114. GLP-1 Medications & Fertility: What Women Need to Know

What if the medication helping your blood sugar and weight was quietly disrupting your menstrual cycle—or even your fertility? In this episode of Cycle Wisdom, Dr. Monica Minjeur explores how GLP-1 agonists (like semaglutide and tirzepatide) intersect with hormones, ovulation, and conception. Learn why some women see improved cycles, while others experience irregular periods, missed ovulation, or fertility delays. Dr. Minjeur breaks down how to navigate these medications safely, plan your washout period, and use restorative strategies to protect both your hormones and fertility.

Ready to create a fertility plan that works with your body? Book a discovery call at radiantclinic.com

Transcript

Speaker: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if the medication helping your blood, sugar and weight was also changing your cycle? Sometimes for the better? Sometimes not, but maybe no one has ever told you what to watch for. Today we're going to unpack how medications called GLP one agonists. Things like semaglutide or tirzepatide intersect with menstrual health ovulation and plans when trying to conceive. Furthermore, we'll discuss how a restorative approach can keep your hormones and your goals front and center. So let's start off today as always, with a patient who I'll call Lauren. Now, Lauren came to me at 35 years old and she had had irregular cycles with features of PCOS for many years. She has had a baby in the past, but wanted to get pregnant again. However, she knew that she wanted to get her health under better control, and she had unfortunately gained a lot of weight over the last few years. Her primary care team had started her on a GLP one medication for insulin resistance and weight. Now, she did start to lose some significant weight, but had some side effects on the medications as a side effect, though she did notice that her cycle started to change. Three months in, she had a first clear ovulation cycle, and the next month she didn't have a period at all. She started to question if she could even stay on the medication because she had significant nausea and GI side effects. She found that she had been changing what she was eating and that she wasn't sleeping very well on the medication. Now, again, she wanted to try and conceive, but also knew that she needed to lose some weight, and so she really struggled to know what the right thing was to do. When Lauren came to see us, we focused first on how could we help to balance her hormones and identify a clear ovulation pattern. We prioritized helping her to balance her protein and carbohydrate intake, as well as recommended adding in resistance training to her exercise regimen. We prescribed luteal phase progesterone to help augment ovulation and discussed a plan for when to stop the medication prior to conceiving. She ended up changing up her type of GLP one that she was utilizing, and found that her cycle started to be much more consistent, better energy, and noticed some weight loss. She now feels like she has a more clear plan as to what the goals are in order to conceive and when she needs to stop that medication. So many people have heard about GLP ones. But they don't necessarily know exactly what they do other than cause dramatic weight loss in most people. So the specific way that GLP One Medications work is to improve insulin sensitivity. And basically this means that when you eat something, your body has a better response to the insulin. It naturally secretes. This oftentimes will decrease your appetite and decrease how quickly food leaves your stomach again. And all of these things together oftentimes lead to weight loss. Now, this can help your menstrual cycles to improve because as we've discussed many times on this podcast, lowering your insulin sensitivity can actually decrease the androgens that are produced. So like testosterone hormones, which helps follicle development and especially in women that have. PCOS. This can be a really powerful tool to get your cycles back on track. Now, GLP ones do have a downside for many women when it comes to your cycles, and in cases like we noticed with Lauren's, we can see that your cycles can actually worsen or sometimes stop altogether. Oftentimes, this happens when they have rapid weight loss. In addition to being on the medications, many women are also dramatically changing their dietary intake while they're taking these meds, and that can oftentimes lead to an energy deficit, meaning there's not enough calories coming in to help support good ovulation function. We also see that these medications oftentimes will cause nausea, diarrhea, and other upset stomach symptoms. And this can also lead to women decreasing the amount of caloric intake that they have. This in the long run will decrease many of the different hormone levels, especially progesterone and estrogen if we don't have an enough of those basic building blocks in order to create those hormones. And then the other piece here is, is that we oftentimes will see sleep and stress shifting while you're adjusting to medications. Now, it's important to note that most GLP one medications are not used during pregnancy. So it's important to create a timeframe that we call a washout period or a time that you're going to be off of those medications prior to trying to conceive based on the specific drug manufacturer. And in discussion with your prescribing physician. I will also just make note here of the term Ozempic babies. So this is something that has been talked about a lot on social media and basically the premise is women that got pregnant while they were taking these medications because it improved their cycle. Now in some of those cases. It changed the impact of the oral contraceptive pill that women were taking. So they didn't know that they were going to be able to get pregnant. They were maybe taking birth control pills, and these GLP one medications can impact the ability to absorb the medications, thus decreasing their efficacy. So animal studies of these medications do show increased risk of birth defects, which is why the labeling on all of these medications is not recommended to take during pregnancy at this time. Now they are studying ongoing registries of women who were on these medications during pregnancy, maybe didn't know that they were pregnant at the time. Or women who chose to stay on them or didn't follow their doctor's advice to stop the medications, and they are trying to continue to follow those infants and look at birth weights and prematurity. Now, some studies do show an increased risk of premature birth, low birth weight, and gestational diabetes and these medications, but no formal studies are being done at this time that are intentionally exposing moms to GLP one medications because of the concern for safety risks. So at Radiant Clinic, we do not recommend or prescribe GLP one agonists to our patients because many of them are trying to conceive and we know that it can significantly throw off the menstrual cycle. Now, we do have some patients that come to us that are on these medications through their primary care doctor, and the