Polycystic ovary syndrome (PCOS) affects up to 13% of women of reproductive age in the UK, causing metabolic dysfunction, irregular periods, and elevated androgen levels. Ozempic (semaglutide), a GLP-1 receptor agonist licensed for type 2 diabetes, has generated interest for PCOS management due to its effects on insulin sensitivity and weight. However, it is not currently licensed for PCOS treatment in the UK, and evidence for its use in this condition remains limited. This article examines the current evidence, explores established PCOS treatments, and provides guidance on discussing treatment options with your GP.

Understanding PCOS and Its Impact on Metabolic Health

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age in the UK, with an estimated prevalence of 10–13%. The condition is diagnosed using the Rotterdam criteria, requiring at least two of three features: irregular menstrual cycles, clinical or biochemical hyperandrogenism (elevated male hormones), and polycystic ovaries visible on ultrasound. However, PCOS extends far beyond reproductive health, significantly impacting metabolic function.

Insulin resistance is a hallmark feature of PCOS, present in approximately 50–70% of affected women (higher in those with obesity). This metabolic dysfunction means the body's cells become less responsive to insulin, prompting the pancreas to produce more insulin to maintain normal blood glucose levels. This compensatory hyperinsulinaemia contributes to weight gain, particularly central adiposity, and creates a vicious cycle that worsens both metabolic and reproductive symptoms. Women with PCOS face elevated risks of developing type 2 diabetes mellitus, with studies suggesting a two- to four-fold increased risk compared to women without the condition.

The metabolic consequences of PCOS are far-reaching. Beyond diabetes risk, women with PCOS experience higher rates of:

• Cardiovascular risk factors including hypertension and dyslipidaemia, though long-term cardiovascular event data remain less definitive

• Non-alcoholic fatty liver disease (NAFLD), with prevalence varying widely depending on BMI and diagnostic methods used

• Obstructive sleep apnoea, particularly in those with elevated BMI

• Psychological distress, including anxiety and depression, partly related to metabolic dysfunction

According to NICE guidelines, addressing insulin resistance and metabolic health forms a cornerstone of PCOS management, as improvements in these areas often lead to amelioration of reproductive symptoms and reduced long-term health risks. Regular screening for metabolic complications is recommended, including glycaemic assessment (OGTT or HbA1c), lipid profile, and blood pressure monitoring.

Red flags requiring urgent referral include sudden onset of severe hirsutism or virilisation, suspected pelvic mass, or abnormal uterine bleeding. Routine referral should be considered for diagnostic uncertainty, persistent symptoms despite initial management, or fertility concerns.

How Ozempic Works in the Body

Ozempic (semaglutide) is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) licensed in the UK by the MHRA primarily for the treatment of type 2 diabetes mellitus. Understanding its mechanism of action helps explain why it has generated interest for PCOS management, despite not being officially licensed for this indication.

Mechanism of action: Semaglutide mimics the naturally occurring hormone GLP-1, which is released from the intestine in response to food intake. By binding to GLP-1 receptors, Ozempic exerts multiple physiological effects:

• Enhances glucose-dependent insulin secretion from pancreatic beta cells, improving glycaemic control

• Suppresses glucagon release, reducing hepatic glucose production

• Slows gastric emptying, which moderates post-prandial glucose excursions

• Acts on appetite centres in the brain, particularly the hypothalamus, reducing hunger and promoting satiety

These combined actions result in improved blood glucose regulation and, notably, weight loss. In clinical trials for type 2 diabetes, patients typically lose 4–6 kg (approximately 4–6% of body weight) at standard diabetes doses. This is distinct from semaglutide 2.4 mg (Wegovy), which is specifically licensed for weight management and produces greater weight loss (typically ≥10%). The weight loss effect occurs through reduced caloric intake rather than increased energy expenditure. Any improvements in insulin sensitivity are largely secondary to weight loss and improved glycaemic control.

Pharmacokinetics: Ozempic is administered as a once-weekly subcutaneous injection, with a long half-life of approximately one week allowing steady-state concentrations after 4–5 weeks. This convenient dosing schedule contributes to improved adherence compared to daily medications. Typical titration involves starting at 0.25 mg weekly for 4 weeks, then increasing to 0.5 mg, with further increases to 1 mg or 2 mg as needed and tolerated.

Important safety considerations from the UK SmPC include risks of pancreatitis, gallbladder disease, diabetic retinopathy complications (particularly with rapid glycaemic improvement), and dehydration with potential acute kidney injury from gastrointestinal side effects.

For women with PCOS, the dual benefits of improved glycaemic control and weight reduction theoretically address two fundamental pathophysiological mechanisms of the condition. However, it is crucial to emphasise that Ozempic is not currently licensed for PCOS treatment in the UK, and its use for this indication would be considered off-label prescribing. Current UK supply constraints also mean that off-label use is unlikely to be supported within the NHS.

Evidence for Ozempic Use in PCOS Management

The evidence base for GLP-1 receptor agonists, including Ozempic, in PCOS management is evolving but remains limited compared to established treatments. Currently, there is no official NICE recommendation or MHRA licence for using Ozempic specifically for PCOS, and most available evidence comes from small studies or research using other GLP-1 agonists.

Research findings to date:

Several clinical trials have investigated GLP-1 receptor agonists in women with PCOS, primarily focusing on liraglutide (a daily GLP-1 RA) rather than semaglutide specifically. Evidence for semaglutide in PCOS is limited to small studies. These investigations have demonstrated:

• Weight reduction: Consistent evidence shows GLP-1 RAs produce greater weight loss than metformin or lifestyle modification alone in women with PCOS and overweight/obesity

• Improved insulin sensitivity: Markers of insulin resistance, including HOMA-IR scores, show significant improvement

• Menstrual regularity: Some studies report improved menstrual cyclicity, likely secondary to metabolic improvements

• Androgen levels: Modest reductions in testosterone levels have been observed in some trials

A 2020 systematic review examining GLP-1 agonists in PCOS found promising metabolic benefits but highlighted the limited number of participants and short follow-up periods in existing studies. Most trials enrolled fewer than 100 women and lasted 6–12 months, insufficient to assess long-term safety or effects on fertility outcomes.

