Weight Management Medication With PCOS or in Perimenopause: What to Ask Your Prescriber

Start-up conversations tend to be about nausea and doses. These questions get missed.

The NIH's child health institute (NICHD) describes PCOS as a set of symptoms related to a hormonal imbalance, and lists birth control pills as the primary long-term treatment option for women with PCOS who don't want to become pregnant. So if you have PCOS, you may already be on it.

Perimenopause doesn't take pregnancy off the table either. The HHS Office on Women's Health says you can still get pregnant during perimenopause, even if you miss periods, and to keep using birth control until a full year after your last period if you don't want to.

PCOS. The common weekly injections list their FDA-approved uses on their labels, and PCOS is not one of them. A 2025 review states plainly that treating PCOS with this class of medication is off-label.

The pill. The labels for two of these injections, both made by Eli Lilly and sharing the same active ingredient, say it may make oral hormonal contraceptives less effective by slowing stomach emptying, most after the first dose. They advise switching to a non-oral method, or adding a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase. Non-oral hormonal methods should not be affected.

Pregnancy. The weight management labels from Novo Nordisk and Eli Lilly say the medicine may cause fetal harm and, for weight management, to stop when pregnancy is recognized. The Novo Nordisk label goes further: stop at least 2 months before a planned pregnancy, because the medicine has a long half-life. Both have pregnancy exposure registries.

Muscle and bone. A 2025 joint advisory from four US obesity and nutrition societies says rapid weight reduction on these medications can affect bone density, with females and older people losing more, and that low protein from a reduced appetite may add to muscle loss, particularly around perimenopause and menopause. NIH's MedlinePlus notes that losing estrogen at menopause can cause bone density loss. And in the Novo Nordisk weight management injection's heart outcomes trial, its label reports more hip and pelvis fractures in women on the medicine than on placebo: 1% vs 0.2%.

The advisory recommends strength training at least three times a week plus at least 150 minutes of moderate aerobic activity, with enough protein, to help preserve muscle and bone.