idea here is that we talk to them about trying to stop their medication at least a couple of months prior to trying to conceive as is recommended by the particular drug manufacturer. If you're currently on a GLP one medication and planning to conceive, one of the first things we'll do is to discuss a discontinuation and transition plan. Now, one of the concerns that many women have is that they're going to have a significant weight gain as soon as they stop those medications. So that's where we always talk through what can we do to help with managing not only the weight gain, but also the insulin resistance that is likely being impacted by these GLP one medications. So we always would start with our labs at baseline, so a fasting blood sugar, a fasting insulin, and in most cases it actually makes sense to do that full two hour glucose tolerance test to determine what's the level and sensitivity of your body to insulin. That helps us then to discuss what are the alternatives that we can utilize in order to help with balancing blood sugar and insulin, whether that's considering Myo Acetol as a supplement, discussing other prescription strength modifications like Metformin, and always discussing a nutrition plan to help. Balance your intake of protein, calories, fiber, carbohydrates, so that you're not undereating for more information on all of these other tools that we can use instead of GLP one medications. Go back and listen to our episode number 1 0 7 where I talk all about blood sugar and insulin sensitivity. So if you're not trying to conceive for quite some time, GLP one, medications may remain an option temporarily to help improve your metabolic health, but always making sure that you know what your washout plan is and have discussed that with your prescribing physician. Again, many women have rebound in weight gain when stopping these medications, so we wanna make sure that you're following other good lifestyle modifications to help balance your metabolism and have good energy stores. In fact, many studies show that it is more problematic to have significant weight gain than weight loss, then weight gain again. Versus if you just were a little bit overweight and continue to maintain that overweight. The issue here is, is that the significant rollercoaster can cause big problems when it comes to your body's ability to track insulin resistance and be able to modulate what goes on from a day-to-day basis. During this time that you're on the medication, if you choose to be on, you still want to be tracking your cycles. Importantly, making sure that you're not dipping into those low energy states where you're not having a cycle at all, because that, again, would mean you're not getting enough caloric intake, which is not sustainable, especially if you're going to come off these medications. So again, GLP ones can be useful metabolic tools to help with regulating what's going on with your insulin levels and your weight, but not while trying to conceive. If you're on these medications and you're trying to conceive, we can help you to transition off safely, keep your insulin levels in, check with other non-medication strategies, and verify that your ovulation and your cycles are on track as they should be, so you can move forward confidently with trying to conceive. When that time comes. So what can you do in the meantime if you're on the fence about starting these medications or not? So the first thing that we always discuss is tracking your cycle. Utilizing an approved fertility awareness-based method that has science at its. Background so that you can help identify when ovulation is occurring to help understand is this adequate? Do I need to be consulting with a medical professional in order to be able to make sure that those cycles are happening consistently, and if they're not, to further evaluate the underlying reason as to why they're not happening regularly. You also always want to be making sure that you are tracking your food intake. Now, we don't have to get militant about this, and I'm an advocate of not tracking calories in particular, but focus instead on am I getting plenty of protein? Am I balancing that with carbohydrates and am I getting good dietary fiber in? Oftentimes, those strategies can help to be sustainable, whether or not that you are on a medication. If you have not had full labs done to evaluate for insulin resistance or insulin sensitivity, I always suggest discussing getting an oral glucose tolerance test along with insulin levels done an A1C alone or blood sugars alone cannot give you that full diagnosis to understand how your body reacts. With insulin when it's exposed to any type of sugar. So it's really important to get that oral glucose tolerance test with insulin testing completed to understand your body's response and how medications and lifestyle changes can make a difference for you. Again, we always want to be checking your hormone levels, especially that luteal phase, progesterone done about a week after ovulation so that we can have a really clear picture on the quality of your ovulation, not just checking the box to see whether it has happened or not. I always recommend working with a skilled dietician or nutritionist when it comes to building your meals. It is easy to say, I'm going to balance my protein and carbs and fiber, but it is really challenging to continue to do that on a daily basis and do it in a way that feels sustainable and not restrictive. One of the most common things that I see is that women are oftentimes. Under fueling their bodies, especially severely restricting carbohydrates or skipping meals altogether in an attempt to lose weight. And in many, many women, especially with insulin resistance, that significantly backfires because our bodies will naturally try and produce sugar in a time of fasting. So work with a registered dietician or nutritionist in order to help you with a dietary meal plan that makes sense for you. Again, I cannot underscore enough the importance of resistance training exercise to help. And in most women that have some weight to lose, we find that adding even 10 to 15 minutes of a walk after a meal, in addition to and in conjunction with that resistance training, that is really where the target should be as far as where to focus your energies on exercise. And most importantly, if you do choose to be on these GLP one medications. You're trying to conceive within the next year, make sure that you have had a discussion with your physician about a washout plan and how to align with your restorative techniques in order to make sure that ovulation is happening consistently, and that when it's time to conceive, that you don't have to wait a significant amount of time to see that ovulation plan return. Imagine if your medications and treatment plan worked with your cycle rather than against it because you had a plan to fuel your body adequately and time your labs and chart your cycles to ensure that that ovulation was happening consistently. Over the course of a few steady months, ovulation can become consistent. Your energy levels return and charts can show real progress to help improve your health. And promote fertility.