Ozempic (semaglutide) is a GLP-1 receptor agonist licensed in the UK for type 2 diabetes management, not for treating ovarian cysts directly. However, emerging research suggests potential benefits for women with polycystic ovary syndrome (PCOS), a condition characterised by insulin resistance and multiple ovarian follicles. Whilst Ozempic may improve metabolic dysfunction underlying PCOS, it remains an off-label use without NICE endorsement. This article examines the evidence, explores standard UK treatments for ovarian cysts and PCOS, and clarifies when discussing Ozempic with your GP may be appropriate.

What Is Ozempic and How Does It Work?

Ozempic (semaglutide) is a prescription medication licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that regulates blood glucose levels.

The mechanism of action involves several key processes:

• Stimulating insulin secretion from pancreatic beta cells in response to elevated blood glucose

• Suppressing glucagon release, which reduces glucose production by the liver

• Slowing gastric emptying, leading to more gradual absorption of nutrients

• Reducing appetite through effects on brain centres that control hunger

Ozempic is administered as a once-weekly subcutaneous injection and is available in pre-filled pens at doses of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. The Medicines and Healthcare products Regulatory Agency (MHRA) has approved it specifically for glycaemic control in adults with type 2 diabetes, often in combination with other glucose-lowering medications or as monotherapy when metformin is not tolerated.

Whilst weight loss is a recognised effect of Ozempic, it is important to understand that it is not licensed for weight management in the UK. A related medication, Wegovy (also semaglutide but at different dosing), has specific licensing for chronic weight management under NICE guidance.

Common adverse effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation. Important safety considerations include risk of pancreatitis, gallbladder disease, and potential worsening of diabetic retinopathy in some patients. Semaglutide should be discontinued at least 2 months before a planned pregnancy and is not recommended during breastfeeding.

If you experience side effects, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Understanding Ovarian Cysts: Causes and Symptoms

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. They are extremely common, particularly in women of reproductive age, and most are functional cysts that form as a normal part of the menstrual cycle. These typically resolve spontaneously within a few weeks to months without intervention.

There are several types of ovarian cysts:

• Follicular cysts: Form when a follicle fails to rupture and release an egg during ovulation

• Corpus luteum cysts: Develop when the corpus luteum (the structure left after ovulation) fills with fluid

• Dermoid cysts: Contain tissue such as hair, skin, or teeth and are present from birth

• Endometriomas: Result from endometriosis, where endometrial tissue grows on the ovaries

• Cystadenomas: Develop from ovarian tissue and can grow quite large

Many ovarian cysts cause no symptoms and are discovered incidentally during pelvic examinations or ultrasound scans. When symptoms do occur, they may include:

• Pelvic pain or a dull ache in the lower abdomen

• Bloating or abdominal swelling

• Pain during intercourse

• Changes in menstrual patterns

• Difficulty emptying the bladder completely

Complications are uncommon but can include cyst rupture (causing sudden, sharp pain), ovarian torsion (twisting of the ovary, which is a surgical emergency), or, rarely, malignant transformation.

Women with polycystic ovary syndrome (PCOS) have multiple small follicles visible on their ovaries as part of a broader metabolic and hormonal condition. These are not true cysts but rather undeveloped follicles, and PCOS requires specific management approaches.

If you experience persistent bloating, early satiety, pelvic/abdominal pain, or urinary urgency, particularly if postmenopausal, you should seek prompt medical advice as these can be symptoms of ovarian cancer. Your GP may arrange tests including CA125 blood test and ultrasound if there are concerns.

PCOS, Insulin Resistance and GLP-1 Medications

Polycystic ovary syndrome (PCOS) affects approximately 10% of women of reproductive age in the UK and is characterised by hormonal imbalance, irregular periods, multiple ovarian follicles, and often insulin resistance. This insulin resistance plays a central role in PCOS pathophysiology, contributing to elevated androgen levels, ovulatory dysfunction, and metabolic complications including type 2 diabetes and cardiovascular disease.

The connection between insulin resistance and ovarian function is well established. Elevated insulin levels stimulate the ovaries to produce excess androgens (male hormones), which interfere with normal follicle development and ovulation. This creates a cycle where hormonal imbalance perpetuates metabolic dysfunction.

GLP-1 receptor agonists like Ozempic have shown promise in addressing the metabolic aspects of PCOS in emerging research. Early studies suggest these medications may:

• Improve insulin sensitivity, potentially reducing hyperinsulinaemia and its downstream effects

• Promote weight loss, which can help restore ovulatory function in overweight women with PCOS

• Potentially affect androgen levels through metabolic improvements

• Possibly support menstrual regularity through metabolic improvements

However, it is crucial to note that there is no official licence for Ozempic in the treatment of PCOS or ovarian cysts in the UK. The evidence base remains limited, with most studies being small, short-term, and often focused on liraglutide rather than semaglutide. GLP-1 agonists are not currently included in NICE guidance as therapy for PCOS.

