how glp-1s may have an impact on people living with pmos and obesity
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as many as 88 per cent of women with pmos also live with obesity, making glp-1s a potential treatment option.
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polyendocrine metabolic ovarian syndrome (pmos), formerly known as polycystic ovary syndrome (pcos), is finally being recognized for what it is: a complex condition that involves a lot more than the ovaries. with that new recognition comes a better understanding of what the syndrome actually is and, in the future, what potential treatments might look like.
“what were thought to be cysts on previously seen on ultrasound, which was one of the diagnostic criteria for pcos, are not actually cysts. they’re immature follicles,” said dr. mark broussenko, family physician based out of toronto and medical director of raven. “so, calling it pcos was inaccurate, but it also overestimated the structural changes, which not everyone with pmos has, and kind of underemphasized the contribution from some of the hormonal and metabolic changes that happened with pmos.”
many of the symptoms that arise and create the most issues in pmos are also not related to the previous characterization of cysts on the ovaries, but rather those metabolic and hormonal issues. for example, weight gain or difficulty losing weight, insulin resistance and heightened androgens are all hallmark symptoms of pmos.
the new naming now gives “a better sense to clinicians who are thinking about it in terms of the right areas to focus on and the impacts that it has on people’s health,” said dr. broussenko.
now, with glp-1s as a treatment for obesity and diabetes, the medication is now being looked at as a potential therapy for pcos because of its metabolic effects.
adding more to the pmos treatment arsenal
insulin resistance and overweight and obesity are common in people with pmos. as many as 80 per cent of people with pmos deal with insulin resistance, which occurs when the body’s cells don’t respond to the hormone insulin as well, creating a system that doesn’t use glucose as effectively in the body. up to 88 per cent of people living with pmos also have overweight or obesity.
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due to the number of people with pmos having those co-conditions, researchers believe that it’s possible that a drug that works effectively on blood sugar management and obesity could work just as well for pmos—especially when compared to current medications like metformin.
“metformin causes really modest amounts of weight loss for people, usually a couple of kilograms, so like five, 10 pounds for the average person,” said dr. broussenko. “glp-1s do much better, so if you’re looking at upwards of 10 per cent [of your body weight] after a year of treatment, and with that, you would expect to see significantly better insulin levels or normalization.”
addressing insulin resistance and weight in people living with pmos is important because it can have a domino effect on other symptoms, such as high androgens or male hormones. for example, a person with pmos losing weight and getting to a healthy weight range helps to lower androgen levels without the need for a secondary medication or intervention.
“there are also some anti-androgen medications, so things like spironolactone that are used to treat the peripheral effects of androgens,” said dr. broussenko. “those are often used in combination with birth control and the insulin-sensitizing agents [such as metformin].”
essentially, a glp-1 taken for pmos-driven obesity can cause more weight loss than metformin while also addressing other symptoms in a trickle-down effect.
weight is important in pmos because of how challenging it can be to lose it and how easy it is to gain it even while doing all the right things. but since these conditions—pmos, obesity and diabetes—are all closely related, putting glp-1s on the radar of pmos patients is a good way to tackle more than one condition at a time.
“it is very much a positive feedback loop, so the heavier people are, the more adipose tissue they have. adipose tissue preferentially leads to peripheral androgen secretion. you’re also getting more insulin resistant … which makes the ovaries make more androgens, and it’s a positive feedback cycle. so, once you put on weight with pmos, it becomes very hard to lose it, and then the more weight you put on, the more pmos symptoms you often have,” said dr. broussenko.
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glp-1 isn’t the gold standard for everyone with pmos
while glp-1s can be added to the options for people living with pmos and obesity and insulin resistance, it isn’t recommended for everyone. for example, if a person living with pmos doesn’t have obesity, taking a glp-1 is not advised because of its weight loss effects.
pmos also makes it challenging to conceive, but people who are looking to become pregnant also may not be good candidates for glp-1s for their pmos because you shouldn’t take the medication at the same time as being pregnant.
while it’s important to have another option for pmos, it’s also important to use it on a case-by-case basis. as treatment options grow, it’s about patient-centred care.
“some people might look at their life plan and say, ‘i’m looking to grow my family in the next six to 12 months. glp-1 doesn’t make sense for me.’ other people are saying, ‘actually, i’m done with that phase in my life. this is absolutely the right way to go,’” said dr. broussenko.
one important caveat to using glp-1s for pmos is how it affects fertility, especially in people who have become used to missed periods or lower chances of getting pregnant in the past.
“[taking] a glp-1 will absolutely change your fertility profile,” said dr. broussenko. “so, we do tell people to be cautious on glp-1s independently in the first week or first month of use.”
pmos and glp-1 research is still emerging
while recent studies on the effects of glp-1s in the treatment of pmos are showing positive results, the field it still in its infancy. glp-1s have been extensively studied for type 2 diabetes and have since expanded into obesity medicine. but with pmos, more time is needed to truly deem it as a first-line therapy.
that said, since many people with pmos have co-conditions, such as insulin resistance and obesity, it could be a great way to “kill two birds with one stone.”
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“the primary lens [looking at glp-1s for pmos] would be weight. so, it would be very much of a weight loss and then some other downstream cascades in terms of hormonal optimization that way,” said dr. broussenko.
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