GLP-1s and PCOS Management: Expert FAQs From Hertility Webinar

Can GLP-1s like Ozempic or Mounjaro help with PCOS? Our experts explain how they work, safety rules before pregnancy, and what to know about long-term use.

Thank you to everyone who joined our recent webinar, “GLP-1 RAs: The PCOS Game Changer?”with Dr. Helen O’Neill and Dr. Paul Hardiman. The overwhelming response (over 600 attendees) confirmed the critical need for transparent, evidence-based information regarding these new therapies and their role in managing Polycystic Ovary Syndrome.

We know the session generated significant interest and, crucially, many complex questions about everything from long-term safety and fertility planning to navigating the NHS and finding effective alternatives.

This document serves as our expert-synthesised FAQ, acting as a crucial next step in your journey. It consolidates the questions we received into a concise, actionable resource.

This FAQ will help you understand:

• The Metabolic Root of PCOS: Why Insulin Resistance is the core driver of symptoms and how GLP-1 RAs work as disease-modifying agents, not just weight loss tools.
• Safety and Fertility: Non-negotiable safety rules for women of reproductive age, including contraception needs and mandatory washout periods before trying to conceive.
• Tailored Treatment: Comparing GLP-1 RAs against traditional options like Metformin, and evaluating the effectiveness of key supplements like the 40:1 Inositol ratio.

By providing these clinically-vetted answers, we aim to empower you to have confident, informed conversations with your own healthcare providers, ensuring your PCOS management pathway is truly personalised and effective.

Understanding PCOS and How GLP-1 Medications Fit In

What does an irregular period mean in PCOS?

According to the 2023 International Evidence-Based Guidelines (Teede et al., 2023), for women 3 years post-menarche up to the perimenopause stage, irregular menstrual cycles are defined as:

• Menstrual cycle intervals less than 21 days or more than 35 days;

OR

• Fewer than 8 cycles per year.

Does everyone with PCOS have insulin resistance, even if my test results (such as glucose) have always been negative?

No, not everyone with PCOS has insulin resistance (IR), but it is a critical part of the syndrome’s pathogenesis, documented in approximately 75% of women with PCOS (Cleveland Clinic, 2024).It is important to know that in the early stages of IR, standard tests like fasting glucose or HbA1c may appear normal because the pancreas is compensating by overproducing insulin (hyperinsulinemia). Therefore, monitoring glucose levels alone will not reliably detect the onset of IR.

If my BMI is within the normal range (lean PCOS), would GLP-1 RAs still help with my symptoms (like skin, mood, or central adiposity)?

Yes, GLP-1 RAs primarily target insulin sensitivity, which is thought to be a core driver of the syndrome, not just weight loss. Preclinical studies indicate that GLP-1 RAs can directly improve reproductive endocrinopathy by reversing high Luteinising Hormone (LH) levels and reducing serum testosterone and the Free Androgen Index (FAI) (Bednarz et al., 2022). These hormonal improvements offer a potential treatment strategy to manage hyperandrogenism-related symptoms regardless of BMI.

What are the non-pill treatment options for managing acne and irregular periods in women with lean PCOS?

For women with a normal BMI who wish to avoid the contraceptive pill, management focuses on lifestyle and targeted therapies:

• Lifestyle & Diet: A healthy diet rich in whole foods, regular exercise, and maintaining a healthy weight is the first-line approach.
• Supplements: Inositols, particularly the 40:1 Myo-Inositol/D-Chiro-Inositol ratio, have been shown in some studies to support hormonal balance and restore ovulation.
• Symptom-Specific Treatments: Medications are available to specifically treat symptoms like acne (topical or oral treatments) or high cholesterol.
• Alternative methods of hormonal contraception such as intrauterine devices (IUD) or the contraceptive implant may offer some of the same benefits as the contraceptive pill without some of the same side effects.

Ensure you consult a doctor or sexual health specialist before taking any supplements, vitamins or starting new treatments. 

. At Hertility, we provide diagnostic testing with clinical grade results into your hormonal health. Get actionable insights into your reproductive health and egg count, and screen for up to 18 conditions such as PCOS. Receive in-depth insights, a comprehensive Doctor-written report, a clinically recommended Care Plan, and a complimentary Clinical Result Review Call.

