Ozempic (semaglutide) is a once-weekly injectable medication licensed in the UK for managing type 2 diabetes in adults. Whilst it has gained attention for weight loss effects, understanding ozempic side effects in females long-term is essential for women considering or currently using this treatment. Common long-term effects include gastrointestinal symptoms such as nausea and diarrhoea, whilst rarer but serious risks require monitoring. Women of childbearing potential must also consider reproductive health implications. This article examines the side effect profile specific to long-term female use, when to seek medical advice, and how to manage symptoms effectively under NHS guidance.

What Is Ozempic and How Does It Work in Women?

Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. Administered as a once-weekly subcutaneous injection, it is prescribed to improve glycaemic control in adults when diet and exercise alone are insufficient. Whilst Ozempic has gained attention for its weight loss effects, it is important to note that its primary indication remains diabetes management, not obesity treatment (Wegovy is the licensed semaglutide product for weight management in the UK).

The mechanism of action involves mimicking the naturally occurring hormone GLP-1, which is released from the gut in response to food intake. Semaglutide works by stimulating insulin secretion in a glucose-dependent manner, meaning it only promotes insulin release when blood sugar levels are elevated. This reduces the risk of hypoglycaemia compared to some other diabetes medications. Additionally, it suppresses glucagon secretion, slows gastric emptying, and acts on appetite centres in the brain to promote satiety.

Ozempic is not indicated for type 1 diabetes or diabetic ketoacidosis and is not a substitute for insulin. In women, Ozempic functions through the same physiological pathways as in men, with adverse effects generally similar across sexes. Individual responses vary considerably. Understanding how Ozempic works is essential for women considering long-term treatment, as it helps contextualise both the therapeutic benefits and potential adverse effects that may emerge over extended use.

Common Long-Term Side Effects of Ozempic in Women

The most frequently reported long-term side effects of Ozempic in women are gastrointestinal in nature. Very common effects (affecting more than 1 in 10 people) include nausea and diarrhoea, while common effects (affecting up to 1 in 10 people) include vomiting, constipation, abdominal pain and decreased appetite. Whilst these symptoms often diminish after the initial weeks of treatment, some women continue to experience them intermittently throughout long-term use. The delayed gastric emptying caused by semaglutide is responsible for many of these effects, and women may find that eating smaller, more frequent meals helps manage symptoms.

Injection site reactions are another common concern, manifesting as redness, itching, or mild swelling at the injection site. Rotating injection sites between the abdomen, thigh, and upper arm can minimise these reactions.

Hypoglycaemia (low blood sugar) is primarily a risk when Ozempic is used in combination with insulin or sulfonylureas. If you are taking these medications together, your doctor may consider reducing your insulin or sulfonylurea dose when starting Ozempic.

Gallbladder-related issues, including gallstones (cholelithiasis), are common in patients using GLP-1 receptor agonists long-term, particularly in those experiencing rapid weight loss. Women should be aware of symptoms such as severe upper abdominal pain, especially after meals, which may indicate gallbladder complications requiring medical assessment. Gradual rather than rapid weight loss may help reduce this risk.

If you experience significant reduction in appetite that affects your nutritional intake, discuss this with your healthcare provider who may recommend dietetic review.

Reproductive Health and Hormonal Considerations

Women of childbearing potential must be aware that Ozempic is not recommended during pregnancy. The MHRA advises discontinuing semaglutide at least two months before a planned pregnancy due to its long half-life and unknown effects on foetal development. Animal studies have shown potential risks, though there is limited human data. Women should use effective contraception whilst taking Ozempic and discuss family planning with their healthcare provider.

Ozempic should not be used during breastfeeding according to UK guidance, as it is unknown whether semaglutide is excreted in human milk or what effects it might have on the breastfed infant.

Regarding contraception, subcutaneous semaglutide (Ozempic) does not reduce the effectiveness of combined oral contraceptives. No additional contraceptive measures are routinely required when taking Ozempic. However, if you experience severe vomiting or diarrhoea, additional contraceptive precautions may be needed temporarily, as with any illness causing these symptoms.

There is currently no official link established between Ozempic and direct hormonal disruption in women, such as effects on menstrual cycles or menopausal symptoms. However, significant weight loss itself can influence hormonal balance, potentially affecting menstrual regularity in premenopausal women. Some women report changes in cycle length or flow, though these are more likely attributable to metabolic changes rather than direct drug effects on reproductive hormones.

