Consequential Delays in Pregnancy

 Scientists are investigating the idea that GLP-1 might be associated with unexpected pregnancies. Overweight and obese people often experience disruptions in their menstrual cycle caused by hormonal imbalances or inflammation. “The female reproductive system is very sensitive and responsive to metabolic health, energy balance and nutrition,” says Nicole Templeman, a cell biologist at the University of Victoria in Canada. The weight loss triggered by GLP-1 drugs might restore regular ovulation for some women.

But she says the effects could also extend beyond weight loss. “GLP-1 receptors have their own effects in the reproductive system that seem to be independent of weight loss,” says Templeman.

Indeed, people on GLP-1 drugs have reported pregnancies despite taking oral contraceptives. Cytotec. Eli Lilly, the company that manufactures tirzepatide, advises people on oral contraceptives to use backup methods of birth control for four weeks after starting tirzepatide, or if they increase their dosage.

A spokesperson for Eli Lilly said that the company studied drug interactions as part of the standard US Food and Drug Administration (FDA) approval process. They found that tirzepatide changes the way oral contraceptives are absorbed, potentially making them less effective.

GLP-1 drugs slow the rate at which food and medications empty out of the stomach and into the intestines, which is where oral contraceptives are absorbed into the bloodstream. Eli Lilly data for tirzepatide showed that it reduced the maximum concentration of contraceptive in the blood by up to 66% after a single dose.

“So, over half of it is gone, which is a big problem,” says Jessica Skelley, a pharmacologist at Samford University in Birmingham, Alabama. Oral contraceptives are concentration dependent: “if there is not enough of them in the body, they can’t effectively provide contraceptive benefit”, Skelley adds.

Semaglutide seemed to affect the concentration of hormonal contraception less markedly than tirzepatide did, but Skelley says it could still be an issue because the two drugs work in a similar manner.

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