Educational only. Not medical advice.

GLP-1s and Women's Hormones: Birth Control, Periods, Fertility, and Menopause

The short version

• Pill absorption: tirzepatide can lower oral contraceptive exposure. Use a non-oral method or add a barrier for 4 weeks after starting and for 4 weeks after each dose increase. Semaglutide and liraglutide did not show a clinically relevant pill effect in studies.

• Fertility: weight loss and better insulin sensitivity can restore ovulation, especially in PCOS. Plan contraception if pregnancy is not desired.

• Pregnancy timing: stop semaglutide about 2 months before trying to conceive. Tirzepatide clears in about 30 days. Breastfeeding data are limited.

• Menopause and HRT: delayed gastric emptying can reduce oral progesterone absorption. Prefer transdermal estrogen with a non-oral progestogen during titration.

How GLP-1s intersect with hormones

1) Birth control and drug absorption

• Tirzepatide may reduce exposure to combined oral contraceptives. Use a non-oral method or add condoms for 4 weeks after initiation and for 4 weeks after each up-titration.

• Injectable semaglutide showed no clinically meaningful effect on standard pill hormones, though general caution with oral drugs is sensible during titration.

• Liraglutide has not shown a pill failure signal in pharmacokinetic studies.

Practical move: If you escalate tirzepatide, set a 4-week backup window each step. If you must stay on a pill, add a barrier method.

2) Periods, PCOS, and fertility

• Improved insulin sensitivity and reduced visceral fat can normalize cycles in PCOS. Ovulation can return quickly. Use contraception if pregnancy is not planned.

3) Pregnancy and breastfeeding

• Semaglutide: stop about 2 months before trying to conceive.

• Tirzepatide: drug washes out in roughly 30 days.

• If pregnancy occurs, stop the drug and contact your clinician. Data in breastfeeding are limited. Decide case by case.

4) Menopause and HRT

• Slower gastric emptying can blunt absorption of oral progesterone used for endometrial protection.

• Preferred setup: transdermal estrogen plus a non-oral progestogen such as an LNG-IUD or micronized progesterone by a non-oral route. If staying oral, some clinicians temporarily adjust dose during GLP-1 dose changes and monitor unscheduled bleeding.

5) Thyroid medication note

• Oral semaglutide (tablet form, not the weight-loss injection) can increase levothyroxine exposure. If you use that oral product with thyroid hormone, monitor TSH.

ScriptScores™: Hormone-Friendliness (0–100)

What we score: lower risk of pill interference 60%, HRT compatibility during titration 25%, clarity of pregnancy guidance 15%. Higher is better.

Rationale: tirzepatide reduces oral contraceptive exposure at start and after each dose increase. Semaglutide injectables lead due to neutral pill impact and clear pre-conception guidance. All benefit from non-oral HRT during titration.

FAQs

Do GLP-1s disrupt sex hormones?
They do not replace or block estrogen or progesterone. Effects are indirect via weight loss and insulin sensitivity. Cycles may normalize in PCOS and fertility may rise.

Can I stay on the pill?
Yes, but add backup with tirzepatide during the 4-week windows after starting and after each dose increase. Non-oral contraception avoids the issue.

I use HRT. Do I need to change it?
Prefer transdermal estrogen and a non-oral progestogen while doses change. Review any unscheduled bleeding.

Trying to conceive soon?
Plan a timeline. Stop semaglutide about 2 months before trying. Tirzepatide clears in about 30 days.

Talk-with-your-clinician checklist

• Which GLP-1 fits my contraception or HRT setup.

• Whether to switch to non-oral contraception during tirzepatide titration.

• Pre-conception stop timing.

• How to monitor cycles if I have PCOS.

• What to do if I see breakthrough bleeding on HRT.

Bottom line

Plan contraception around tirzepatide dose changes. Favor non-oral HRT during GLP-1 titration. Expect fertility to rise with weight loss, especially in PCOS. Coordinate timing if pregnancy is a goal.