Semaglutide and Multidisciplinary Care Show Promise for PCOS Symptoms

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting 1 in 10 people who menstruate. Marked by abnormally high levels of androgens, the group of sex hormones responsible for male characteristics, patients with PCOS experience irregular periods, oily skin and acne, weight gain and hirsutism (excessive hair growth). PCOS is also a leading cause of infertility. Despite the prevalence of adolescents with PCOS, diagnosing and treating it has remained difficult due to its complex symptomology and the multidisciplinary nature of managing the condition.

Children’s Hospital Colorado endocrinologist Melanie Cree, MD, PhD, has dedicated her research to better understanding this disease and its relationship to the essential hormone insulin. Her recent findings demonstrate the link between PCOS and metabolic disease, and how lifestyle changes and weight loss can improve long-term health outcomes.

Recognizing PCOS across disciplines

Historically, diagnosing PCOS was challenging because the diagnostic criteria kept changing until an international guideline was established in 2018. Additionally, PCOS symptoms span so many different areas that patients often seek help from a range of experts.

For instance, people with PCOS and obesity often have sleep apnea, so they may search for help from a sleep clinic. Or someone experiencing severe acne from PCOS might visit the dermatologist. However, detecting PCOS on a lab test requires a nuanced understanding of the condition, which isn’t consistent across this range of disciplines, and irregular menstruation may not be a go-to area for investigation for areas like sleep, dermatology, hepatology and psychiatry, all of which PCOS can touch.

“I very firmly believe that menses is the sixth vital sign in people assigned female at birth,” Dr. Cree says. “And if they are abnormal and they're not taking any hormones that make it that way, then the reason needs to be pursued.”

To support providers in making accurate diagnoses, Dr. Cree and her team at Children’s Colorado developed an order set for diagnosis, which is essentially a checklist that outlines the key factors for diagnosing PCOS, including irregular menses (less than 21 or greater than 45 days between periods) one year after menarche. There’s also an order set for treatment and a standardized note template that reminds providers what questions to ask. “People from all different specialties have expressed that this really helps them to diagnose and manage PCOS because they don't have to try to keep everything in their head and feel overwhelmed,” Dr. Cree says.

PCOS symptoms and semaglutide

Improving diagnosis and treatment for PCOS is important for helping relieve symptoms in the short term, but it’s also essential for improving long-term health outcomes. Dr. Cree’s PCOS research has shown that the condition is associated with obesity and metabolic associated steatotic liver disease (MASLD) which can lead to Type 2 diabetes.

“My overall research hypothesis is that if we can reduce and treat fatty liver disease in girls with PCOS and obesity, we may be able to prevent them from getting type 2 diabetes,” Dr. Cree says. “Research has shown that, without intervention, these teens who develop type 2 diabetes are starting to die in their late 20s and early 30s.”

Dr. Cree’s fifth trial in teens with PCOS and excess weight compared treatment with oral semaglutide, a hormone which stimulates insulin production to reduce blood sugar, against meeting with a dietician weekly and following a lifestyle food program that reduced simple carbohydrates and fructose. While the patients on semaglutide lost more weight than those on the dietary plan, as expected, the smaller amount of weight loss in the lifestyle-only group still showed a promising improvement in metabolic disease. In fact, both groups showed equal improvement across period regularity, decreased liver fat and overall hormone regulation.

Since PCOS is a condition that needs to be managed throughout life, Dr. Cree’s research has also focused on the transition of care for these patients, making it easier for them to seamlessly grow into adult care without compromising the multidisciplinary care they received as children.

Currently, Dr. Cree is working on a similar trial using Wegovy, a form of injectable semaglutide that has become available on the market since her previous trial.

Increasing access, decreasing stigma

Dr. Cree’s findings show that weight loss is crucial to improving life expectancy in patients with PCOS, regardless of how that weight loss is achieved, but the popularity of semaglutide in our current culture makes it difficult to access due to both cost and low inventory. Therefore, cutting out sugary drinks, energy drinks and other high-sugar foods, in combination with a healthy lifestyle and more affordable weight loss drugs like phentermine, can reduce insulin resistance, lessen symptoms and create a healthier future without the high financial cost.

In addition to helping patients improve their metabolic health through weight loss, Dr. Cree emphasizes the importances of combating the stigma of obesity. It's common for adolescents with PCOS to think that they’re responsible for the physical and psychological symptoms they face; however, helping them understand their disease on a metabolic level can reduce the self-blame and shame that tends to only worsen their outcomes overall.

“For example, if you've got bad acne and hirsutism and you’re being bullied at school, you have low self-esteem, so you're not going to be able to make lifestyle changes. If you have untreated obstructive sleep apnea, you crave sugary, fatty foods that you cannot overcome with willpower and you're too tired to exercise,” Dr. Cree says. “If you really get into the physiology of PCOS, there are so many things that can be done to approach getting these patients healthier.”