Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. There are many possible causes of PCOS, but overweight/obesity and insulin resistance are two of the most well-known contributing factors that can also affect overall health.
Management of PCOS typically involves multiple approaches, which may include diet and lifestyle changes, and various medications, such as oral contraceptives and insulin sensitizers. Emerging research is examining whether incretin-based therapies — including single-action GLP-1 receptor agonists and dual-action agonists that target both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors — may have a role in addressing certain metabolic features associated with PCOS. No medication in either class is currently FDA-approved for PCOS; any use for PCOS is off-label and is a decision to be made between an individual patient and her treating clinician.
This article explores emerging research on incretin-based therapies in women with PCOS, including the mechanism of action of these medication classes, observations from recent studies, and considerations that an individual patient and her treating clinician may discuss. This content is educational only; it is not medical advice and is not a substitute for evaluation by a qualified healthcare professional who can review your specific history, medications, and goals.
What is PCOS?
PCOS is an endocrine and metabolic disorder, characterized primarily by menstrual irregularities, hyperandrogenism (elevated testosterone and androgen levels), and enlarged ovaries with small cysts. While these are the main criteria, PCOS often involves many other features and symptoms as well, which are discussed below.
PCOS is estimated to affect 4 to 10% of reproductive-aged women worldwide, with other estimates showing higher rates, making it a common disorder. Some published estimates suggest a substantial portion of women with PCOS may remain undiagnosed due to variations in clinical presentation.
What are causes of PCOS?
The exact causes of PCOS aren't definitively known, but it is thought to arise from a combination of genetic and environmental factors. Hormonal imbalances, insulin resistance, chronic inflammation, and elevated androgen levels all appear to play a role in its development and maintenance. More recently, research has suggested that altered gut function may play a role in PCOS's development, in part by affecting inflammation and insulin sensitivity.
Other possible factors associated with PCOS include:
- Sedentary lifestyle
- Lack of exercise
- Diets high in refined carbohydrates and sugars
- Excessive calorie intake
- Obesity
- Exposure to environmental pollutants
- Smoking
What are symptoms of PCOS?
There are several possible symptoms of PCOS. Common symptoms include:
- Irregular menstrual periods, which may include infrequent, prolonged, unusually heavy, or missed periods
- Reduced fertility or difficulty getting pregnant
- Acne
- Hirsutism (excessive, dark hair growth in male-pattern areas, such as the face, chest, and back)
- Enlarged ovaries, which often have small fluid-filled sacs (cysts) on the edge
- Weight gain, especially around the midsection
- Difficulty losing weight
- Male-pattern baldness or thinning hair
- Skin tags (especially on the neck or armpits)
- Dark or thick skin patches in various areas (e.g., neck, armpits, under breasts)
Some women may also experience mood-related symptoms such as anxiety, depression, or mood swings, although individual experiences vary. PCOS has been associated in observational research with an elevated risk of other health conditions, such as high blood pressure, high cholesterol, heart disease, and sleep apnea.
Incretin-Based Therapies and PCOS Research
Incretin-based therapies have been studied for a range of metabolic conditions. Researchers are examining whether these medications may have utility in addressing certain metabolic features common in PCOS, such as insulin resistance and obesity. As of the date of this article, no medication in either of the classes discussed below is FDA-approved for the treatment of PCOS.
Two Classes of Incretin-Based Therapies
Incretin hormones are gut-derived peptides that influence insulin secretion, appetite, gastric emptying, and other metabolic processes. The principal incretin hormones are glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Two broad classes of medication act on these pathways:
- Single-action GLP-1 receptor agonists. These medications bind selectively to the GLP-1 receptor and have been studied and FDA-approved for indications including type 2 diabetes and chronic weight management. Reported effects include enhanced glucose-dependent insulin secretion, slowed gastric emptying, reduced appetite, and weight reduction in studied populations.
