GLP-1 Receptor Agonists in Women’s Health: Key Clinical Considerations

Introduction

GLP-1 receptor agonists (GLP-1 RAs) activate the GLP-1 receptor to increase glucose dependent insulin secretion, suppress glucagon secretion and slow gastric emptying. These medications are indicated for type 2 diabetes mellitus and chronic weight management. Common types include semaglutide, exenatide, liraglutide and tirzepatide (which additionally enhances insulin sensitivity).

The Therapeutic Goods Administration (TGA) recommend against the use of GLP1 – RAs during pregnancy (TGA, 2025). Despite this, recent Australian retrospective cohort data suggests a rising use of GLP1- RAs in women of reproductive age, with low rates of contraception use at treatment initiation (Thapaliya et al).

Pregnancy

GLP-1 RAs are classed as a Category D medicine by the TGA. They are not approved for use during pregnancy and should be ceased prior to conception. If pregnancy occurs, GLP1-RAs should be immediately ceased due to limited human safety data (Drummond, 2025) and potential risks suggested in animal studies (TGA, 2025). Due to lack of conclusive evidence abortion is not recommended based solely on exposure to GLP-1 RAs.

Animal reproductive toxicology studies have demonstrated adverse fetal effects (decreased fetal growth, skeletal, visceral anomalies and embryonic death) at high doses supporting continued caution (Ozempic TGA, 2024). Human data is derived primarily from observational cohorts is not powered for definitive safety conclusions (Kettner 2025) but has not demonstrated a clear pattern of congenital anomalies after periconceptional inadvertent exposure (Dao 2024, Parker 2025).

Registries and larger prospective studies are needed to clarify the true pregnancy safety profile of this increasingly used class of medications, particularly in preconception and pregnancy (Varughese, 2025).

Preconception

Human evidence on GLP-1 RA use specifically in the preconception period is extremely limited and primarily derived from small clinical trials and case reports. Given the lack of high-quality evidence, discontinuation of GLP1-RAs is advised two months prior to attempting conception Endocrine Society, 2025) to account for washout periods. However it must be noted that each GLP-1 RA has a different timeline of washout and some data suggests tirzepatide could be closer to 4 weeks and exenatide up to 12 weeks.

Acknowledging the adverse effects of obesity, insulin resistance, and metabolic syndrome on fertility and pregnancy outcomes, alternative strategies for metabolic optimization, such as lifestyle modification and metformin therapy, should be considered during the preconception period (Thakore et al., 2025; Kettner et al., 2025; American Diabetes Association, 2026). Preconception counselling should include discussion of contraception during therapy, timing of discontinuation and risks of inadvertent early pregnancy exposure (TGA 2025).

Contraception

Due to limited safety data and potential fetal risk, effective contraception is advised for all women of childbearing age whilst on GLP-1 RAs. Pharmokinetic evidence suggests tirzepatide is the only widely used GLP1-RA that significantly reduces bioavailability of oral contraceptives (Skelley, 2024; Kettner 2025), hence potential for reduced effectiveness (CoSRH, 2025). TGA recommends switching to non-oral or additional barrier methods for 4 weeks after tirzepatide initiation or dose escalation (TGA, 2025).

There is no pharmacokinetic data regarding the impact of GLP-1 receptor agonists on emergency hormonal contraception; however, given delayed gastric emptying and potential reduced absorption of oral agents, guidelines suggest considering non-oral emergency contraception, particularly copper intrauterine device insertion noting the reduced efficacy of levonorgestrel emergency contraception in women with a BMI >26 (RANZCOG).

Menopause

Current evidence regarding the interaction between GLP-1 RAs and menopausal hormone therapy is limited. Available reviews suggest no clear pharmacologic interaction, and observational data indicate potential additive benefits on weight and cardiometabolic outcomes in postmenopausal women receiving both therapies (Graczyk, 2026; Mikdachi, 2025). However, this evidence requires robust randomized controlled trials for confirmation of effect.

Current regulatory product information and Australian guidance from the TGA do not provide specific recommendations regarding co-administration. However, it should be noted that bodies such as the British Menopause Society (BMS) recommend consideration of up-titration of oral progesterone in the setting of GLP1-RA use due to risk of altered absorption (BMS, 2025). In the absence of robust evidence, individualised assessment of cardiometabolic risk and routine clinical monitoring are recommended; in consultation with a primary care physician or treating specialist.

