What is PCOS?
Polycystic ovary syndrome (PCOS) is one of the commonest hormonal disorders affecting an estimated 1 in 10 women in the UK of reproductive age. The exact cause is unknown, but it’s said to be related to abnormal hormone levels in the body, including high levels of insulin (a hormone that controls sugar levels in the body).
Insulin resistance can trigger higher insulin levels, which in turn lead to a production of androgens – hormones that worsen many of the symptoms of PCOS (including acne and hirsutism).
Elevated androgen levels disrupt the normal hormonal signals that regulate the menstrual cycle, often leading to irregular or absent periods in women with PCOS.
Insulin resistance is strongly connected to weight gain and obesity. When insulin levels are high, the body tends to store more fat, making it harder to lose weight. This can create a cycle where gaining weight worsens insulin resistance, leading to weight management being more difficult.
Symptoms can vary from person to person but if left unmanaged, PCOS can lead to long-term health issues such as type 2 diabetes, infertility, metabolic syndrome, and cardiovascular disease.
What is Wegovy (Semaglutide)?
Wegovy is a Glucagon-like-peptide (GLP-1) receptor agonist initially developed for type 2 diabetes and later approved by the Food and Drug Administration (FDA) for chronic weight management. It is specifically indicated for adults with obesity (BMI ≥30), or adults who are overweight (BMI ≥27) with at least one weight-related condition such as PCOS.
Wegovy works by mimicking a natural hormone called GLP-1, which plays a role in regulating appetite, insulin secretion, and food intake. By stimulating GLP-1 receptors in the brain, Wegovy helps reduce hunger and increase feelings of fullness.
It is administered via a once-weekly subcutaneous injection, making it a convenient option for long-term use under medical supervision.
Wegovy's effects on PCOS symptoms and management
Wegovy offers promising benefits for managing PCOS, especially in women facing weight gain and insulin resistance. Clinical trials show it can produce significant weight loss—typically 15–20% of body weight—in adults with obesity. Research suggests that even a 5–10% weight loss can help restore regular menstrual cycles and ovulation, where this reduction can play a crucial role in easing PCOS symptoms like irregular periods, high androgen levels, and fertility challenges.
Wegovy also reduces visceral fat, lowers inflammation, and improves metabolic health markers such as cholesterol and blood pressure.
Unlike traditional diet-focused weight loss methods, Wegovy mimics the natural hormone GLP-1 to regulate insulin, decrease blood sugar, and targets harmful fat accumulation, directly addressing the metabolic dysfunction underlying PCOS symptoms.
While not a cure, Wegovy provides an effective option for women who struggle with lifestyle changes alone.
How Wegovy impacts insulin resistance and blood glucose
Better Insulin Sensitivity = Better Hormone Balance
Insulin resistance affects 50%–70% of women with PCOS. Since insulin resistance is a core driver of PCOS, improving insulin function is critical for long-term health and hormonal regulation.
Wegovy can help:
- Your body use insulin more effectively
- Lower insulin levels
- Reduce inflammation
- May help your cells respond better to glucose (sugar)
By lowering insulin levels, Wegovy may also lower testosterone and reduce symptoms like acne, irregular cycles, and excess hair.
Hormonal balance and reproductive health changes on Wegovy
Many women with PCOS have irregular or missing periods because they don’t ovulate regularly. Improving insulin sensitivity can help restore more regular ovulation and menstrual cycles.
Wegovy has been shown to improve menstrual regularity and support more frequent ovulation.
Getting your period back regularly and ovulating is a big step toward improving fertility.
Wegovy can help by:
- Supporting mature egg development
- Reducing excess LH, a hormone that’s often too high in PCOS
- Improving the health of the uterine lining, which helps with implantation
High insulin can lead to high testosterone, which causes common PCOS symptoms like irregular cycles, acne, hair growth on the face/body (hirsutism) and thinning scalp hair.
Wegovy lowers insulin — and as a result — can help lower testosterone levels. A recent review found that GLP-1s may be even more effective than metformin at reducing androgens in some women [7].
By balancing insulin and testosterone, these medications help restore more regular periods and reduce other hormonal symptoms of PCOS.