- Dual-action incretin agonists (GLP-1 and GIP). A newer class targets both the GLP-1 and the GIP receptors. The dual mechanism has been associated in clinical research with effects on insulin secretion, appetite, gastric emptying, and lipid metabolism. The clinical significance of dual receptor activity relative to single-action GLP-1 agonism continues to be studied; comparative claims of superiority across all clinical endpoints are not currently supported by head-to-head evidence in PCOS populations.
For both classes, individual products differ in dosing, route, and FDA-approved indications. Specific product selection is a clinical decision made between the patient and her treating clinician, taking into account FDA-approved labeling and the patient's full clinical picture.
Mechanisms of Action
Activation of the GLP-1 receptor — and, in the dual-action class, of the GIP receptor as well — has been associated in clinical trials with effects such as:
- Enhanced glucose-dependent insulin secretion: which may contribute to more stable post-meal blood glucose in studied populations.
- Reduced appetite: through central and gut-mediated pathways.
- Slower gastric emptying: which can promote a sense of fullness.
- Effects on lipid metabolism: observed in clinical studies of type 2 diabetes and chronic weight management. Dual-action agonists have additionally been associated with effects on certain lipid parameters that single-action GLP-1 agonists have not consistently shown, although the clinical significance and durability of these differences continue to be studied.
- Reductions in certain inflammatory markers: reported in some studies; the long-term clinical significance is still being evaluated.
Specific incretin-based medications are FDA-approved for indications such as type 2 diabetes and chronic weight management. None is FDA-approved for the treatment of PCOS. At Genesis Lifestyle Medicine, FDA-approved medications in these classes may be incorporated into a comprehensive weight management program when clinically appropriate and consistent with FDA-approved labeling. Use of any such medication in connection with PCOS, where considered at all, is an off-label clinical decision made by the treating clinician in consultation with the individual patient.
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What does the Research Say about Incretin-Based Therapies and PCOS?
Early research has examined associations between incretin-based therapies and certain metabolic and clinical features observed in women with PCOS. Findings to date are limited in number, size, and duration; large randomized trials in PCOS populations are needed before conclusions about clinical benefit can be drawn.
In a 2025 study, researchers examined a dual-action incretin agonist in women with obesity and PCOS. The investigators reported an average weight reduction of approximately 10%, with reductions in fasting blood glucose and HbA1c.
Reported findings also included changes in the proportion of participants with menstrual irregularities and ovarian cysts over the study period, with reductions in insulin resistance prevalence reported as well. These are observational, single-study results and have not been replicated in large randomized controlled trials. Individual outcomes may vary.
Several clinical trials have examined incretin-based therapies in adults with type 2 diabetes or obesity — not in PCOS populations. These trials have reported weight reduction and improvements in fasting insulin, lipids, and blood pressure in those populations. These trials supported the type 2 diabetes and chronic weight management indications and do not establish efficacy or safety in PCOS.
Another small study examined the weight loss effects of metformin compared to metformin plus a dual-action incretin agonist in women with obesity and PCOS, reporting greater weight reduction in the combination group at study end. Sample size and duration limit the strength of these findings.
Additional studies have examined effects of incretin-based therapies on weight, satiety, and metabolic markers in populations including, but not limited to, individuals with type 2 diabetes and obesity. The body of research specific to PCOS remains early-stage, and any decision to use any such medication in connection with PCOS is an individualized clinical decision made by a qualified healthcare provider.
Administration
Incretin-based therapies in the GLP-1 receptor agonist and dual-action incretin agonist classes are most commonly administered as subcutaneous injection, with frequencies determined by the specific product's FDA-approved labeling. Dosing is typically initiated at a low strength and titrated upward per FDA-approved labeling under clinician supervision. Treatment decisions, product selection, dosing, and adjunctive therapies are determined by the prescribing clinician based on individual clinical factors and applicable FDA-approved labeling.
Is an Incretin-Based Therapy Right for You?
