New Delhi: Weight-loss injections may help some women with Polyendocrine Metabolic Ovarian Syndrome (PMOS), earlier known as PCOS, manage excess weight and related metabolic problems, but the medicines are not a cure for the hormonal disorder and should not be used without medical supervision, experts said.
With drugs belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class gaining attention for weight management, specialists have cautioned that women with PMOS need an individualised treatment plan based on their symptoms, weight, metabolic health and reproductive goals.
Dr Hrishikesh Pai, Gynaecologist and IVF Specialist; Medical Director, Bloom IVF Group, said weight-loss injections should not be viewed as a universal treatment for PMOS, which can cause irregular menstrual cycles, excess hair growth, acne and difficulties with ovulation.
“PMOS is a complex hormonal and metabolic condition, and excess weight is only one part of the picture. While weight reduction may improve metabolic health and menstrual regularity in some women, it does not mean the underlying condition has been cured.
“Treatment must address the woman’s specific symptoms and long-term health needs rather than focus exclusively on the number on the weighing scale,” Dr Pai said.
GLP-1 medicines regulate appetite, satiety and blood sugar. Depending on the drug, they may be prescribed for type 2 diabetes or weight management in eligible patients. However, PMOS is not an established standalone indication.
The 2023 international evidence-based PCOS guideline says anti-obesity drugs, including semaglutide and liraglutide, may be considered for adults with PCOS and higher weight, following general obesity-management guidelines and alongside lifestyle changes.
The 2023 international evidence-based PCOS guideline says anti-obesity medicines, including semaglutide and liraglutide, may be considered for adults with PCOS and higher weight in line with general obesity-management guidelines, alongside lifestyle interventions.
Endocrinologist Dr Kunal Gupta, consultant endocrinologist, SPARSH Hospital, Infantry Road in Bangalore, said the decision to prescribe these medicines should follow an assessment of body weight, blood sugar levels, insulin resistance and other associated risk factors.
“Not every woman with PMOS needs a weight-loss drug, and having the diagnosis alone is not a reason to start injections. Doctors need to establish whether the patient meets the criteria for pharmacological weight management and discuss the expected benefits, possible adverse effects and alternatives. These medicines should complement, rather than replace, appropriate nutrition, physical activity and follow-up,” Dr Gupta said.
He also cautioned that the benefits may not persist after the treatment is discontinued, particularly if sustainable lifestyle changes and long-term weight-management strategies are not in place. Dr Gupta said weight regain can occur after stopping GLP-1 medicines as the appetite-suppressing effects diminish.
“A doctor should plan how weight and metabolic health will be monitored if treatment is stopped, instead of allowing patients to discontinue or restart the drug on their own,” he said.
Dr Nehal Dhaduk, Consultant Gynaecology, PB Health, Gurugram, said women should be counselled about the possibility of weight regain before starting treatment.
“Patients should understand that these medicines are not a quick fix for PMOS. Weight regain can occur after discontinuation as the appetite-suppressing effects diminish, although the extent varies between individuals. Women should have a long-term management plan and remain in touch with their doctors rather than stop or restart injections on their own,” Dr Dhaduk said.
Common side-effects include nausea, vomiting, diarrhoea, constipation and abdominal discomfort. Some patients may also develop more serious complications, including gallbladder problems or pancreatitis, Dr Dhaduk said.
Medical supervision is necessary to assess risks, select the appropriate medicine and monitor treatment, she added.
Gynaecologist Dr Megha Mittal, Senior Consultant, Obstetrics and Gynaecology, Apollo Spectra Hospital Delhi, said pregnancy planning is another important consideration, as improvements in metabolic health and ovulation may increase the chances of conception in some women with PMOS.
“Women planning pregnancy must discuss these medicines with their doctors before starting treatment. These drugs should not be used for weight loss during pregnancy, and the recommended interval between stopping treatment and attempting conception depends on the medicine,” Dr Mittal said.
“For instance, semaglutide should be discontinued at least two months before a planned pregnancy. Women should also discuss contraception and preconception care with their gynaecologist,” she said.
Dr Mittal underlined that PMOS management should address menstrual health, fertility goals, mental well-being and metabolic risks, including type 2 diabetes.
Depending on the individual woman’s symptoms and clinical assessment, treatment may include lifestyle interventions, hormonal contraceptives, metformin or fertility treatments.
Experts stressed that the goal should be sustainable weight management and long-term health, rather than rapid weight loss through unsupervised medication.