Important limitations:

There is currently insufficient evidence regarding Ozempic's effects on:

• Ovulation rates and fertility outcomes

• Long-term cardiovascular risk reduction in PCOS

• Safety during pregnancy (GLP-1 RAs are contraindicated in pregnancy and must be discontinued at least two months before conception attempts)

• Comparative effectiveness versus established PCOS treatments

The Royal College of Obstetricians and Gynaecologists (RCOG) has not issued specific guidance on GLP-1 agonist use in PCOS. Women considering this treatment should understand it represents off-label use with an evolving evidence base, and decisions should be made collaboratively with healthcare professionals experienced in PCOS management.

Alternative Treatments for PCOS in the UK

NICE provides comprehensive guidance on PCOS management (Clinical Knowledge Summary), emphasising a holistic approach addressing metabolic, reproductive, and psychological aspects. Several evidence-based treatments are available through the NHS, tailored to individual symptoms and reproductive goals.

First-line lifestyle interventions:

For all women with PCOS, particularly those with elevated BMI, lifestyle modification forms the foundation of treatment. Even modest weight loss of 5–10% can significantly improve:

• Insulin sensitivity and metabolic parameters

• Menstrual regularity and ovulation rates

• Androgen levels and associated symptoms (hirsutism, acne)

• Psychological wellbeing and quality of life

NHS weight management programmes and referral to specialist dietitians can provide structured support.

Pharmacological treatments:

Metformin remains the most commonly prescribed medication for metabolic aspects of PCOS in the UK. This insulin-sensitising agent:

• Improves insulin resistance and may reduce diabetes risk

• Can promote modest weight loss (typically 2–3 kg)

• May improve menstrual regularity in some women

• Is generally well-tolerated, though gastrointestinal side effects are common initially

NICE recommends considering metformin for women with PCOS who have not responded adequately to lifestyle measures, particularly those with impaired glucose tolerance.

For specific symptoms:

• Menstrual irregularity: Combined oral contraceptive pills regulate cycles and reduce endometrial hyperplasia risk

• Hirsutism and acne: Co-cyprindiol (Dianette) for severe acne/hirsutism (note MHRA warnings regarding venous thromboembolism risk; requires individual risk assessment); spironolactone (off-label) with reliable contraception is an alternative anti-androgen; topical eflornithine for facial hirsutism (availability may vary)

• Fertility: Letrozole is generally preferred first-line for ovulation induction in specialist settings, with clomifene citrate as an alternative; referral to specialist fertility services as appropriate

Emerging options:

Inositol supplements, particularly myo-inositol, show promise in some studies for improving insulin sensitivity and ovulation, though evidence remains limited. These are available over-the-counter but should be discussed with healthcare professionals.

Treatment selection should be individualised based on predominant symptoms, reproductive intentions, contraindications, and patient preferences, with regular review to assess response and adjust management accordingly. Periodic screening for metabolic complications (glycaemic status, lipids, blood pressure) is recommended.

Speaking to Your GP About Ozempic and PCOS

If you are considering Ozempic for PCOS management, an informed discussion with your GP or specialist is essential. Approaching this conversation with realistic expectations and understanding of the current evidence will facilitate shared decision-making.

Preparing for your appointment:

Before consulting your GP, consider:

• Documenting your symptoms: Keep a record of menstrual patterns, weight changes, and how PCOS affects your daily life

• Previous treatments tried: Note what you have already attempted and the response

• Your primary concerns: Clarify whether metabolic health, fertility, or specific symptoms are your main priorities

• Questions about alternatives: Be open to discussing evidence-based treatments alongside or instead of Ozempic

Key discussion points:

Your GP will likely explain that:

• Ozempic is not licensed for PCOS in the UK, meaning its use would be off-label

• Prescribing pathways for semaglutide in the NHS are specific: Ozempic is for type 2 diabetes, while Wegovy (semaglutide 2.4 mg) is the licensed formulation for weight management under NICE TA875 via specialist services

• Current supply constraints mean that off-label use of GLP-1 receptor agonists is unlikely to be supported within the NHS

• Evidence limitations mean long-term safety and efficacy for PCOS specifically remain uncertain

Safety considerations:

Your doctor will assess whether semaglutide is appropriate by considering:

• Important warnings: Risk of pancreatitis (persistent severe abdominal pain), gallbladder disease, diabetic retinopathy complications, and dehydration with potential kidney effects from gastrointestinal side effects

• Common side effects: Nausea, vomiting, diarrhoea, and constipation affect many users, particularly during dose escalation

• Pregnancy planning: GLP-1 RAs must be discontinued at least two months before conception attempts and are contraindicated in pregnancy

• Monitoring requirements: Regular follow-up for weight, metabolic parameters, and adverse effects

When to seek specialist referral:

Your GP may refer you to:

• Endocrinology for complex metabolic management or if diabetes/pre-diabetes is present

• Gynaecology for fertility concerns or severe menstrual irregularity

• Weight management services for structured support with lifestyle modification

Remember that effective PCOS management often requires a multifaceted approach. While semaglutide may offer benefits for some women, established treatments with stronger evidence bases should typically be optimised first. Maintain open communication with your healthcare team, attend regular reviews, and report any concerning symptoms promptly. If you experience side effects from any medication, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions