Weight loss drugs could be a gamechanger for women with a common hormonal disorder

For well over a decade, Grace Hamilton, 27, experienced hair loss, heavy periods, infrequent menstrual cycles, mental health issues and difficulty losing weight without knowing why. It wasn’t until 2021 when she was diagnosed with polycystic ovary syndrome, or PCOS, a hormonal disorder common among women of reproductive age.

After she saw limited improvements from birth control, diet and exercise, Hamilton joined a trial in 2024 examining a GLP-1 drug in PCOS patients. By October, she received her first weekly dose of semaglutide, the active ingredient in Novo Nordisk‘s obesity injection Wegovy and diabetes shot Ozempic.

She said some results were almost immediate: after months without a cycle, her period resumed within two weeks of starting the drug. After 10 months on the treatment, Hamilton lost 50 pounds, saw hair regrowth and reported significant improvements in depression and anxiety

“I’m so glad that I stuck with it because it was just clear as day that it was the missing link for me,” said Hamilton, who works at a nonprofit in Arvada, Colorado, adding that she maintained diet and exercise while on the drug. 

She is just one of several women who have reported improvements in symptoms of PCOS after using GLP-1s, a growing class of obesity and diabetes treatments that have drawn massive patient demand and investor buzz over the last few years. Treating PCOS is among several new but unapproved potential uses of the blockbuster drugs beyond promoting weight loss and regulating blood sugar.

PCOS, which is frequently underdiagnosed, affects an estimated 5 million to 6 million women of reproductive age in the U.S., according to some estimates. 

The condition is typically characterized by higher levels of testosterone and other hormones usually associated with men called androgens, which can leads to symptoms such as irregular and painful periods, excess hair growth and acne. PCOS is the most common cause of infertility. 

The condition is strongly linked to metabolic issues, as an estimated 35% to 80% of patients experience insulin resistance. That means the pancreas pumps out more insulin to keep blood sugar in check, and high insulin levels can promote weight gain and disrupt hormone balance. A significant share of women with PCOS have obesity or Type 2 diabetes. 

Yet there’s no standard PCOS treatment. Current options like birth control, lifestyle changes and the diabetes drug Metformin may only help with certain symptoms, which could differ depending on the patient. 

But some health experts see promise in GLP-1s, particularly given their effect on improving weight loss and insulin sensitivity. 

“The unmet need is massive,” said Dr. Melanie Cree, a pediatric endocrinologist at Children’s Hospital Colorado. “Primary therapies used for PCOS symptoms haven’t changed in nearly 50 years.”

Cree has been studying the effect of GLP-1s in adolescents with PCOS for more than 10 years. She previously studied the oral form of semaglutide and has an ongoing clinical trial on the injectable version, which is what Hamilton participated in for 10 months. 

But her studies are still small in comparison to drugmakers’ previous clinical trials on GLP-1s with thousands of patients. Not all of the women who have so far completed Cree’s ongoing study lost significant weight, demonstrating that not everyone may respond to GLP-1s.

Novo Nordisk and rival Eli Lilly have been studying their GLP-1s as potential treatments for other chronic conditions like fatty liver disease, but not PCOS. Cree said that’s because the Food and Drug Administration has not established specific “endpoints” or goals drugs must meet in clinical trials to demonstrate how effective they are for PCOS. 

In a statement, a Novo Nordisk spokesperson said the company welcomes “independent research investigating the safety, efficacy and clinical utility of our products, including semaglutide.” Eli Lilly did not immediately respond to a request for comment. 

Conducting longer and larger trials to better understand the effect of GLP-1s on PCOS symptoms is crucial, said Sasha Ottey, executive director of the advocacy group PCOS Challenge. It is still unclear if GLP-1s can help address or resolve all PCOS symptoms, or whether the effect differs depending on a patient’s age or the specific drug, Ottey said. 

She added that certain patients may not lose weight on GLP-1s, and others may not need to shed pounds.

Meanwhile, insurance coverage for GLP-1s is a barrier for some PCOS patients, who are often eligible for approved uses of the drugs. Most plans cover GLP-1s for diabetes, but not for obesity or unapproved uses. The drugs can cost roughly $1,000 per month before insurance. Still, Eli Lilly and Novo Nordisk offer significant discounts on their drugs to some patients who pay for it out-of-pocket.

The trial, which began in 2023, follows girls and women ages 12 to 35 with obesity and PCOS who are on or off Metformin. The study is designed to administer semaglutide to patients for 10 months, and examine their weight loss, metabolic changes and improvements in reproductive function. 

Cree hopes the trial will answer whether GLP-1s can improve ovulation in women with PCOS. Many women with PCOS don’t ovulate regularly, which can lead to irregular periods and difficulty getting pregnant.

Cree has initial data on 11 women who completed the 10 months on semaglutide and were not on Metformin. She said eight of them lost more than 10% of their body weight and saw a reduction in their testosterone levels. 

Five out of the eight patients had their testosterone levels reach “normal ranges,” Cree said. Meanwhile, six out of the eight patients reported more regular periods. 

Cree said her trial will eventually have data from 40 women, but she is still enrolling patients in the group that takes Metformin. She said it will likely take two years before she publishes the first results from the study, which will focus on the differences in outcomes between kids and adults who only received semaglutide. 

She said comparing the groups is crucial because hormones that control growth are released during puberty, which could change how kids respond to GLP-1s. 

Not all women with PCOS will benefit from taking a GLP-1. Cree said in her trial, three patients who completed 10 months on semaglutide did not lose at least 10% of their body weight. One of those women did not lose weight at all, she said. 