Whether any incretin-based therapy is appropriate for any individual is a decision that should be made between the patient and a qualified clinician based on a full clinical evaluation. At Genesis Lifestyle Medicine, that evaluation typically considers the patient's current symptoms, medical history, current medications, laboratory findings, and treatment goals.
Factors a clinician may consider include:
- Overall health and medication profile: Certain medical conditions and concurrent medications may affect whether a particular incretin-based therapy is appropriate or may increase the likelihood of side effects.
- Current weight and metabolic status: FDA-approved indications for medications in these classes relate to type 2 diabetes and/or chronic weight management; the prescribing clinician will assess whether the patient meets the clinical criteria in the applicable FDA-approved labeling.
- Patient preferences: Lifestyle, treatment philosophy, and preferences are part of any shared decision-making conversation.
What are Possible Side Effects?
Important safety information. Medications in the GLP-1 receptor agonist class and the dual-action GLP-1/GIP agonist class carry a boxed warning for the risk of thyroid C-cell tumors based on findings in rodent studies; they are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. Reported serious risks across these classes include pancreatitis, gallbladder disease (including cholelithiasis and cholecystitis), severe gastrointestinal adverse reactions, acute kidney injury (most often related to volume depletion from GI losses), diabetic retinopathy complications in patients with type 2 diabetes, hypoglycemia (particularly when used in combination with insulin or insulin secretagogues), hypersensitivity reactions, and reports of suicidal ideation or behavior during postmarketing surveillance of GLP-1 receptor agonists. This is not a complete list. Risk profile, labeling, and contraindications may differ by individual product. Patients should review the full FDA-approved prescribing information and Medication Guide for the specific medication prescribed and report any side effects to their healthcare provider and to FDA MedWatch at 1-800-FDA-1088.
More commonly reported side effects across the class include:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Abdominal pain
- Decreased appetite
- Dyspepsia
- Injection-site reactions
- Fatigue
- Hypoglycemia (especially in combination with insulin or sulfonylureas)
Lifestyle Strategies that Support PCOS Management
Diet and lifestyle interventions are a foundation of PCOS management regardless of whether medications are used. Strategies that may support PCOS-related symptoms and overall health include:
Healthy Diet
A diet emphasizing fiber, lean protein, complex carbohydrates, and healthy fats, while limiting refined carbohydrates, added sugars, ultra-processed foods, and excess saturated fat, has been associated in published nutrition research with improved metabolic markers.
Regular Exercise
Regular physical activity supports a healthy body weight and metabolic health. Moderate activity (such as 150 minutes per week) can provide benefit; the appropriate intensity for any individual should be discussed with a clinician.
Weight Management
For individuals with overweight or obesity, modest weight reduction (a 5–10% reduction in body weight) has been associated in research with improvement in certain PCOS-related markers while supporting overall health.
Stress Management
Stress reduction practices, social support, regular self-care, and adequate sleep are important components of overall health and may support PCOS management.
Educational Information; Not Medical Advice
The information in this article is provided for general educational purposes only and reflects the professional opinion of the authors as of the date of publication. It does not constitute medical advice, does not establish a clinician-patient relationship with Genesis Lifestyle Medicine or any of its providers, and is not a substitute for individualized evaluation, diagnosis, or treatment by a qualified healthcare professional who has reviewed your personal medical history, current medications, and clinical circumstances. References to classes of medications, such as single-action GLP-1 receptor agonists and dual-action GLP-1/GIP agonists, are educational only. No medication in these classes is currently FDA-approved for the treatment of polycystic ovary syndrome (PCOS); any use for PCOS is off-label. Off-label prescribing is permitted at the discretion of a treating clinician but should occur only after a full individualized evaluation. Always read the FDA-approved prescribing information and Medication Guide for any medication prescribed, and discuss the potential benefits and risks with your healthcare provider.
Medically reviewed by Dr. Alex Spinoso