Standard UK treatments for PCOS remain lifestyle modification (first-line), metformin for insulin resistance, and hormonal contraceptives for menstrual regulation and hyperandrogenism. Any use of Ozempic for PCOS would be considered off-label and should only be undertaken under specialist endocrinology or gynaecology supervision, typically in cases where type 2 diabetes coexists with PCOS.

Treatment Options for Ovarian Cysts in the UK

Management of ovarian cysts in the UK follows RCOG guidelines and depends on several factors including cyst size, type, symptoms, and the patient's age and menopausal status. The approach is typically conservative for simple, functional cysts.

Watchful waiting is appropriate for most premenopausal women with simple cysts under 5 cm in diameter. These cysts usually resolve spontaneously within two to three menstrual cycles and generally require no follow-up. For cysts between 5-7 cm, periodic follow-up may be considered, while cysts larger than 7 cm or those with complex features typically warrant further assessment.

Hormonal contraceptives (combined oral contraceptive pill) may be prescribed to prevent new cyst formation by suppressing ovulation, though they do not accelerate the resolution of existing cysts. This approach is particularly useful for women experiencing recurrent functional cysts.

For symptomatic or persistent cysts, or those with concerning features on imaging, surgical intervention may be necessary:

• Laparoscopic cystectomy: Removal of the cyst whilst preserving the ovary (preferred for younger women)

• Oophorectomy: Removal of the affected ovary in cases of large, complex, or potentially malignant cysts

In women with PCOS, treatment focuses on managing the underlying metabolic and hormonal dysfunction:

• Lifestyle modification: Weight loss of 5–10% can restore ovulatory function

• Metformin: First-line pharmacological treatment for insulin resistance in PCOS

• Ovulation induction: Letrozole (often used first-line though off-label) or clomifene citrate for women trying to conceive

• Anti-androgens: Such as co-cyprindiol for severe hirsutism and acne when other treatments have failed (note: co-cyprindiol carries an increased risk of venous thromboembolism)

Urgent referral to gynaecology is warranted if there is sudden, severe abdominal pain (suggesting rupture or torsion) or signs of internal bleeding. Postmenopausal women with ovarian cysts require specialist assessment due to increased malignancy risk. If cancer is suspected, CA125 blood test and transvaginal ultrasound are typically performed, with urgent referral via the two-week wait pathway if the Risk of Malignancy Index (RMI) is elevated (e.g., >200) or other concerning features are present.

When to Speak with Your GP About Ozempic

If you are considering Ozempic for any reason related to ovarian cysts or PCOS, it is essential to have an open discussion with your GP or specialist. Ozempic is a prescription-only medication that requires careful assessment of suitability, potential benefits, and risks.

Appropriate scenarios for discussing Ozempic with your healthcare provider include:

• You have type 2 diabetes and PCOS, and standard treatments have not adequately controlled your blood glucose or metabolic symptoms

• You have significant obesity alongside PCOS and have not achieved sufficient weight loss through lifestyle measures and metformin (note that Wegovy, not Ozempic, is the licensed semaglutide product for weight management through specialist NHS weight management services)

• You are experiencing insulin resistance confirmed through blood tests, and first-line treatments have been insufficient

Your GP will need to assess several factors before considering Ozempic:

• Current medications and potential drug interactions

• Medical history, particularly thyroid disease, pancreatitis, gallbladder disease, or diabetic retinopathy

• Treatment goals and whether Ozempic aligns with evidence-based management

Important safety considerations to discuss include:

• Common gastrointestinal side effects and how to manage them

• Risk of hypoglycaemia if used with sulfonylureas or insulin

• The need for regular monitoring of blood glucose, kidney function, and weight

• Pregnancy planning, as semaglutide should be discontinued at least 2 months before conception and is not recommended during breastfeeding

• Symptoms of pancreatitis (severe abdominal pain) or gallbladder disease that require prompt medical attention

• Potential worsening of diabetic retinopathy in those with pre-existing disease

It is vital to understand that Ozempic is not a substitute for established PCOS treatments and should not be viewed as a direct treatment for ovarian cysts themselves. If you are experiencing symptoms such as pelvic pain, irregular periods, or difficulty conceiving, these require proper investigation and management according to UK guidelines. Your GP can arrange appropriate referrals to endocrinology or gynaecology services if specialist input is needed.

Frequently Asked Questions