In recent years, Ozempic and Wegovy, both containing the generic compound semaglutide, have gained attention for their potential in aiding weight loss. These medications belong to the Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) class. Originally developed for treating type 2 diabetes, they have piqued interest for their effectiveness in losing weight rapidly even in individuals without diabetes. These medications have garnered a lot of interest in the PCOS community and have been effective for weight loss and insulin resistance management.

However, concerns over their side effects have raised questions about their safety profile. Side effects include gastrointestinal disorders, pancreatitis, and gallbladder issues. Moreover, serious concerns about mental health, including suicidal thoughts, have prompted a closer look at their impact on non-diabetic individuals, necessitating further research.

How do Ozempic and Wegovy cause weight loss in PCOS patients?

Polycystic Ovary Syndrome (PCOS) affects millions of women worldwide, bringing with it a host of challenging symptoms. In recent years, drugs like Ozempic and Wegovy, primarily developed for diabetes and weight management, have shown promise in assisting with PCOS symptoms. While not officially approved for PCOS treatment, these medications have sparked interest due to their potential benefits.

Regulation of Insulin and Blood Sugar

Semaglutide, the active component in Ozempic and Wegovy, acts to lower blood sugar levels and regulate insulin secretion. This mechanism is particularly crucial for individuals with type 2 diabetes. By enhancing insulin production and reducing glucose release from the liver, these medications help maintain stable blood sugar levels, leading to improved glycemic control.

Appetite Suppression

In addition to their effects on glucose metabolism, GLP-1 RAs profoundly influence appetite and satiety. Semaglutide, as a GLP-1 receptor agonist, binds to GLP-1 receptors in the brain, triggering a signaling cascade that curbs hunger and promotes feelings of fullness. This leads to reduced food intake and increased satisfaction after eating, ultimately contributing to weight loss.

Slowing Gastric Emptying

Another mechanism through which GLP-1 RAs induce weight loss is slowing down stomach emptying. Semaglutide prolongs the time it takes for the stomach to empty its contents into the intestines. This delayed gastric emptying helps individuals feel fuller for longer periods, reducing the urge to eat frequently and aiding in calorie control.

Reducing other PCOS symptoms

Other than weight loss, these medications have been found to help with insulin resistance. Insulin resistance is a hallmark feature of PCOS, contributing to the complex hormonal imbalances seen in affected individuals. Ozempic and Wegovy might help with insulin resistance due to their ability to increase insulin sensitivity. Insulin resistance, a hallmark of PCOS, occurs when cells become less responsive to the hormone insulin. GLP-1 RAs enhance insulin sensitivity, allowing cells to utilize glucose more effectively. By improving insulin resistance, these medications help regulate blood sugar levels and promote weight loss. Although off-label use, this approach has garnered attention for its potential to improve the condition.

Significant reductions in weight also lead to decreased androgen levels, responsible for issues like abnormal hair growth and acne. Moreover, metabolic parameters such as blood glucose, blood pressure, and cholesterol often see positive changes, enhancing overall health. Weight loss through Ozempic and Wegovy may also play a crucial role in regulating menstrual cycles and restoring ovulation in women with PCOS. As these medications address one of the leading causes of infertility, namely excess weight, studies suggest that fertility may improve as a result. However, the impact of these drugs on pregnancy and fetal development remains uncertain, making it essential to avoid them during pregnancy.

While Ozempic and Wegovy have shown potential benefits for PCOS management, concerns about their side effects have emerged in recent years. Doctors have reported an increase in ER admissions among users of these medications, raising questions about their safety.

Below, we’ll explore some of the common side effects associated with Ozempic and Wegovy:

1. Nausea and vomiting

Nausea and vomiting are the most frequently reported side effects of semaglutide, the active compound found in medications like Wegovy. Clinical trials involving non-diabetic participants have shed light on the common challenges faced by individuals using this drug. In these trials, about 20% of participants experienced nausea when taking a dose of 1 mg, while 9% reported vomiting. However, it’s important to note that these effects were generally transient and of mild-to-moderate severity. Moreover, the likelihood of experiencing nausea is higher when using a higher dose, such as Wegovy. Starting with a lower dose of 0.5 mg and gradually increasing the dosage has proven effective in minimizing these side effects. This approach allows the body to adjust gradually to the medication, reducing the likelihood and intensity of nausea and vomiting.

