GLP-1 Receptor Agonists Influence Reproductive Health, Contraception, Fertility, and Pregnancy Outcomes

The rapid expansion of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for obesity and type 2 diabetes includes many women of reproductive age. Understanding their impact on reproductive health is critical, as GLP-1 signaling may influence the hypothalamic-pituitary-ovarian axis and metabolic pathways relevant to fertility. Current evidence is sparse on how these widely used medications affect contraception, conception, and pregnancy outcomes, creating a significant gap in clinical guidance.

This debate paper synthesized existing literature on GLP-1 RAs and reproductive health. It examined evidence regarding their effects on contraceptive efficacy, fertility outcomes, and pregnancy safety in women of reproductive age. The review specifically addressed central effects on the hypothalamic-pituitary-ovarian axis and indirect metabolic pathways, aiming to provide a comprehensive overview of current knowledge and identify areas requiring further research.

GLP-1 RAs improve insulin resistance and androgen profiles in women with polyendocrine metabolic ovarian syndrome (PMOS), potentially enhancing menstrual regularity. Most GLP-1 RAs do not significantly alter oral contraceptive pharmacokinetics, suggesting no widespread impact on efficacy. However, tirzepatide may necessitate temporary backup contraception due to its unique pharmacokinetic profile and potential for reduced oral contraceptive absorption. > Evidence regarding direct fertility outcomes and pregnancy safety with GLP-1 RAs remains limited, highlighting a critical knowledge gap for reproductive-aged individuals and clinicians.