I’m finding that many women who are on the GLP-1 medications do not know about the possible changes to their menstrual cycles because of the meds. I’m here to offer some information. Mind you, I am speaking as if I was doing kindergarten chemistry and biology, so what I describe is in the most simplistic terms possible. Feel free to correct me.
Insulin Resistance
Who knew insulin could affect our periods? With insulin resistance, the body struggles to regulate insulin (whether from the pancreas being tuckered out or the liver unable to keep up with processing the sugar), it affects many hormones. One of the main ones relating to our menstrual cycles is estrogen. Too much insulin in our bodies sets off a chain reaction that lowers estrogen and when that happens, we get irregular, or absent, periods.
PCOS
While Insulin Resistance and Polycystic Ovary Syndrome (PCOS) are different issues, they are intertwined in many ways. One of the most relevant ones is how high androgen levels in the body kick in with high blood glucose levels. If the insulin isn’t able to modulate the glucose, androgens wander around and knock out the estrogen, lowering it. As mentioned above, low estrogen causes irregular periods.
Infertility
This is a book-length topic that I will describe in a short paragraph. Hormones do wonky things because of our high glucose levels… the pancreas is tired and can’t shoot out enough insulin to moderate the glucose in the blood… the liver wigs out trying to process sugar without the needed insulin… our periods go haywire because the androgens have a field day swimming in glucose and then they play pool with estrogen and knock it right into the side pocket. All of this makes our ovulation weird and many women, if they get a period at all, might not have an egg to fertilize. Whether the period is “sterile” (without an egg) or not requires a medical looking glass. Women can ovulate even if they have no periods. With specialists, if they find there is no ovulation, that is one type of infertility. If a woman has two periods a year (as I did for 30 years) with no idea when one is coming or going, trying to get pregnant can take on a Rubik’s Cube sort of guessing game.
GLP-1 and Our Periods
Women are talking about their periods coming regularly again. Many thought they were in perimenopause, a time when periods can spread out. What was really happening was their glucose levels were too high for their insulin production, having the dominos falling that collapse estrogen production and cause weird cycles.
But when they take a GLP-1 like semaglutide, tirzepatide, dulaglutide, or lose weight, the biological mechanics realign, often very quickly, and then a woman’s menstrual cycle readjusts to normal. Well, a new normal. If I had had regular periods after 20 years of two a year, I would think it was rather strange. But what was strange was the very few periods… that was not normal.
Fertility Returns… With a Vengeance
Because so many people are using online prescribers and have not had blood work or talked to an endocrinologist, gynecologist, or any quality GLP-1 prescriber, women are not realizing they have (in most cases) become quite fertile again.
When periods are regular, the likelihood of ovulating regularly is much greater.
YOU CAN GET PREGNANT.
I have seen 45-year old women on semaglutide having regular periods and laughing about how crazy it would be to get pregnant, how they were so glad they were in perimenopause and can’t have a baby at that age.
When you have any periods, you have to assume you can get pregnant.
The way to prevent pregnancy is with birth control… anything but oral birth control pills. As I reported before, warnings that oral birth control might be compromised by the GLP-1s are finally being disclosed. Not always by the providers, mind you. Many seem to forget to caution women about fertility returning.
Metformin has long been a common medication when women are having issues conceiving. I’m willing to bet doctors will find a way to incorporate GLP-1s, but not before they figure out how to get women off right before conception.
I wrote GLP-1 Pregnancy Worries guessing/predicting what could/might happen when/if women get pregnant on GLP-1 medications.
There’s still so much to learn!
I’m watching and listening.