My GP is reluctant to diagnose or treat me for PCOS; what steps can I take to get appropriate care?

PCOS diagnosis in the UK is guided by International Evidence-based Guidelines, typically using the Rotterdam Criteria (2 out of 3 features: irregular periods, hyperandrogenism, or polycystic ovarian morphology) (NICE, 2025; Teede et al., 2023). If you are struggling to get a diagnosis, ensure you have documented evidence of your symptoms (irregular periods, clinical signs like acne or hirsutism, and any relevant blood test or ultrasound reports).

The Hertility Advanced Hormone & Fertility Test is a diagnostic test with clinical grade results into your hormonal health. Get actionable insights into your reproductive health and egg count, and screen for up to 18 conditions such as PCOS. Receive in-depth insights, a comprehensive Doctor-written report, a clinically recommended Care Plan, and a complimentary Clinical Result Review Call. We also provide fast referrals to leading UK private fertility clinics and treatment centres for comprehensive onward care.

GLP-1 for PCOS: Safety, Effectiveness and Long-Term Use

If I achieve my weight and symptom goals on a GLP-1 RA, will I regain the weight and symptoms if I stop taking it? Is this medication necessary long-term?

GLP-1 RAs should generally be viewed as a long-term management strategy for a chronic metabolic condition. Clinical data does indicate a considerable likelihood of weight regain upon cessation, with weight often returning toward the pre-treatment baseline within about a year (Budini et al., 2025). However, the outlook is not universally negative; some evidence suggests that more than half of patients are able to maintain the achieved weight loss one year after discontinuing the medication (Szczesnowicz et al., 2023).

Are there any known long-term health risks associated with taking GLP-1 RAs?

While GLP-1 RAs are generally well-tolerated, rare but serious adverse events can occur, including acute pancreatitis and gallbladder issues (Szczesnowicz et al., 2023). Furthermore, long-term safety, particularly regarding combination therapy (e.g. with Metformin) in women with PCOS is an area that requires further research. It is crucial to obtain these prescriptions only from a doctor and fill them at a pharmacy, as unapproved or compounded versions have not been reviewed for safety or quality.

If hair loss or fatigue occurs while taking a GLP-1 RA, what steps or supplements can help manage these side effects?

Hair thinning or increased shedding (telogen effluvium) reported while on GLP-1 RAs is typically considered temporary and is usually attributed to the physiological stress of rapid weight loss or significant dietary changes, rather than the drug itself (Healthline, 2025). Management involves consulting your healthcare provider to assess your overall health and ensuring adequate nutritional intake, as inadequate consumption of key vitamins and minerals can impede the hair growth cycle. Vitamin D, iron and zinc are common deficiencies that can cause hair loss, but ensure you contact your doctor before taking any vitamins or supplements. 

Through targeted dietary and lifestyle advice, Hertility works alongside you to help manage your symptoms of PCOS or help you to optimise cycle regularity to put you in the best position for fertility and pregnancy using personalised, evidence- based advice, in a non-restrictive manner working in collaboration with you and your personal needs. This will give you the tools to manage your PCOS for a lifetime, minimising the short and long term consequences associated with PCOS. Book a nutrition consultation through the Hertility website.

What is the benefit of using GLP-1 RAs in combination with Metformin for fertility and weight loss, especially if Metformin alone was previously ineffective?

Combining GLP-1 RAs with Metformin has been shown to have a synergistic effect, offering superior benefits compared to either drug alone (Akel et al., 2024; Tao et al., 2021; Jensterle et al., 2017). This approach leads to greater weight loss, significantly improved mean blood glucose levels, and more favourable outcomes on endocrine regulation. This combined therapy simultaneously targets both weight-dependent and weight-independent determinants of PCOS abnormalities.

How long does it typically take for menstrual cycles to regulate after starting a GLP-1 RA?

GLP-1 RAs have been associated with improvements in menstrual cycle regularity. For example, treatment with low doses of Semaglutide has been shown to significantly reduce body weight and is often associated with the normalisation of menstrual cycles in nearly 80% of obese PCOS patients who were previously unresponsive to lifestyle changes (Carmina et al., 2023). The exact time frame is individual, as the metabolic response is unique to each person and thus the time to metabolic correction will vary.

