This content material initially appeared on diaTribe. Republished with permission.
By April Hopcroft
As a result of GLP-1 receptor agonists decelerate digestion, they might delay the absorption of oral drugs like contraception tablets, 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 negative effects of those remedies (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 damaging aspect of issues, the FDA lately up to date the label for Ozempic with a warning about intestinal blockages after a number of stories of the uncommon however extreme aspect impact.
Now, there’s concern about whether or not GLP-1s could work together with contraception tablets.
As a result of GLP-1 medicines gradual digestion, they might have an effect on the absorption price of different oral medication. By slowing the speed at which meals travels by way of your digestive system, they may doubtlessly delay the absorption of the hormones in contraception tablets, which might have an effect on ovulation and fertility.
We spoke with Dr. Claire Meek, a marketing consultant 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 tablets work?
General, analysis on GLP-1s and contraception is “very sparse,” Meek stated. On one hand, Meek stated some research performed by drug firms have discovered no proof that GLP-1s have an effect on contraception absorption.
As an example, a 2015 examine discovered that Ozempic (semaglutide) didn’t have an effect on the degrees of oral contraception out there within the bloodstream. The examine was small (simply 43 girls) and lasted for about 23 weeks.
Nonetheless, Meek stated she has obtained stories from sufferers about points with GLP-1s and contraception. Certainly, a 2023 case examine described a girl with sort 2 diabetes who turned pregnant whereas taking Mounjaro (tirzepatide) and contraception tablets.
The interplay between GLP-1s and contraception is unclear
One key drawback is that the method by which GLP-1s scale back the effectiveness of contraception isn’t properly understood. It’s attainable that the burden loss brought on by GLP-1s improves fertility, which ends up in greater 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-about themselves infertile,” Meek stated.
Preliminary analysis suggests that GLP-1s could enhance menstrual regularity and enhance fertility charges amongst individuals with weight problems with hormonal problems like polycystic ovarian syndrome.
It’s additionally attainable that GLP-1s straight scale back the absorption of hormonal contraceptives by delaying gastric emptying, as acknowledged on Mounjaro’s drug label.
Meek stated it’s essential to contemplate how persistently you’re taking contraception. Oral contraceptives are handiest at stopping being pregnant when taken daily. Nonetheless, in actual life, individuals could miss a tablet right here and there.
One idea is {that a} missed dose of contraception has completely different results relying in your physique weight. In case you’ve misplaced a big quantity of weight and also you miss a contraception tablet, it could have a better impact on enhancing fertility than a missed tablet would have on somebody with a better physique weight.
“It’s fairly attainable that lacking a dose of contraception is extra prone to end in being pregnant whenever you’re on a GLP-1 agonist, as substantial weight reduction with improved glucose ranges will enhance fertility,” Meek stated.
“It’s a really completely different state of affairs to lacking a dose when you will have weight problems, insulin resistance, and hyperglycemia, which all scale back fertility,” she added.
Key concerns for taking a GLP-1 and oral contraception
Presently, the drug labels for GLP-1s don’t embody suggestions concerning contraception tablets.
Nonetheless, the FDA states that Mounjaro – a twin GIP/GLP-1 receptor agonist – could scale back the efficacy of oral contraception resulting from delayed gastric emptying. In line with the drug label, Mounjaro is probably to scale back contraception efficacy after the primary dose, with this potential aspect impact diminishing over time.
Monitor negative effects
It’s frequent to expertise negative effects for each GLP-1s and contraception tablets when beginning both medicine.
Antagonistic reactions to GLP-1s are typically gastrointestinal, together with signs like nausea, vomiting, and diarrhea. Unintended effects of contraception embody nausea, breast tenderness, complications, modifications in your interval, weight acquire, and temper modifications.
“Beginning a medicine, there can be a interval (typically 2-4 weeks) whenever you’re getting used to any negative effects,” Meek stated. “There might be nausea, vomiting, and modifications to intestine transit, which might affect the absorption of contraception.”
After beginning a GLP-1, Meek stated healthcare suppliers ought to show you how to monitor negative effects. It’s essential to acknowledge that negative effects might additionally come up from interactions between GLP-1s and any drugs you’re taking for different circumstances.
Name your healthcare supplier instantly for those who expertise severe negative 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 growing GLP-1 doses
In case you simply began taking a GLP-1 and are on contraception tablets, it’s possible you’ll need to add a second sort of contraceptive to stop being pregnant.
As an example, Mounjaro’s label recommends that individuals taking contraception tablets “swap 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 need to think about additional safety for peace of thoughts. This might embody a contraception injection, implant, patch, vaginal ring, IUD, or condoms.
Change to a long-acting reversible contraception
Meek stated 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 issues, reminiscent of hypertension, low blood sugar, and life-threatening delivery defects for the infant. Subsequently, it’s essential to plan forward and work on decreasing your A1C and growing time in vary earlier than conceiving.
“Typically, individuals with any sort of diabetes who should not planning a being pregnant are really useful to be on long-acting reversible contraception,” Meek stated.
Examples of long-acting contraception choices embody an IUD or hormonal implant. These strategies final for a number of years, present wonderful safety in opposition to being pregnant, and might 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 drugs might doubtlessly impression fertility or hurt a creating fetus.
Meek stated there’s not plenty of proof that GLP-1s trigger hurt to a fetus, however some animal research have proven the chance.
“We’re nonetheless unclear of the dangers of GLP-1 agonist use in human being pregnant, and due to this fact probably the most cautious method is to guarantee that a GLP-1 is stopped properly upfront of making an attempt for being pregnant,” Meek stated.
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 targets.
“I think about GLP-1 agonists a extremely priceless a part of girls’s care earlier than and after being pregnant,” Meek stated.
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 could 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 providers are particularly essential for individuals with sort 2 diabetes, Meek stated, as many have had diabetes for a shorter interval and won’t know that they’re eligible for such providers.
Finally, enhancing reproductive well being for individuals with diabetes is a matter of “altering conversations to ensure girls can entry the assist and schooling they want each pre- and post-pregnancy,” Meek stated.