2. Diarrhea

Diarrhea is another common semaglutide side effect. Around 9% of people taking it for Type 2 diabetes and 30% of people taking it for weight loss reported diarrhea during clinical trials.

Similar to nausea and vomiting, you’re more likely to experience diarrhea with higher doses of semaglutide. Constipation can also happen, but it tends to be less common than diarrhea. These side effects can sometimes get better over time but, according to Dr. Meera Shah, an endocrinologist at the Mayo Clinic, at least 10% of patients who start these drugs have to be taken off of them because the side effects do not improve.

3. Stomach pain

Mild stomach pain is another common stomach-related side effect of semaglutide. Similar to nausea, vomiting, and diarrhea, this should subside over time.

Severe stomach pain can be a sign of other side effects, like pancreatitis or gallbladder problems (like gallstones).

4. Pancreatitis

Although rare, pancreatitis has been reported with semaglutide. If it happens, it can be life-threatening. Pancreatitis is a possible side effect of all medicines that fall into glucagon-like peptide-1 (GLP-1 receptor agonists, not just Ozempic). It is rare and more common in patients with other risk factors for pancreatitis – prior history of pancreatitis, high triglycerides, high alcohol intake, or other genetic predispositions to pancreatitis. The reason GLP-1 receptor agonists can cause pancreatitis is because the medications stimulate the pancreas to make insulin. Therefore, in an already inflamed organ, this might just worsen the process.

5. Gallbladder disease

Gallbladder disease, including gallstones, is a potential side-effect of Ozempic and Wegovy and the broad class of semaglutides. Symptoms of gallbladder problems include upper stomach pain, fever, and jaundice. Gallbladder disease has been reported both in clinical trials and in the adverse events reported to the FDA through the fourth quarter of 2021 for these medications.

The Ozempic clinical trials resulted in 90% of patients reporting cholelithiasis (gallstones) coded as a serious event requiring cholecystectomy (gallbladder removal). There have been over 10,000 adverse events tied to Ozempic reported to the Food and Drug Administration’s (FDA) Adverse Reporting System (FAERS) through the fourth quarter of 2021. Many of these adverse events involved gallbladder-related issues such as gallstones and gallbladder inflammation. A potential reason behind this side-effect could be the rapid weight loss. rapid weight loss causes the liver to pump out more bile and more cholesterol, both of which can lead to the formation of gallstones within the gallbladder. The extent of this risk also seemed to vary widely concerning whether the GLP-1 RA trial was aimed at weight loss versus type 2 diabetes. For example, a study found that there was an increased risk for gallstones when semaglutides were used for weight loss in non-diabetic patients. The risk increased further with higher dosage and longer duration of use (more than 26 weeks).

6. Rebound weight gain

It has been found that people taking this medication have gained weight back after the medicine was stopped. A study on non-diabetic patients found that the participants regained most of the lost weight. Certain improvements in cardiometabolic parameters were also reversed.

7. Low blood sugar – hypoglycemia

The risk of low blood sugar or hypoglycemia with GLP 1 receptor agonists like Ozempic is low, but may still occur. You may be at a greater risk for this side effect if you also take other drugs for diabetes, including sulfonylureas (for example glipizide or glyburide) or insulin. Higher doses of Ozempic may also increase your risk for low blood sugar.

8. Changes to your face

Some people taking semaglutide may notice less fullness in their faces. This phenomenon has been referred to as “Ozempic face.” Facial fat loss is a potential side effect of rapid and significant weight loss. The skin elasticity is affected by significant weight loss at a fast pace, ay making it harder for the skin to resorb the new shape of the tissue underneath it. Such loose skin and wrinkles can also appear in other body parts, such as thighs or breasts.

