This content material initially appeared on diaTribe. Republished with permission.
By April Hopcroft
As a result of GLP-1 receptor agonists decelerate digestion, they could delay the absorption of oral medicines like contraception drugs, which might have an effect on ovulation and fertility.
As extra individuals start taking GLP-1 receptor agonists and different incretin-based medication for glycemic management and weight administration, new unwanted effects of those therapies (each good and dangerous) are rising.
Trying on the positives, a big trial of over 17,600 adults discovered that Wegovy diminished the speed of cardiovascular occasions, together with coronary heart illness and stroke, by 20%. On the unfavorable aspect of issues, the FDA lately up to date the label for Ozempic with a warning about intestinal blockages after a number of experiences of the uncommon however extreme aspect impact.
Now, there may be concern about whether or not GLP-1s might work together with contraception drugs.
As a result of GLP-1 medicines sluggish digestion, they could have an effect on the absorption fee of different oral medication. By slowing the speed at which meals travels via your digestive system, they might probably delay the absorption of the hormones in contraception drugs, which might have an effect on ovulation and fertility.
We spoke with Dr. Claire Meek, a guide within the diabetes in being pregnant service at Addenbrooke’s Hospital and principal investigator on the Institute of Metabolic Science on the College of Cambridge within the U.Ok., to discover how GLP-1s have an effect on oral contraception.
Do GLP-1s impression how properly contraception drugs work?
General, analysis on GLP-1s and contraception is “very sparse,” Meek mentioned. On one hand, Meek mentioned some research carried out by drug firms have discovered no proof that GLP-1s have an effect on contraception absorption.
For example, a 2015 research discovered that Ozempic (semaglutide) didn’t have an effect on the degrees of oral contraception out there within the bloodstream. The research was small (simply 43 ladies) and lasted for about 23 weeks.
Nonetheless, Meek mentioned she has obtained experiences from sufferers about points with GLP-1s and contraception. Certainly, a 2023 case research described a lady with kind 2 diabetes who grew to become pregnant whereas taking Mounjaro (tirzepatide) and contraception drugs.
The interplay between GLP-1s and contraception is unclear
One key drawback is that the method by which GLP-1s cut back the effectiveness of contraception isn’t properly understood. It’s potential that the burden loss attributable to GLP-1s improves fertility, which results in increased charges of being pregnant.
“In the long term, extended use of GLP-1 agonists seems to vastly enhance fertility, even in individuals who beforehand thought of themselves infertile,” Meek mentioned.
Preliminary analysis suggests that GLP-1s might enhance menstrual regularity and improve fertility charges amongst individuals with weight problems with hormonal issues like polycystic ovarian syndrome.
It’s additionally potential that GLP-1s instantly cut back the absorption of hormonal contraceptives by delaying gastric emptying, as said on Mounjaro’s drug label.
Meek mentioned it’s essential to contemplate how constantly you’re taking contraception. Oral contraceptives are best at stopping being pregnant when taken every single day. Nonetheless, in actual life, individuals might miss a tablet right here and there.
One concept is {that a} missed dose of contraception has totally different results relying in your physique weight. For those who’ve misplaced a big quantity of weight and also you miss a contraception tablet, it could have a larger impact on bettering fertility than a missed tablet would have on somebody with a better physique weight.
“It’s fairly potential that lacking a dose of contraception is extra prone to end in being pregnant while you’re on a GLP-1 agonist, as substantial weight reduction with improved glucose ranges will enhance fertility,” Meek mentioned.
“It’s a really totally different state of affairs to lacking a dose when you may have weight problems, insulin resistance, and hyperglycemia, which all cut back fertility,” she added.
Key issues for taking a GLP-1 and oral contraception
At present, the drug labels for GLP-1s don’t embrace suggestions relating to contraception drugs.
Nonetheless, the FDA states that Mounjaro – a twin GIP/GLP-1 receptor agonist – might cut back the efficacy of oral contraception because of delayed gastric emptying. In response to the drug label, Mounjaro is almost certainly to cut back contraception efficacy after the primary dose, with this potential aspect impact diminishing over time.
