Across 25 studies encompassing 356 screened records, semaglutide — a GLP-1 receptor agonist — produced mean weight reductions of 7.6–11.5 kg over 3–6 months in women with polycystic ovary syndrome (PCOS), with roughly 80% of patients in responsive cohorts achieving ≥5% body weight loss. Fasting insulin and HOMA-IR improved concurrently, and multiple studies reported restoration of menstrual regularity. Gastrointestinal side effects dominated the safety profile, while gallbladder disease, pancreatitis, and inadvertent pregnancy from restored ovulation were flagged as critical concerns.
PCOS affects an estimated 8–13% of reproductive-age women globally and remains notoriously difficult to manage, with metformin and lifestyle interventions delivering modest, inconsistent results. Semaglutide's dual action — appetite suppression and insulin sensitization — aligns mechanistically well with PCOS's core pathophysiology of hyperinsulinemia driving androgen excess. The menstrual cycle improvements are particularly significant, as ovulatory restoration represents a meaningful clinical endpoint beyond metabolic markers.
However, this review's conclusions rest on shaky ground. Only 5 of 25 included studies had confirmed full-text access; the remaining 23 relied on abstracts or conference summaries — a methodological vulnerability that substantially limits confidence. No randomized controlled trials power the conclusions. The inadvertent pregnancy risk deserves outsized clinical attention: restoring ovulation in women not seeking conception without contraceptive counseling creates a genuine safety gap. Overall, this is a signal-generating, hypothesis-confirming review rather than definitive evidence — but the mechanistic fit is compelling enough to prioritize rigorous RCTs urgently.