GLP-1 and HRT/Contraceptive Advice
GLP-1 and HRT/Contraceptive Advice
GLP-1 receptor agonists, including Mounjaro® and Wegovy®, have become more commonly used in recent years. They are primarily used to help manage raised blood sugar levels and weight loss. Increasingly, patients are prescribed these injections through private providers.
One of the ways GLP1’s work is by slowing down the emptying of your stomach (called delayed gastric emptying). Whilst this has the effect of helping you feel fuller for longer, it can also affect the way in which some medications are absorbed. In particular, concerns have been raised about the effects of GLP1’s on HRT and contraceptive pills.
We’re currently reviewing and advising patients who may be affected. However, we aren’t always notified if patients are accessing weight-loss injections privately or online. The prescribing clinician should appropriately counsel you about this, and it is important that you discuss your repeat medications with them directly. A brief summary of the risks is outlined below:
HRT:
The part of HRT we’re particularly concerned about is oral progesterone (e.g., Utrogestan®, Geptrix®). Progesterone plays a vital role in protecting your womb lining (endometrium) if you’re taking oestrogen. If the progesterone isn’t properly absorbed, your womb lining could build up, putting you at risk of heavy bleeding, abnormal bleeding, or even endometrial cancer.
The British Menopause Society has issued new interim guidelines specifically for women on Mounjaro®, Wegovy® and other GLP-1 medications.
Here’s what you need to know:
You may need to switch to a non-oral form of progesterone. Options include a Mirena® coil fitted in the womb, or in some cases a switch to a combined oestrogen and progesterone patch may be appropriate.
If you stay on oral progesterone you may need to temporarily increase your progesterone dose, when starting Mounjaro® or Wegovy®, or when the dose increases, typically for 4 weeks after any change.
If you feel that the above information applies to your current circumstance, or if your are using HRT alongside a GLP1 and have noticed a change in bleeding, unusual pelvic discomfort or changes in discharge, please book an appointment to discuss this – never change your dose without first discussing it with a prescriber.
Contraceptives
If you are taking the contraceptive pill, some GLP1 injections may also affect its effectiveness, meaning that there is a risk of pregnancy.
With some GLP1 injections, it is therefore recommended to use an additional barrier method (e.g. condoms) for 4 weeks after starting or changing your dose.
The Faculty of Sexual and Reproductive Healthcare have put together the following information to help advise patients on the most appropriate courses of action to take, when starting or changing the dose of a GLP1 injection:
Patient-information-GLP-1-agonists-and-contraception.pdf