The 2023 international PCOS guideline says GLP-1 medications could be considered with lifestyle support to manage higher weight in adults with PCOS. PCOS-specific trials are still small and short, use for PCOS is off-label, and effective contraception is advised.
GLP-1 medications are not approved specifically for polycystic ovary syndrome (PCOS), but the 2023 international PCOS guideline says medications such as semaglutide and liraglutide could be considered, alongside lifestyle support, to manage higher weight in adults with PCOS. The PCOS-specific research is still limited: a 2024 review found that GLP-1 medications improved weight and body measurements in small, short trials, with little data yet on fertility or long-term outcomes. Using a GLP-1 medication to address PCOS is therefore off-label, and the guideline asks that effective contraception be in place whenever pregnancy is possible.
The National Institute of Child Health and Human Development (NICHD) describes PCOS as a set of symptoms related to a hormonal imbalance, and notes that it is also called polyendocrine metabolic ovary syndrome (PMOS). People with PCOS usually have at least two of these three features:
NICHD adds that PCOS can show up as acne, dark patches of skin, insulin resistance and irregular bleeding, and that it is the most common cause of infertility due to absent ovulation. The 2024 review cited below estimates that PCOS affects about 10 percent of reproductive-aged women.
Weight is often part of the picture, though not for everyone. The 2023 guideline acknowledges that many people with PCOS have underlying mechanisms that drive greater weight gain over time, which can make weight management harder. It also stresses that healthy habits have benefits even without weight loss, and that weight stigma in health care is a real problem clinicians should actively avoid.
The International Evidence-based Guideline for PCOS, published in 2023, includes a section on anti-obesity medications. In summary:
The guideline also states that medical therapy is generally not approved specifically for PCOS, so recommended uses are evidence based but off-label.
The guideline's recommendations were informed by a systematic review and meta-analysis published in Obesity Reviews in 2024. The authors searched for trials of anti-obesity medications in PCOS through July 2022 and found 11, with 545 participants in treatment groups and 451 in comparison groups.
Their main findings:
The authors could not make definitive recommendations because the trials were few, short and mostly at high or unclear risk of bias. They described the PCOS-specific data as very limited and called for larger placebo-controlled studies. The review did not include tirzepatide trials. In practice, this means clinicians rely partly on the much larger general obesity trials when discussing GLP-1 treatment with people who have PCOS.
Because irregular ovulation is central to PCOS, the reproductive side of GLP-1 treatment deserves special attention. ACOG's 2026 practice advisory notes that some studies show improved fertility with these medications and that weight loss may increase the likelihood of conception, which is why it advises counseling on effective contraception during use.
Two label details are practical:
Our guide to GLP-1 medications, fertility and pregnancy planning covers these steps in more detail.
Spironolactone is FDA-approved, as Aldactone, for heart failure, high blood pressure, certain types of fluid retention, and primary hyperaldosteronism. Prescribers sometimes use it off-label for PCOS-related excess hair growth (hirsutism) because it blocks some androgen effects.
The 2023 guideline says anti-androgens could be considered for hirsutism, in combination with effective contraception, when the response to at least 6 months of a combined oral contraceptive or cosmetic treatment has not been enough, or when the pill is not an option. It asks clinicians to counsel about the risk to a male fetus and to strongly advise effective contraception. The Aldactone label warns that spironolactone can raise potassium, recommends checking potassium within a week of starting and regularly after that, and lists high potassium and Addison's disease as reasons not to use it.
| Approach | Main target | Key notes |
|---|---|---|
| Healthy eating and activity | Metabolic health, weight, well-being | Recommended for everyone with PCOS; no single diet is favored |
| GLP-1 medication | Higher weight and related metabolic measures | Off-label for PCOS itself; effective contraception advised |
| Spironolactone | Hirsutism and other androgen effects | Off-label; contraception and potassium monitoring needed |
No. Their FDA-approved uses relate to weight management and other conditions, not PCOS. The 2023 guideline supports considering GLP-1 medications for higher weight in adults with PCOS, but use aimed at PCOS itself is off-label. Compounded semaglutide and tirzepatide, including those available through NewDay Wellness, are not FDA-approved for any use.
The 2024 review found that metabolic and reproductive improvements appeared to follow the amount of weight lost, but the trials were small and short. The review's authors called for more research on androgen-related features such as hair growth, on quality of life, and on longer-term outcomes. Expectations are best set with your clinician.
Pregnancy safety data for these medications are lacking, and weight loss may make conception more likely, especially if ovulation becomes more regular. The PCOS guideline and ACOG both advise effective contraception when pregnancy is possible. Tirzepatide can also reduce the effectiveness of oral contraceptives for a period after starting and after each increase.
They address different things, and a prescriber can consider both as part of one plan. Your clinician will review your full medication list, potassium and kidney function, and pregnancy plans before prescribing. Do not start or combine medications without that review.
PCOS looks different from person to person, so a good plan starts with your priorities and history. A licensed provider can review your symptoms, labs and goals, explain what is on-label and what is off-label, and help you choose contraception that fits. This article is educational and does not determine eligibility for any treatment.
Written by the NewDay Wellness editorial team from the sources above and checked against them before publication, and medically reviewed by Dr. Sean Arora and Dr. Shannon Arora of Arora Health & Aesthetics; see our editorial standards. This article is educational and does not diagnose conditions, establish eligibility for any medication, or replace care from a licensed provider. Compounded medications are not FDA-approved.
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