Polycystic ovary syndrome (PCOS) is common among women with type 2 diabetes and insulin resistance. Whilst Ozempic may improve insulin sensitivity and support weight management—both beneficial for PCOS—women with this condition should maintain regular gynaecological follow-up. Any use of Ozempic specifically for PCOS without diabetes would be off-label. The metabolic improvements may restore ovulation in some women, unexpectedly increasing fertility and necessitating careful contraceptive planning if pregnancy is not desired.

Serious Long-Term Risks Women Should Monitor

Whilst rare, several serious adverse effects require vigilant monitoring during long-term Ozempic use. Pancreatitis (inflammation of the pancreas) has been reported with GLP-1 receptor agonists, though causality remains debated. Women should be alert to symptoms including severe, persistent abdominal pain radiating to the back, nausea, and vomiting. Any suspicion of pancreatitis warrants immediate medical assessment and discontinuation of the medication pending investigation.

Diabetic retinopathy complications have been observed in some clinical trials, particularly in patients with pre-existing retinopathy who experienced rapid improvements in glycaemic control. Women with established diabetic eye disease should undergo regular ophthalmological screening through the NHS Diabetic Eye Screening Programme. Sudden vision changes, floaters, or visual disturbances should prompt urgent ophthalmology referral.

Animal studies have shown thyroid C-cell tumours with semaglutide, though the relevance to humans is unknown. Women should report any neck lumps, persistent hoarseness, or difficulty swallowing to their GP promptly.

Acute kidney injury has been reported, often in the context of severe dehydration from gastrointestinal side effects. Women experiencing persistent vomiting or diarrhoea should maintain adequate hydration and seek medical advice if symptoms are severe or prolonged. No dose adjustment is required for renal impairment, but monitoring is important if severe gastrointestinal symptoms occur.

Some reports suggest a possible association with gastroparesis (delayed stomach emptying), though this remains under investigation and is not definitively established. Persistent severe gastrointestinal symptoms should be discussed with your healthcare provider.

Managing Side Effects and When to Seek Medical Advice

Effective management of Ozempic side effects begins with appropriate dose titration. The standard initiation involves starting at 0.25 mg weekly for four weeks, then increasing to 0.5 mg weekly. Further increases to 1 mg or 2 mg should only occur at intervals of at least 4 weeks if tolerated and clinically indicated. Women experiencing significant side effects may benefit from slower dose escalation or remaining at a lower maintenance dose if glycaemic targets are achieved.

Dietary modifications can substantially reduce gastrointestinal symptoms. Women should focus on smaller, more frequent meals, avoid high-fat and spicy foods, and ensure adequate hydration. Eating slowly and stopping when comfortably satisfied—rather than full—aligns with the medication's mechanism. Some women find that taking the injection on the same day each week and timing it relative to their schedule (e.g., before a lighter eating day) helps manage predictable side effects.

When to contact your GP:

• Persistent vomiting or diarrhoea lasting more than 24 hours

• Signs of dehydration (dark urine, dizziness, reduced urination)

• Severe abdominal pain, especially if radiating to the back

• Symptoms of gallbladder problems (pain after eating, yellowing of skin or eyes)

• Unexplained weight loss exceeding clinical targets

• Changes in vision or eye symptoms

• Symptoms of low blood sugar (if taking Ozempic with insulin or sulphonylureas)

Seek immediate medical attention (A&E or 999) for:

• Severe allergic reactions (difficulty breathing, facial swelling, severe rash)

• Suspected pancreatitis (severe, unrelenting abdominal pain with vomiting)

• Signs of kidney problems (significantly reduced urination, swelling, confusion)

For urgent but non-emergency concerns, contact NHS 111 for advice.

Regular follow-up with your diabetes care team is essential for long-term Ozempic use. This typically includes monitoring HbA1c levels, renal function, and weight, alongside discussion of any emerging side effects. Women should maintain open communication with healthcare providers about all symptoms, even those seeming minor, as early intervention can prevent complications and optimise treatment outcomes.

If you suspect you are experiencing side effects from Ozempic, you can report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Frequently Asked Questions