If I cannot tolerate Metformin due to side effects, is a GLP-1 RA a viable alternative?

Yes, GLP-1 RAs are a powerful new addition to the therapeutic options for the metabolic management of PCOS, and can be considered when Metformin has not been tolerated.. The efficacy of GLP-1 RAs in promoting significant weight loss and improving insulin sensitivity is well-established. Furthermore, patients have reported a willingness to tolerate the common gastrointestinal adverse events associated with GLP-1 RAs in exchange for successful weight loss. However, make sure to discuss with your doctor/GP before starting new medications (Akel et al., 2024).

Are oral forms of GLP-1 RAs as effective as injectable forms for treating PCOS?

There are few studies comparing the oral and injectable forms of Semaglutide, which show comparable effectiveness in promoting weight loss and improving metabolic parameters. For instance, one study found that the median percent weight reduction was similar between the oral group (3.74%) and the injectable group (4.02%) over 26 weeks, demonstrating that the oral method is an effective delivery option (Pinto et al., 2024). It is important to note that the majority of evidence for the use of GLP-1 RAs in PCOS is based on the injectable form. At the moment data in PCOS using oral form is limited.

GLP-1 and Fertility: Pregnancy Planning, TTC and Contraception

What are the mandatory pre-conception safety protocols for women taking GLP-1 RAs, including the necessary washout period?

There is a lack of safety data available for use of GLP-1 agonists in pregnancy. Women must use effective, secure contraception while on treatment, as rapid metabolic improvement can lead to unexpected ovulation (FSRH, 2025). A washout period is advised before trying to conceive:

• Semaglutide (Wegovy, Ozempic, Rybelsus): 2 months.
• Tirazeptide (Mounjaro, Zepbound): 1 month.
• Exenatide: 12 weeks.

Should I prioritise weight loss medication over trying to conceive right now to maximise future fertility?

Losing just 2-5% of your initial body weight can lead to a significant improvement in fertility outcomes and overall PCOS symptoms (NHS, 2025). GLP-1 RAs are highly effective at achieving this weight loss. However, starting them requires a mandatory pause in conception attempts due to their unknown safety in pregnancy and the subsequent necessary washout period. This is a critical decision that requires personalised advice from an endocrinologist or reproductive specialist.  At Hertility, you can take the stress away from finding a Private Gynaecologist and get online appointments with leading Private Gynaecologists and reproductive health specialists—all without a GP referral.

For women who have failed to conceive with initial treatments like Clomid/Letrozole and Metformin, is a GLP-1 RA a better next step for fertility?

GLP-1 RAs offer a promising opportunity by facilitating weight loss, enhancing insulin sensitivity, and regulating menstrual cycles to treat infertility. They target the underlying metabolic issues and can be particularly beneficial in assisted reproductive settings when metabolic correction is needed to improve outcomes. They have been shown to reduce hyperandrogenism and improve ovulation among obese patients (Clark et al., 1998; Cena et al., 2020)). At Hertility, you can take the stress away from finding a Private Gynaecologist and get online appointments with leading Private Gynaecologists and reproductive health specialists—all without a GP referral.

What advice is available for women with PCOS trying to conceive later in life (e.g. in their 40s)?

We understand that trying to conceive in your 40s can feel particularly challenging, especially when managing PCOS. While the chance of conception naturally declines with age for all women, compounded with PCOS, the journey requires maximum preparation (Femia, 2025). Please know that Hertility is here to support you in optimising every factor within your control to maximise your chances. With an Advanced Hormone & Fertility Test, you can get in-depth insight into how your hormones impact your health. Meet your diagnostic symptoms test with clinical grade results, including a clinical Care Plan and Clinical Result Review Call.

The focus remains on optimising the metabolic and hormonal environment as much as possible. Key steps include:

• Optimising Metabolic Health: Lifestyle modification (diet and exercise) is the first step.
• Targeted Supplementation: Supplements like Vitamin D, Inositol, and Omega-3 fish oil may support metabolic health, reduce inflammation, and improve fertility outcomes.
• Thyroid Screening: Regularly screen thyroid hormones, as co-existing hypothyroidism can worsen PCOS symptoms and impact fertility.
• Medical Intervention: Fertility treatment options include ovulation induction agents or In Vitro Fertilization (IVF).

Given conflicting opinions, should women with PCOS use standard home ovulation tests (e.g, LH strips)?

Standard urine-based ovulation test kits that detect the Luteinizing Hormone (LH) surge can be unreliable for women with PCOS. This is because LH levels in PCOS may be consistently elevated or pulse erratically, leading to a high risk of false-positive results (suggesting ovulation is near when it is not). Consequently, methods such as charting Basal Body Temperature (BBT) and monitoring changes in cervical mucus may provide more accurate indications of ovulation.

Lifestyle and Nutrition: Diet, Exercise and Supplements for PCOS

How do non-pharmaceutical options like Inositol (specifically the 40:1 ratio) and Berberine compare to Metformin for insulin resistance?

Inositol (Myo-Inositol (MI) and D-Chiro-Inositol (DCI)) acts as a messenger in the body’s insulin signalling cascade. Clinical trials have established that the 40:1 ratio (MI:DCI) is the most effective non-pharmaceutical formulation for restoring ovulation and normalizing important endocrine parameters in women with PCOS. Inositol could be considered in women with PCOS based on individual preferences and values, noting limited harm, potential for improvement in metabolic measures, yet with limited clinical benefits including in ovulation, hirsutism or weight. (International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023)

Berberine shows similar efficacy to Metformin in improving glucose uptake and overall body composition (weight/BMI). Studies also suggest berberine may offer improved lipid parameters (reducing LDL and total cholesterol) compared to Metformin. However, it is important to note that due to a lack of appropriate studies, there is little information currently available on the long-term impacts of using berberine. Berberine is not included in the ‘International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023’, to which clinicians refer when managing PCOS (Teede et al., 2023).

What kind of exercise is best for PCOS – High-Intensity Interval Training (HIIT) or low-intensity cardio?

Exercise is vital for improving insulin efficiency. High-Intensity Interval Training (HIIT) can be effective for boosting cardiorespiratory fitness and improving insulin resistance. However, intense exercise can sometimes cause hormonal stress and disrupt menstrual cycles (Richards et al., 2021). A balanced routine is recommended, combining higher-intensity sessions with gentle, low-intensity activity, which is particularly helpful for combating fatigue.

What are your thoughts on using intermittent fasting or time-restricted eating for weight loss with PCOS?

Preliminary research suggests an 18-hour Time-Restricted Eating (TRE) protocol may improve PCOS metabolic and hormonal markers (von Damm et al., 2025). However, traditional dietary advice for managing insulin resistance prioritises maintaining stable blood sugar to prevent the hyperinsulinemia that drives the syndrome. Clinicians often caution that fasting may lead to overconsumption during permitted eating windows or ignoring hunger cues and skipping meals which can cause fluctuating blood glucose levels, having a negative impact on androgen levels and amplifying symptoms and thus, more research is needed before Intermittent Fasting is widely recommended for the PCOS population.  It is best to consult a doctor or dietitian or registered nutritionist before making any big lifestyle changes. 

At Hertility, we work alongside you to help manage your symptoms of PCOS or help you to optimise cycle regularity to put you in the best position for fertility and pregnancy using personalised, evidence-based advice, in a non-restrictive manner working in collaboration with you and your personal needs. This will give you the tools to manage your PCOS for a lifetime, minimising the short and long term consequences associated with PCOS. Book a nutrition consultation through the Hertility website.

Is a vegetarian or plant-based diet generally advised for PCOS? Should I limit my intake of high-carb foods like lentils and beans?

There is no evidence to support any one type of diet over another for PCOS, which is why sustainable healthy eating tailored to individual preferences and goals is key, avoiding unduly restrictive and nutritionally unbalanced diets, in line with general population guidelines.

However, a a well planned plant-based diet rich in whole foods can be beneficial for PCOS as it is rich in beneficial fibre and plant based proteins that  can help to regulate blood glucose levels and improve insulin sensitivity, as well as being low in saturated fat but containing important poly and monounsaturated fats which are protective of heart health. This is why low glycaemic index (GI) carbohydrates such as wholegrains including oats, beans and lentils should absolutely be included and are particularly beneficial to those with PCOS due to the nutrient profile and slower and more gradual release of glucose into the bloodstream.