Monitor unwanted effects
It’s frequent to expertise unwanted effects for each GLP-1s and contraception drugs when beginning both medicine.
Opposed reactions to GLP-1s are usually gastrointestinal, together with signs like nausea, vomiting, and diarrhea. Uncomfortable side effects of contraception embrace nausea, breast tenderness, complications, modifications in your interval, weight acquire, and temper modifications.
“Beginning a drugs, there will probably be a interval (typically 2-4 weeks) while you’re getting used to any unwanted effects,” Meek mentioned. “There will be nausea, vomiting, and modifications to intestine transit, which may affect the absorption of contraception.”
After beginning a GLP-1, Meek mentioned healthcare suppliers ought to make it easier to monitor unwanted effects. It’s essential to acknowledge that unwanted effects might additionally come up from interactions between GLP-1s and any medicines you are taking for different situations.
Name your healthcare supplier straight away if you happen to expertise severe unwanted effects, reminiscent of extreme abdomen ache, chest ache, new or worsening complications, blurred imaginative and prescient, fever, extreme hypoglycemia, or dehydration after beginning a GLP-1 or contraception.
Use extra safety when beginning or rising GLP-1 doses
For those who simply began taking a GLP-1 and are on contraception drugs, you could wish to add a second kind of contraceptive to stop being pregnant.
For example, Mounjaro’s label recommends that individuals taking contraception drugs “change to a non-oral contraceptive technique, or add a barrier technique of contraception for 4 weeks after initiation and 4 weeks after every dose escalation.”
Whereas GLP-1 drug labels don’t comprise particular suggestions about contraception, you should still wish to take into account further safety for peace of thoughts. This might embrace a contraception injection, implant, patch, vaginal ring, IUD, or condoms.
Change to a long-acting reversible contraception
Meek mentioned she encourages deliberate pregnancies, relatively than unplanned pregnancies, for any particular person with diabetes.
Diabetes provides one other layer of complexity to being pregnant and will increase the danger for severe problems, reminiscent of hypertension, low blood sugar, and life-threatening start defects for the infant. Subsequently, it’s essential to plan forward and work on reducing your A1C and rising time in vary earlier than conceiving.
“Typically, individuals with any kind of diabetes who aren’t planning a being pregnant are beneficial to be on long-acting reversible contraception,” Meek mentioned.
Examples of long-acting contraception choices embrace an IUD or hormonal implant. These strategies final for a number of years, present glorious safety in opposition to being pregnant, and will be eliminated at any time.
Can GLP-1s hurt a being pregnant?
The drug labels for Ozempic, Rybelsus, Wegovy, and Mounjaro all acknowledge that these medicines might probably impression fertility or hurt a creating fetus.
Meek mentioned there’s not plenty of proof that GLP-1s trigger hurt to a fetus, however some animal research have proven the likelihood.
“We’re nonetheless unclear of the dangers of GLP-1 agonist use in human being pregnant, and subsequently probably the most cautious method is to guarantee that a GLP-1 is stopped properly upfront of making an attempt for being pregnant,” Meek mentioned.
The underside line on GLP-1s and contraception
Having a person dialog together with your healthcare supplier is essential to make sure you’re assembly your diabetes and reproductive well being objectives.
“I take into account GLP-1 agonists a extremely precious a part of ladies’s care earlier than and after being pregnant,” Meek mentioned.
General, it’s essential to look at dangers and advantages for every particular person individually. It’s additionally essential to contemplate how dangers and advantages might change throughout transitions from being pregnant prevention and preconception planning to being pregnant and postpartum.
For anybody with diabetes who’s contemplating turning into pregnant sooner or later, Meek recommends utilizing preconception care to plan for a wholesome being pregnant. Pre-pregnancy companies are particularly essential for individuals with kind 2 diabetes, Meek mentioned, as many have had diabetes for a shorter interval and won’t know that they’re eligible for such companies.
Finally, bettering reproductive well being for individuals with diabetes is a matter of “altering conversations to verify ladies can entry the help and schooling they want each pre- and post-pregnancy,” Meek mentioned.