Fasting for surgery

Current Australian multidisciplinary guidance recommends continuing GLP-1 RAs peri-operatively, with a 24 hour clear fluid diet followed by standard 6 hour fasting to mitigate aspiration risk due to delayed gastric emptying. Where the 24 hour clear fluid strategy is not followed, clinicians should manage the patient as unfasted to mitigate aspiration risk (Hocking, 2025).

Conclusion

GLP-1 RAs require caution across reproductive, menopausal, and perioperative contexts. They should be combined with effective contraceptive in women of childbearing age and stopped in preconception. Use should be monitored in menopause with further studies required to clarify safety and optimal use with MHT. Recent updates recommend continued use in the peri-operative period with altered fasting protocols.

Therapeutic Goods Administration. Updated contraception advice for Mounjaro (tirzepatide). TGA Medicines Safety Update. 2025 Dec 1.
Thapaliya K, Sweeting A, Black KI, et al. Incidence of GLP-1 receptor agonist use by women of reproductive age attending general practices in Australia. Med J Aust. 2025.
Skelley JW, Swearengin K, York AL, Glover LH. The impact of tirzepatide and glucagon-like peptide-1 receptor agonists on oral hormonal contraception. J Am Pharm Assoc. 2024;64(1):204-211.e4.
Kettner J, Donnelly E, Maes ML. Glucagon-like peptide-1 receptor agonists and reproductive health: current evidence and clinical implications. J Pharm Pract. 2025 Sep 4:8971900251376795. doi:10.1177/08971900251376795
College of Sexual and Reproductive Healthcare (CoSRH). Glucagon-like peptide-1 (GLP-1) agonists and oral contraception. London: CoSRH; 2025 Feb.
Thakore S, et al. GLP-1 receptor agonists in preconception and fertility management: a narrative review. J Endocrinol Metab. 2025;11(3):115-126.
American Diabetes Association. Standards of care in diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S1-S273.
American Diabetes Association, Endocrine Society, European Society of Endocrinology. Management of preexisting diabetes and pregnancy: joint clinical practice guideline. 2025.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Contraception Clinical Guideline (C‑Gyn 3), July 2024.
British Menopause Society. Use of incretin-based therapies in women using hormone replacement therapy (HRT): Tool for Clinicians. London: British Menopause Society; April 2025.
Varughese MS, O’Mahony F, Varadhan L. GLP-1 receptor agonist therapy and pregnancy: evolving and emerging evidence. Clin Med (Lond). 2025;25(2):100298. doi:10.1016/j.clinme.2025.100298
Drummond RF, Seif KE, Reece EA. Glucagon-like peptide-1 receptor agonist use in pregnancy: a review. Am J Obstet Gynecol. 2025;232(1):17-25. doi:10.1016/j.ajog.2024.08.024
Novo Nordisk Pty Ltd. Ozempic (semaglutide) product information. Therapeutic Goods Administration; 2024.
Dao K, Shechtman S, Weber-Schoendorfer C, Diav-Citrin O, Murad RH, Berlin M, et al. Use of GLP-1 receptor agonists in early pregnancy and reproductive safety: a multicentre, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ Open. 2024;14(4):e083550. doi:10.1136/bmjopen-2023-083550
Parker CH, Slattery C, Brennan DJ, leRoux CW. Glucagon-like peptide 1 (GLP-1) receptor agonists’ use during pregnancy: Safety data from regulatory clinical trials. Diabetes Obes Metab. 2025;27(8):4102-4108. doi:10.1111/dom.16437
Graczyk NA, Bisschops J. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity and symptoms in menopause: a review. Cureus. 2026;18(1):e101693. doi:10.7759/cureus.101693
Mikdachi H, Dunsmoor-Su R. GLP-1 receptor agonists for weight loss for perimenopausal and postmenopausal women: current evidence. Curr Opin Obstet Gynecol. 2025;37(2):97-101. doi:10.1097/GCO.0000000000001015
British Menopause Society. Use of incretin-based therapies in women using hormone replacement therapy (HRT). Tool for Clinicians. April 2025. Available from: BMS PDF document
Hocking SL, Scott DA, Remedios ML, Horowitz M, Story DA, Greenfield JR, Boussioutas A, Devereaux B, Andrikopoulos S, Shaw JE, Olesnicky BL. 2025 ADS/ANZCA/GESA/NACOS clinical practice recommendations on the peri-procedural use of GLP-1/GIP receptor agonists. Anaesth Intensive Care. 2025;53(5):300-306. doi:10.1177/0310057X251355288