. Nutrition, exercise, and stress management should be incorporated with medical management. If you think this drug may help you, check with your doc.