Strict vegan diets require careful planning and appropriate supplementation. Women with PCOS should be vigilant about key nutrients (such as Vitamin B12, iodine and omega-3’s) that are often easier to obtain from animal products, ensuring they supplement appropriately to prevent deficiencies.   .

The Mediterranean style diet is generally recommended due to its pattern of eating that centres around whole, plant-based foods that support long-term health.

Do women with PCOS need a higher dose of folic acid (e.g. 5mg daily) if they are trying to conceive?

A higher dose of 5mg may be recommended in families with a history of Neural Tube Defects (NTD), in women who have Type 1 Diabetes, Type 2 Diabetes, Haematological conditions, or take medications that interfere with absorption. This will need to be prescribed by your GP. Folic acid supplementation has also been linked to beneficial effects on glycemic and inflammatory markers in women with PCOS and overweight/obesity. Always consult with your doctor when trying to conceive if you have PCOS to ensure you are taking the correct measures to ensure successful pregnancy.

PCOS, Thyroid and Beyond: Managing Co-Existing Conditions

I have polycystic ovaries but am not fully diagnosed with PCOS, and I also have Hypothyroidism. How do these conditions overlap, and how should they be managed together?

PCOS and Hypothyroidism are common endocrine disorders that share many overlapping symptoms, including weight gain, insulin resistance, fatigue, fertility challenges, and anxiety/depression (Voluson Club, 2019). Hypothyroidism can cause anovulation via prolactin/GnRH effects and thus worsen PCOS symptoms. Due to this complex relationship, it is important to have your thyroid hormones checked if you have PCOS or symptoms of both conditions. It is important your doctor is aware of both conditions, and thyroid replacement therapy dose can be tailored to your individual response.

Are there specific benefits to using GLP-1 RAs for co-existing conditions like PCOS and Endometriosis?

GLP-1 RAs are known to address two key issues relevant to both conditions: obesity and chronic inflammation (Bednarz et al., 2022). By reducing systemic inflammation and improving insulin resistance, GLP-1 RAs offer a broad benefit for overall reproductive and metabolic health. Current research is heavily focused on the metabolic and fertility benefits for PCOS, but continued study will clarify the specific impact of GLP-1 RAs on endometriosis.

What does PCOS look like through and post-menopause, and what long-term health risks should I monitor?

Menopause typically resolves the irregular periods that characterise PCOS. However, PCOS is a lifelong condition, and the underlying metabolic and inflammatory risks persist. Women with a history of PCOS are at a greater long-term risk for conditions like cardiovascular disease. Post-menopause, continued monitoring of cardiovascular risk, metabolic health, and weight management is crucial (Dr. Jolene Brighten, 2024).

What is the current status of emerging drugs like Retatrutide, and is it safe to purchase unapproved versions now?

Newer agents like Retatrutide have shown impressive weight loss results in early clinical trials, but they are not yet approved or commercially available for prescription, especially for PCOS. We strongly caution against purchasing any unapproved, black-market, or compounded versions of any GLP-1 RA. Compounded drugs bypass regulatory review for safety and quality, and improper storage (e.g. arriving warm without refrigeration) can lead to drug degradation.

Can vaping or nicotine use make PCOS symptoms worse?

Research suggests that smoking can exacerbate PCOS symptoms, making the condition more challenging to manage (Yang et al., 2024). However, there is a lack of data around how substances in e-cigarettes and vapes may impact PCOS symptoms specifically. Hertility have published how vaping may affect reproductive health by affecting oestrogen levels and ovarian function, which can, in turn, reduce fertility and disrupt overall hormonal balance (Wainwright et al., 2024).

Watch the Full Webinar

If you missed our live session with Dr Helen O’Neill and Dr Paul Hardiman, you can now watch the full discussion on demand. They break down the latest research, safety data and fertility considerations around GLP-1 medications in PCOS, helping you separate fact from hype.
👉 Watch it here: GLP-1 RAs — The PCOS Game Changer? (YouTube)