GLP-1 drugs gain traction among women with PCOS as obesity care gaps persist

Use of GLP-1 weight-loss medicines among women with polycystic ovary syndrome has surged in recent years, highlighting growing off-label demand for treatments that address the condition’s strong links to obesity and insulin resistance.

Women with polycystic ovary syndrome (PCOS) are emerging as a fast-growing group of off-label users of GLP-1 weight-loss drugs, raising fresh questions about how obesity and metabolic conditions linked to reproductive health are treated.

New US data reported by Reuters show that prescriptions of GLP-1 drugs for women with PCOS have risen more than sevenfold since 2021. The increase is being driven primarily by semaglutide and tirzepatide, the active ingredients in Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound.

The analysis, conducted by health data firm Truveta using records from 120 million patients, found that by 2025, 17.6 per cent of women diagnosed with PCOS had received a GLP-1 prescription, compared with just 2.4 per cent in 2021. Over the same period, the proportion of all GLP-1 prescriptions going to women with PCOS rose from 4.6 per cent to 5.7 per cent, based on data from conventional healthcare settings.

Although the figures are drawn from the United States, clinicians say the trend reflects broader international interest in GLP-1 medicines for PCOS, particularly given the condition’s close association with obesity and metabolic disease.

PCOS is one of the most common hormonal conditions affecting women of reproductive age and is widely under-diagnosed. CNBC estimates that 5 million to 6 million women in the US are affected, while Reuters reports that globally up to 13 per cent of women of reproductive age live with the condition. PCOS is also the leading cause of infertility.

The condition is strongly linked to excess weight and insulin resistance. According to CNBC, between 35 per cent and 80 per cent of people with PCOS experience insulin resistance, and many also have obesity or type 2 diabetes. Symptoms can include rapid weight gain, irregular menstrual cycles, acne and excess hair growth.

That metabolic profile helps explain why GLP-1 drugs are attracting attention. Current treatments for PCOS typically include lifestyle advice, hormonal contraceptives and metformin, which tend to address individual symptoms rather than underlying metabolic dysfunction.

Paediatric endocrinologist Melanie Cree told CNBC that PCOS represents a “massive” unmet clinical need, noting that first-line treatments for the condition “haven’t changed in nearly 50 years”. Reuters added that standard prescribing often includes metformin to improve insulin sensitivity, orlistat for weight loss and birth control pills to regulate menstrual cycles.

GLP-1 medicines work on pathways central to both obesity and PCOS. Drugs such as semaglutide improve insulin sensitivity and reduce appetite by slowing gastric emptying, stimulating insulin release when blood glucose is high and suppressing hormones that raise blood sugar. Weight loss itself can further improve insulin resistance.

Cree said research in adults with PCOS suggests that losing as little as 5 per cent of body weight can lead to meaningful metabolic improvements. These changes may reduce insulin levels, lower ovarian testosterone production and ease symptoms such as irregular periods and androgen-related effects.

Insulin resistance is considered a key driver of PCOS. Reuters reported that women with a family history of type 2 diabetes face a higher risk of developing the condition, and that elevated insulin levels may stimulate excess testosterone production in the ovaries. This can create a self-perpetuating cycle of abdominal weight gain and worsening insulin resistance.

Judy Korner, an endocrinologist at Columbia University Medical Center, described this as a “chicken versus egg phenomenon”, with ongoing debate over whether insulin resistance causes PCOS or whether PCOS itself leads to insulin resistance.

Evidence on GLP-1 use in PCOS is still limited but growing. Reuters noted that at least a dozen studies published between 2018 and 2025, including research on older GLP-1 drugs such as liraglutide, sold as Saxenda or Victoza, suggest potential benefits for insulin resistance and menstrual regularity.

For UK obesity specialists, the rapid uptake of GLP-1 drugs among women with PCOS underscores both the metabolic nature of the condition and the limitations of existing treatment pathways. As access to anti-obesity medicines expands, clinicians and policymakers may face increasing pressure to consider how these drugs fit into the long-term management of PCOS, beyond weight loss alone.