9. Hair loss

Some people taking Wegovy or Ozempic are reported hair loss during treatment. During Wegovy’s clinical trials, 3% of people receiving the medication reported this side effect. This type of hair loss, called telogen effluvium, is usually temporary. Since these medications affect one’s appetite, hair loss can also result from not getting enough vitamins and minerals. The American Hair Loss Association (AHLA) reports that rapid weight loss is the reason behind temporary telogen effluvium, a form of hair shedding that can further contribute to hair loss in those susceptible. Additionally, AHLA experts hypothesize that the hormonal shifts from semaglutide and similar drugs can trigger not only temporary telogen effluvium but also early onset male and female pattern hair loss, also known as androgenic alopecia. Androgenic alopecia is a progressive condition that can continue to worsen over time, resulting in permanent hair loss.

10. Thyroid tumors

Semaglutide has a boxed warning (the strictest warning) from the FDA about the risk of thyroid C-cell tumors. This is because animal studies found that rodents developed thyroid tumors when exposed to GLP-1 agonists. However, human studies have yet to confirm this risk. Still, you shouldn’t take semaglutide if you or your family have a history of medullary thyroid cancer or multiple endocrine neoplasia (MEN) type 2.

11. Malnutrition and eating disorders

Though it is not mentioned on Ozempic’s website, doctors have reported some patients, their appetites so suppressed, experience malnutrition. Patients are advised to take multivitamins or protein supplements in addition to the medication because they aren’t getting the nutrients they need from food. Model and TikTok star Remi Bader said on the “Not Skinny But Not Fat” podcast earlier this year that a doctor prescribed her Ozempic after she was found to be pre-diabetic and insulin resistant. Weight loss was also a goal. But after going off the medication, Bader gained back the weight she lost while on Ozempic, which subsequently intensified her binge eating disorder. Eating disorder experts have stressed that hunger suppressants of any kind can lead to or worsen eating disorders. Eating disorders are not cured by weight loss or weight gain.

12. Blurred vision

There were multiple cases reported of blurred vision within the 2,100 adverse events reported regarding these drugs at the FDA. 140 cases dealt with vision changes, including diabetic retinopathy, macular complications, and blurred vision. Certain clinical studies also showed these medications to cause vision changes, including blurred vision, worsening of diabetic retinopathy, and macular complications.

13. Mental health

There were 150 reports of possible cases of self-injury and suicidal thoughts of Ozempic and other semaglutide users that are currently being investigated by the European Medicines Agency. The EMA said it’s not yet clear whether the medicines caused the events or whether they’re linked to patients’ underlying conditions or other factors. Clinical trials in adults found that nine people on the drug, of more than 3,300, reported suicidal ideation, compared with two of more than 1,900 on placebo. One adult on Saxenda attempted suicide, the prescribing information says. The Food and Drug Administration (FDA) says it has received at least 60 reports of suicidal thoughts among patients taking the weight loss drug or its sister medication Wegovy.

A Reddit group for people taking the drug shows how dozens of patients have suffered from depression after taking up the weekly injections, saying they feel “hollow” and as though “rarely anything makes me happy”. Many users have reported facing crippling anxiety and depression. A chilling post by an Ozempic user says ” I never understood why anyone would commit suicide, now I understand”.

In conclusion, we need to be mindful of the potential side effects of Ozempic, Wegovy, and similar semaglutide medications, although they present promising benefits for weight loss and insulin resistance management in PCOS patients. As users, we must prioritize open communication with our healthcare providers and share any concerns or experiences related to side effects during the treatment. Regular monitoring and adjustments in dosage can help manage and mitigate these effects effectively. Considering that these medications may need to be taken for an extended period, possibly indefinitely, it’s essential to be aware of the potential long-lasting implications they might have. Close follow-up with healthcare professionals is essential to ensure safe and successful long-term management. Furthermore, it’s crucial to acknowledge that more research is needed to gain a comprehensive understanding of these medications and their side effects. Ongoing studies will help uncover further insights into their safety and efficacy, paving the way for improved treatment options for PCOS.

Share with us your stories and experience regarding using Ozempic or any other semaglutide drug.

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