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.

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Depending on the location and size of the fibroids, you might experience heavy bleeding, pelvic pain, discomfort during sex, and other unwanted symptoms. But do fibroids affect pregnancy and fertility?

Fibroids and Fertility

Unfortunately, fibroids can impact your ability to get pregnant. However, the good news is that most women with fibroids can conceive naturally. With guidance and care from a fibroids specialist, the odds of having a successful pregnancy are even higher. Fertility issues are relatively rare. Whether or not they cause infertility depends on many factors.

One crucial detail that makes fibroids affect pregnancy and fertility is location. These tumors can develop in various parts of the uterus. Submucosal fibroids generally have the most impact on fertility. These growths appear just under the endometrium and protrude into the uterine cavity. This type of fibroid makes up just five percent of all fibroid cases. They’re the rarest but also one of the most problematic.

Larger fibroids over six centimeters in diameter are also to blame for fertility issues. Regardless of the tumor’s location, the sheer size of the growth can cause significant fertility problems.

These types of fibroids can affect fertility in a few different ways.

First, the growths can change the shape of the uterus entirely. As a result, fewer sperm can enter the uterus. Furthermore, the malformed nature of the uterus can disrupt the sperm’s movement as it makes its way to the egg during conception.

Fibroids can also block the fallopian tubes or change the size of the uterine lining. Even if the sperm successfully penetrates the egg, there’s no guarantee that the embryo will implant in the uterine wall. Fibroids can restrict blood flow, stopping development before it even begins.

It’s true that fibroids affect pregnancy, but these cases are rare. Most women with these tumors can conceive without any issues. If you’re in doubt, don’t hesitate to reach out. Dr. Tahery specializes in fibroid evaluation and treatment.

RELATED: Minimally Invasive and Non-Surgical Fibroid Treatment Options

Fibroids During Pregnancy

One of the most common questions people have about these non-cancerous growths is whether or not fibroids affect pregnancy and delivery. Once again, it’s possible but rare.

Between two and 12 percent of pregnant women receive a fibroid diagnosis. But an estimated 10 to 30 percent of that figure develop complications during pregnancy. That means most women with fibroids have perfectly normal pregnancies without any challenges.

In those instances when fibroids affect pregnancy, it’s usually in the first trimester. Experts believe that these growths rely on estrogen to grow. Because your body produces more estrogen during the first third of the gestation period, that’s when complications manifest.

The biggest concern due to fibroids in pregnant women is preterm births and the possibility of miscarriage. Unfortunately, women with fibroids have an estimated 14 percent chance of miscarriage. That’s noticeably higher than the 7.6 percent risk in women without fibroids. The dangers increase with larger tumors.

Fibroids can also put you at a higher risk of preterm birth before 37 weeks and cesarean delivery.

Other potential concerns include extreme pain and developmental problems. As the uterus expands in the second and third trimesters, it can push against the tumors. The fibroids may twist or even outgrow their blood supply, creating severe stomach pain that could result in miscarriage.

In cases of extreme fibroid growth, placental abruption can occur. When this happens, the placenta tears away from the uterine wall, cutting off oxygen to the fetus and causing heavy bleeding.

Diagnosis and Treatment of Fibroids

The best way to minimize the ways fibroids affect pregnancy is to be proactive about treatment. Diagnosing these uterine tumors is a straightforward process. We use 3D ultrasound technology to evaluate the size, location, and the number of growths.

After diagnosis, we can recommend a course of action that’s right for your needs. Possible treatment options include hormone therapy, radiofrequency ablation, and embolization. Hormone therapy uses gonadotropin-releasing hormone agonists to decrease estrogen and progesterone levels that feed the fibroids. Meanwhile, ablation and embolization aim to reduce the size of the tumors and cut off their blood supply.

Whether you have plans to get pregnant or not, contact Dr. Michael Tahery to explore treatment options for your fibroids. Dr. Michael Tahery is a urogynecologists who understands the complex nature of fibroids and their potential impact on pregnancy and fertility. Contact our offices today to learn more and schedule your appointment.

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How many couples do you know trying to get pregnant and have difficulty? Or have “fertility anxiety”?

On any given day in my practice, I am faced with the seemingly straight forward, yet complex question from women at various stages of their lives; “can I get pregnant?”. Women in their twenties and nervous about their health; those in their thirties worried about the metaphorical clock ticking away; and women in their forties optimistically seeking guidance. Some may have tried a few cycles naturally to get pregnant and others may not be ready yet.

Fertility is big news because the rate of infertility is increasing in both men and women. Several factors are implicated and the most common are environment, age, genetics, and medical conditions.

Diet and environmental toxins are very concerning topic. Pesticides, hormones added to foods, chemicals in the air we breathe and water we drink may play an important role. It effects the health of the female ovaries and the eggs they produce; it also effects the number and quality of sperm in men.

Advanced maternal age is another big factor. As ovaries age, the produced eggs are harder to fertilize. The number of eggs also decrease with age. The rate of attrition increases after 30, speeds up after 35 and at 40 very few eggs are left. If you are from a family with children born to mothers in their forties, your chance of having children later in life also increases. Genetics is an important factor and is much harder to analyze. Testing can determine your approximate egg count and quality and many of the factors that impede fertility.

Medical conditions that may not play a significant role in the fertility of a young adult can become serious factors as the person ages. Fibroids and endometriosis are two common examples. These conditions worsen with age and cause damage to reproductive organs. Hormonal imbalance such as polycystic ovarian syndrome, disrupt ovulation cycles and make eggs weaker. Simple office evaluation can diagnose many of these medical conditions.

Some of the fertility anxiety experienced by women may be justified and many are not, and most are easily treated. Discuss any concerns with a gynecologist. There are many ways your fertility can be evaluated. Simple, tried and true instructions can increase your odds of pregnancy, such as treating your body better with a balanced diet, exercise, and getting your checkup at least annually. In my practice, at times, simple solutions and early detection have made tremendous improvements in a couples fertility.

Oddly enough, anxiety about fertility has shown to reduce the chances of pregnancy. So, relax. Seek the help of a gynecologist.

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