GLP‑1 prescriptions for women with PCOS have jumped more than sevenfold since 2021, US data show
Women with polycystic ovary syndrome (PCOS) are rapidly emerging as a major off‑label user group for GLP‑1 drugs, pushing weight‑loss and diabetes medications into a new, largely unregulated corner of reproductive and metabolic care.
According to Reuters, health data firm Truveta analysed 120 million US patient records and found that GLP‑1 prescriptions among women with PCOS have risen more than sevenfold since 2021, centred on semaglutide and tirzepatide, the active ingredients in Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound.
Reuters reported that by 2025, 17.6 percent of women with a PCOS diagnosis had a GLP‑1 prescription, up from 2.4 percent in 2021, and the share of all GLP‑1 prescriptions going to PCOS patients increased from 4.6 percent to 5.7 percent, based on conventional health‑care systems only.
PCOS itself is common and under‑recognised.
CNBC reported that it affects an estimated 5 million to 6 million women of reproductive age in the United States and is the most common cause of infertility.
According to Reuters, PCOS affects up to 13 percent of women of reproductive age globally and can cause rapid weight gain, insulin resistance and infertility.
CNBC said the condition is strongly linked to metabolic issues, with an estimated 35 percent to 80 percent of patients experiencing insulin resistance and many also living with obesity or type 2 diabetes.
That metabolic profile helps explain why GLP‑1s have become attractive in PCOS.
Traditional options such as birth control, lifestyle changes and metformin often target only specific symptoms.
CNBC reported that paediatric endocrinologist Melanie Cree described the situation as a “massive” unmet need and said primary therapies for PCOS symptoms “haven’t changed in nearly 50 years.”
Reuters noted that PCOS patients are generally prescribed metformin for insulin regulation, orlistat for weight loss and birth control pills for menstrual cycle control.
GLP‑1s act directly on the same pathways that trouble many PCOS patients.
CNBC reported that drugs such as semaglutide improve insulin sensitivity and reduce appetite by slowing how quickly food leaves the stomach, triggering insulin release when blood sugar is high and suppressing a hormone that raises blood sugar, with weight loss further improving insulin sensitivity.
Cree said studies in adults with PCOS show that losing as little as 5 percent of body weight can improve insulin sensitivity, which may lower insulin levels, reduce ovarian testosterone production and ease symptoms like irregular periods, acne and excess hair growth.
The insulin link is central.
Reuters reported that women with a family history of type 2 diabetes face higher PCOS risk and that high insulin levels may trigger excess testosterone production in the ovaries, creating a “vicious cycle” of abdominal weight gain and worsening insulin resistance.
Columbia Medical Center endocrinologist Judy Korner called it a “chicken versus egg phenomenon” over whether insulin resistance drives PCOS or PCOS drives insulin resistance..
Evidence on GLP‑1s in PCOS is still early but broadly encouraging.
Reuters said at least a dozen research papers published between 2018 and 2025 – including studies on Novo Nordisk’s older GLP‑1 Saxenda, also sold as Victoza – suggest GLP‑1 medicines may improve menstrual regularity and insulin resistance in PCOS patients.
CNBC reported that in Cree’s ongoing trial of injectable semaglutide in girls and women aged 12 to 35 with obesity and PCOS, early data on 11 participants not taking metformin showed eight lost more than 10 percent of their body weight and saw reduced testosterone levels.
Five of those eight reached “normal ranges,” and six reported more regular periods.
CNBC also noted that three participants did not lose at least 10 percent of body weight, including one who did not lose any, which Cree said aligns with broader obesity data.
Real‑world signals mirror those findings.
In a survey of 1,700 people by the birth control app Natural Cycles, 64 percent of women with PCOS who took a GLP‑1 reported more predictable periods and 20 percent said their bleeding days were shorter.
According to Reuters, some doctors have also observed higher pregnancy rates among patients whose cycles stabilise on GLP‑1s and now caution about unintended pregnancies.
For plan sponsors and insurers, cost and coverage are now pivotal.
CNBC reported that most health plans cover GLP‑1s for diabetes but not for obesity or unapproved indications such as PCOS, even when patients qualify under BMI or related conditions.
These drugs can cost around US$1,000 a month before insurance.
Reuters said Eli Lilly and Novo Nordisk offer discounts to some patients paying out of pocket.
CNBC reported that more than one‑third of employers now cover GLP‑1s for both weight loss and diabetes, while 55 percent only cover them for diabetes, based on an International Foundation of Employee Benefit Plans survey.
Coverage gaps have pushed some patients towards compounded versions.
California patient Nabeelah Karim, who has long‑standing PCOS, initially paid more than US$1,000 a month for Mounjaro without clear insurer approval before turning to a third‑party compounding pharmacy that offered a cheaper but unapproved version, which she used for six months with continued symptom relief.
Pharmacists can legally produce compounded versions during US Food and Drug Administration (FDA)‑declared shortages or when medically necessary, but the FDA does not approve compounded drugs and has declared GLP‑1 shortages over.
Endocrinologist Alyssa Dominguez said, “When people ask about how safe compounded drugs are, the answer I typically give is I don’t know,” contrasting them with branded products that have clearly defined trial‑based risk–benefit profiles.
Despite rising use, drugmakers have not yet pursued PCOS as a formal indication.
Reuters reported that Novo Nordisk and Eli Lilly are testing GLP‑1s for conditions such as Parkinson’s, Alzheimer’s, substance abuse and fatty liver disease, but not PCOS.
CNBC said Cree partly attributes this to the FDA’s failure so far to define PCOS‑specific trial “endpoints.”
Sasha Ottey of PCOS Challenge is calling for larger and longer GLP‑1 trials in PCOS to clarify which symptoms improve, how age and drug choice matter and why some patients do not lose weight or may not need to.
