What obgyns need to know about GLP-1 receptor agonists.

PURPOSE OF REVIEW: Obstetricians and gynecologists increasingly encounter patients using glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide agonists. This review synthesizes evidence on these agents, focusing on their relevance in women's health.

RECENT FINDINGS: GLP-1 receptor agonists and dual agonists achieve 15-21% body weight reduction in phase 3 trials, with tirzepatide demonstrating superior efficacy compared to semaglutide. Key populations of interest include patients with polycystic ovary syndrome (PCOS), pregnant patients, and those undergoing gynecologic surgery. In women with PCOS, meta-analyses confirm improvements in insulin resistance, androgen levels, and ovulation rates. Tirzepatide significantly delays gastric emptying, prompting manufacturer guidance to use backup contraception for 4 weeks after initiation or dose escalation. Emerging human cohort studies of inadvertent early pregnancy exposure report no increased risk of major congenital malformations, providing preliminary reassurance despite animal teratogenicity data. Perioperative guidance has evolved from blanket discontinuation to individualized, risk-stratified approaches.

SUMMARY: GLP-1 receptor agonists offer benefits across the lifespan, with promising applications in PCOS and preconception optimization. Reproductive-aged women need counseling regarding contraception and preconception discontinuation. Knowledge gaps include the need for pregnancy registries. Obstetrician-gynecologists will increasingly encounter these therapies and must navigate evolving evidence regarding their safety, efficacy, and clinical implications.