With the increasing popularity of GLP-1 medications for weight loss, many women have questions about interactions between GLP-1 medications and birth control. The concern regarding how GLP-1 medications affect birth control has to do with the fact that these medications significantly impact the rate of gastric emptying after meals. Specifically, GLP-1s slow down gastric emptying to help a person stay fuller longer. This change means that GLP-1s can also alter the way birth control and other medications that are taken orally are absorbed. Patients and care providers have also reported a phenomenon of “Ozempic babies” tied to fertility changes experienced by some women who take GLP-1 medications.
While research is still emerging on the relationships between GLP-1 medications and birth control, fertility, and pregnancy, manufacturers of these popular weight-loss drugs have provided recommendations for women who are currently taking oral contraceptives to avoid pregnancy.
WHAT EXACTLY ARE GLP-1 MEDICATIONS?
Glucagon-like peptide-1 (GLP-1) receptor agonists are medications that have been used to treat type 2 diabetes for years. More recently, they gained approval for the treatment of obesity. GLP-1 medications work by mimicking the body’s natural GLP-1 hormones that regulate blood sugar, insulin release, digestion, and appetite. GLP-1 medications are commonly prescribed under the brand names of Ozempic, Wegovy, Mounjaro, Trulicity, and Zepbound. Within the past few years, GLP-1 prescriptions for non-diabetes patients have risen by more than 700%.
INTERACTION BETWEEN GLP-1 AND BIRTH CONTROL PILLS
Can GLP-1 medications make birth control less effective? There’s some evidence to suggest that popular weight-loss medications can affect how oral birth control works. For example, one study found evidence that a GLP-1 medicine called tirzepatide, that is sold under the brand name of Mounjaro had a greater impact on absorption of oral hormonal contraceptives than other GLP-1 medications. The study found that patients taking Mounjaro and oral contraceptives together resulted in a 20% decrease in overall exposure to oral contraceptives. Currently, there is no evidence suggesting that GLP-1 medications reduce effectives of non-oral contraception.
In response to findings on GLP-1 medications and birth control, manufacturers have put out usage recommendations for women taking oral contraceptives. Due to risks for decreased bioavailability of birth control pills, the manufacturer of Mounjaro (tirzepatide) recommends that patients either use barrier contraception for four weeks after initiation or dosage increase or switch to a non-oral contraceptive. Due to risks for diminished therapeutic effects of oral birth control pills, the manufacturer of Bydureon (exenatide) recommends taking birth control at least one hour prior to exenatide. The manufacturer of Adlyxin (lixisenatide) recommends taking oral birth control at least one hour prior or 11 hours after lixisenatide for the same reason. Currently, all other manufacturers of GLP-1 agonists assert that their products have no effect on the bioavailability of oral contraceptive pills.
Related: Ozempic Vagina: What Are The Side Effects Of Semaglutide?
ALTERNATIVES TO BIRTH CONTROL PILLS
Patients concerned about interactions between GLP-1 medications and birth control should talk to their care providers to make sense of manufacturer recommendations and learn about alternatives to oral contraceptives. Non-oral forms of contraception that bypass the digestive system are not believed to be affected by GLP-1 medications. This includes options like intrauterine devices (IUDs), injections, implants, rings, and patches. Patients should also be aware of the potential for increased fertility that stems from the weight loss and general health changes that many people experience after beginning GLP-1 medications. For women who have had difficulty conceiving due to obesity, it may be important to speak with your doctor about the potential for an unexpected pregnancy if birth control has not been a part of the equation due to perceived or assumed low risk for pregnancy.
GLP-1 WHILE PREGNANT
The simple answer is that women should not take GLP-1 while pregnant or attempting to conceive. Currently, there is a lack of long-term data on the safety of GLP-1 medications while pregnant. Recent studies show that exposure to GLP1-RA in the first trimester is not associated with a risk of major birth defects when compared with diabetes or obesity. While these findings offer reassurance in cases of inadvertent exposure to GLP-1 medications during the first trimester of pregnancy, larger trials are needed for more conclusive results. Additionally, animal studies have found that exposure to glucagon-like peptide-1 receptor agonists in pregnancy resulted in adverse outcomes for offspring that included decreased fetal growth, skeletal and visceral anomalies, and embryonic death.
The Food and Drug Administration (FDA) currently advises women to stop taking GLP-1 medications like Ozempic at least two months prior to trying to conceive. While the amount of time it takes the body to metabolize medication can vary by person, it takes an average of six weeks for most GLP-1 medications to be gone from the body in healthy, non-pregnant women. Patients who discover that they are pregnant while still taking a prescription GLP-1 medication should contact their care providers right away.
If you’re looking for more information on interactions between GLP-1 medications and birth control or how taking weight-loss medications may impact your fertility, Dr. Michael Tahery is a leading Obstetrician-Gynecologist (OB-GYN) and Urogynecologist serving the Los Angeles and Glendale areas. Book a consultation today.