PMOS and GLP-1s

What are follicles? How do they work when you have PMOS [10]? 

A follicle is a small sac in the ovaries that contains one egg. They are constantly developing, but most stop growing before they fully mature. 

Normally, each month, one follicle is the “dominant follicle.” It continues to mature until it breaks open and releases the egg.  

In people with PMOS, increased androgens can interfere with the normal development of the follicles. Androgens are normally involved in follicle growth, but when androgen levels are too high (like in individuals with PMOS), an abnormally high number of follicles begin to grow. 

Higher androgen levels can also disrupt signals between the brain and ovaries, causing increased luteinizing hormone. Luteinizing hormone is a hormone that helps follicles mature and triggers ovulation. When luteinizing hormone levels are persistently high, the normal pattern of hormone signals that cause ovulation are disrupted, making it harder for one follicle to become mature enough to release an egg (a.k.a ovulation doesn’t happen).  

As a result, many small follicles are present in the ovaries at the same time and can group around the outside of the ovary like a “string of pearls”. 

What causes PMOS? 

Researchers are still unsure what exactly causes PMOS, but it may be related to genetics, epigenetics (how behaviour and environment affect how your genes work), or insulin resistance [3].  

Will GLP-1 receptor agonists help my symptoms if I do not have insulin resistance? 

So far, PMOS research has studied people who have higher weights or have metabolic problems, so we are still unsure if it can help people who don’t have insulin resistance. 

If you are having difficulties managing your weight, a GLP-1 receptor agonist can be helpful because it slows stomach emptying and makes you feel full for longer [3]. If you do not have difficulties managing your weight, GLP-1 receptor agonists may not be the right fit for you because it may lead to excessive weight loss. This is why it is always important to talk to your healthcare provider about what medications are right for you. 

Is it safe to use GLP-1 receptor agonists if I’m pregnant? 

Animal studies have found possible risks including reduced fetal growth and changes in bone development [11]. But human studies are limited, so we are not sure. Because of this, GLP-1 receptor agonists are not currently approved for use in pregnancy. You should use reliable contraception while taking them and stop using them for 1-2 months – depending on the medication – before a planned pregnancy [12]. If you are taking a GLP-1 receptor agonist and find out you are pregnant, this does not mean that you harmed your baby. Contact your healthcare provider to talk about next steps.

What if we combined GLP-1 receptor agonists and metformin? 

Some studies suggest a combination has greater benefits than using metformin alone, including improved body weight, insulin sensitivity, menstrual regularity, lower testosterone, and natural pregnancy rate [7,8]. 

GLP-1 receptor agonists can have serious side effects

Inflammation of the pancreas, dizziness, vision problems, reduced blood pressure, and interaction with other medications are other possible adverse health outcomes [9].