Cree said that’s consistent with previous studies on GLP-1s in adults with obesity. 

Despite the promise of GLP-1s in improving symptoms, more research is also needed on PCOS itself, said Dr. Karen Tang, an OB-GYN and founder of Thrive Gynecology. She said some people can experience hallmark symptoms of the condition, such as facial hair and acne, even though they have normal levels of testosterone. 

“There’s still a lot that’s very much unknown about PCOS and exactly how the disease kind of works,” Tang told CNBC. 

Anecdotal evidence suggests GLP-1s may address more than just weight issues for people with PCOS. In a recent survey of 1,700 people by the birth control app Natural Cycles, 64% of women with PCOS who took a GLP-1 reported more predictable periods, and 20% said their bleeding days were shorter.

Some patients with PCOS may also lose more weight on GLP-1s than those without the condition, said Dr. Kerry Krauss, an OB/GYN and medical director at Natural Cycles, who has PCOS herself.

Research needs to confirm those benefits, but she said it gives hope to many PCOS patients who are frustrated with common treatments for the condition. Those options typically target just one aspect of PCOS, such as reducing androgen levels with certain types of birth control. 

Tang added that diet and exercise alone often fall short of addressing symptoms: “A lot of people can exercise very aggressively and regularly or watch what they eat and still struggle with hormone imbalances, weight, and blood sugar.”

That was the case for Haley Sipes, a 31-year-old mother of three based in Western Kentucky who experienced PCOS symptoms for years without a diagnosis. In 2022, before being diagnosed, she lost 75 pounds over 10 months through diet and exercise alone. 

Her progress stalled in late 2022 despite an intense diet and exercise regimen, and her weight began to fluctuate in 2023. By mid-2024, she had regained about 30 pounds. 

Sipes sought help from her primary care provider and underwent blood work, which revealed she had a hormonal imbalance. Initial efforts to regulate her hormones with progesterone and testosterone had a limited effect.

Further bloodwork diagnosed Sipes with PCOS and insulin resistance, which she views as the root cause of her weight loss struggles. She recalled bloating, fatigue, low energy, and water retention during earlier efforts to lose weight.

Despite her history of painful, irregular periods and ovarian cysts since age 10, her providers never mentioned PCOS as a possible diagnosis.

In September 2024, her doctor prescribed Zepbound. Her insurance covered it due to her BMI and prediabetes status.

Sipes said she noticed changes within the first month: her food cravings quieted, her inflammation decreased, she experienced less joint pain, and her period became less painful and occurred more regularly. Sipes added that she has not had ovarian cysts since starting Zepbound. 

After around eight months on the medication, she lost more than 60 pounds. Sipes said those results significantly improved her emotional health.

“All the symptoms and being overweight might not seem like big things, but when you have 20 little things that are constantly nagging you, then you’re going to be in a bad mood sometimes,” Sipes said. 

“I’m just a better version of myself when I’m not controlled by food thoughts and hormonal issues that cause mood swings,” she continued. “My life does feel so much more enjoyable.”

Sipes plans to continue taking Zepbound to maintain her results, possibly at lower doses. She noted that more research is needed on whether PCOS symptoms can fully resolve.

More than one-third of employers now cover GLP-1s for both weight loss and diabetes, while 55% only cover them for diabetes, according to a recent survey from the International Foundation of Employee Benefit Plans. 

In April, President Donald Trump rejected a Biden administration plan that would have required Medicare and Medicaid to cover obesity drugs.

Some patients, like 34-year-old California mom Nabeelah Karim, have turned to other options. 

Karim was diagnosed with PCOS at 19 and took birth control on and off until giving birth in 2021. She said she struggled with hair loss, irregular periods, debilitating cramps, facial hair growth, severe water retention and mood swings. 

Karim said her period symptoms worsened after she gave birth, and in late 2023, she began what would be a painful five-month-long period. Doctors suggested that she lose weight, take painkillers or return to birth control. 

While Karim lost some weight through diet and exercise, she was eventually prescribed Eli Lilly’s diabetes drug Mounjaro through the digital health startup Noom in April 2024. 

Her long period stopped and symptoms eased within days, and she began to lose more weight over time. 

“It had solved all the problems that I had experienced for years up until that point,” Karim said. 

But her insurance plan never formally approved or denied coverage of Mounjaro, forcing her to pay its more than $1,000 per month out-of-pocket price. She eventually found a third-party compounding pharmacy that accepted her prescription, allowing her to buy a cheaper but unapproved version of the drug. 

Karim used that compounded version for six months and continued to experience weight loss and improvements to her PCOS symptoms. 

During FDA-declared shortages, pharmacists can legally make compounded versions of brand-name medications. They can also be produced on a case-by-case basis when it’s medically necessary for a patient, such as when they can’t swallow a pill or are allergic to a specific ingredient.

But Novo Nordisk, Eli Lilly and some health experts have pushed back – and in some cases, taken legal action – against the practice, largely because the FDA does not approve compounded drugs. The FDA has declared U.S. shortages of both companies’ drugs over. 

“When people ask about how safe compounded drugs are, the answer I typically give is I don’t know,” said Dominguez from USC’s School of Medicine. She said that’s unlike branded drugs, which have clearly defined risks and benefits proven in clinical trials.

Hamilton, the 27-year-old patient who took a GLP-1 for PCOS symptoms, has never taken a compounded GLP-1. She is currently appealing her insurer’s denial of semaglutide now that she has completed Cree’s trial. 

“My whole life has been an inability to access care for my medical condition, and I’m tired of that,” she said. “If somebody would have been able to provide 11-year-old Grace with this drug, that would have saved me.”