Wegovy's impact on other PCOS symptoms
PCOS often involves low-grade inflammation, poor sleep quality, and increased risk of chronic diseases. Wegovy may contribute to overall wellness by reducing inflammation, especially when combined with anti-inflammatory diets, improving sleep, as weight loss is known to enhance sleep apnoea and general sleep quality and lowering long-term risk of complications such as type 2 diabetes and heart disease.
What to consider when taking Wegovy to treat PCOS
Guidelines to prescription and dosage for Wegovy
Wegovy must be prescribed by a licensed healthcare provider, ideally one familiar with PCOS, endocrinology, or obesity medicine.
- Initial dose typically starts at 0.25 mg weekly, gradually increasing over 16–20 weeks to a maintenance dose of 2.4 mg weekly.
- Titration should be gradual, especially in PCOS patients, to reduce any adverse effects
- Monitoring is essential to assess weight loss, metabolic improvements, and overall tolerance.
What side effects of Wegovy to be aware of
Wegovy may cause common side effects like nausea, vomiting, diarrhoea, constipation, and abdominal pain. They are usually mild and often improve as your body adjusts to the medication.
To reduce these symptoms, it helps to eat smaller meals, avoid high-fat foods, and stay well hydrated.
While serious side effects are rare, they require immediate medical attention. Regular monitoring of gallbladder, pancreatic, and thyroid function is recommended during treatment.
Can Wegovy be taken alongside other PCOS treatments?
- Wegovy and metformin can be safely used together. Both medications improve insulin sensitivity, which is a key issue in many women with PCOS.
- Wegovy can be used alongside birth control safely. While birth control doesn’t treat insulin resistance or weight gain, Wegovy does — so together, they can tackle different aspects of PCOS.
- Wegovy may help reduce the need for other PCOS medications over time — especially those used to treat insulin resistance or aid in weight loss. For example, lower insulin and testosterone levels may mean less need for anti-androgens or weight loss may improve cycles without needing cycle-regulating drugs
However, this depends on individual goals (e.g., fertility vs. symptom control), so always review your treatment plan with your doctor.
Ensuring to continue with healthy eating and regular physical activity is essential. These lifestyle changes improve insulin resistance, help with weight management, and support hormone balance — all of which are central to managing PCOS.
What are the long-term implications of taking Wegovy when you have PCOS
Wegovy is generally intended for long-term use. Patients should have realistic expectations, understanding that benefits like weight loss, improved menstrual cycles, and clearer skin may take several months. Regular monitoring of blood sugar levels, hormone balance, and reproductive health is important. As ongoing research develops, we are likely to see and provide more insights into Wegovy’s long-term benefits specifically for women with PCOS.
References
- American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome (PCOS). (online) American College of Obstetricians and Gynecologists.
- Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjøth TV, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: The SCALE Diabetes randomized clinical trial. (online) JAMA.
- Food and Drug Administration (FDA). Wegovy (semaglutide) injection, for subcutaneous use: Prescribing information. (online) U.S. Food and Drug Administration.
- Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK. Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society clinical practice guideline. (online) Journal of Clinical Endocrinology & Metabolism.
- Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. (online) Cochrane Database of Systematic Reviews.
- National Health Service (NHS). Polycystic ovary syndrome (PCOS). (online) National Health Service.
- National Institute for Health and Care Excellence (NICE). Semaglutide for managing overweight and obesity (TA875) – Information for the public. (online) National Institute for Health and Care Excellence.
- Roth JD, Knudsen LB, Lemke G. GLP-1 receptor agonists in polycystic ovary syndrome: A review of efficacy and safety. (online) Acta Obstetricia et Gynecologica Scandinavica.
- Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway F, Jensen C, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: The STEP 4 randomized clinical trial. (online) JAMA.
- Tan TM, Batterham RL. GLP-1 receptor agonists in the treatment of polycystic ovary syndrome: A systematic review. (online) Clinical Endocrinology.
- Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. (online) New England Journal of Medicine.
- World Health Organization. Polycystic Ovary Syndrome – Fact Sheet. (online) World Health Organization.
