Can Women on Wegovy Experience Menstrual Cycle Changes?
There is no high-quality evidence documenting menstrual cycle alterations as a recognized adverse effect of semaglutide (Wegovy). The extensive clinical trial data and FDA approval documentation for semaglutide do not identify menstrual irregularities among reported side effects 1, 2, 3.
What the Evidence Shows
Documented Side Effects of Wegovy
The most common adverse effects of semaglutide 2.4 mg are gastrointestinal, occurring in 53% of patients and typically being mild-to-moderate and transient 1, 3. These include:
- Nausea (occurring in 18-40% of patients) 1
- Diarrhea (12-32% of patients) 1
- Vomiting (8-16% of patients) 1
- Constipation (10-23% of patients) 1
Serious but rare adverse events include pancreatitis, gallbladder disease (cholelithiasis and cholecystitis), and acute kidney injury 1, 2, 3.
Why Menstrual Changes Might Theoretically Occur
While not documented in the semaglutide literature, significant weight loss itself can affect menstrual cycles through several mechanisms:
- Rapid weight reduction of 14.9% at 68 weeks (as seen with Wegovy) may temporarily disrupt hormonal balance 2, 3
- Changes in adipose tissue alter estrogen metabolism and production
- Caloric restriction (the required 500-kcal daily deficit) can affect hypothalamic-pituitary-ovarian axis function 1
Special Consideration for Women of Reproductive Age
Women using oral contraceptives should be aware of a specific interaction with tirzepatide (a related GLP-1/GIP agonist), where switching to non-oral contraceptive methods or adding barrier contraception for 4 weeks after initiation and each dose escalation is recommended 1. While this specific guidance has not been established for semaglutide, the delayed gastric emptying mechanism is shared across GLP-1 receptor agonists 1.
Clinical Approach
If Menstrual Changes Occur on Wegovy
Do not automatically attribute menstrual irregularities to the medication. Instead:
- Evaluate for pregnancy in all women of reproductive age experiencing menstrual changes
- Assess for other causes of menstrual irregularities (thyroid dysfunction, polycystic ovary syndrome, stress, other medications)
- Consider that rapid weight loss may be the primary driver rather than the medication itself
- Monitor thyroid function, as GLP-1 receptors are expressed in the thyroid, though semaglutide is contraindicated only in patients with personal or family history of medullary thyroid cancer or MEN2 1, 2
When to Continue vs. Discontinue
Continue semaglutide if menstrual changes are mild and transient, particularly given the substantial cardiovascular benefits (20% reduction in cardiovascular death, nonfatal MI, or stroke in patients with established cardiovascular disease) 1, 2.
Consider discontinuation only if:
- Severe, persistent menstrual abnormalities develop that significantly impact quality of life
- Other serious adverse effects emerge (persistent severe abdominal pain suggesting pancreatitis, signs of gallbladder disease) 1, 2
- Weight loss is inadequate (<5% after 3 months at therapeutic dose) 1
Critical Monitoring Points
Women on Wegovy should be monitored every 3-6 months for 1:
- Weight loss progress and cardiovascular risk factors
- Gastrointestinal tolerance (the most common reason for discontinuation)
- Signs of pancreatitis or gallbladder disease
- Blood pressure (may decrease with weight loss, requiring antihypertensive adjustment)
The absence of menstrual cycle changes in the documented adverse event profile suggests this is not a common or clinically significant concern with semaglutide therapy 1, 2, 3.