GLP-1 and Female Reproductive Health: Fertility, Contraception, and Gestational Safety

Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly used in the treatment of type 2 diabetes mellitus and obesity, expanding their exposure among women of reproductive age. In addition to metabolic effects related to glycemic control and body weight reduction, the use of these medications raises specific questions regarding fertility, contraception, and safety during pregnancy. Improvements in insulin resistance, excess adiposity, and metabolic changes associated with polycystic ovary syndrome may favor reproductive function and increase the likelihood of conception, while effects on gastric emptying and pharmacological particularities of certain agents raise concerns regarding oral contraception. At the same time, the limited availability of data on gestational exposure and findings from preclinical studies justify caution regarding use during pregnancy. This review aimed to analyze the implications of GLP-1 receptor agonists for female reproductive health, considering their potential effects on fertility, contraception, and gestational safety. This is a narrative literature review, guided by a structured question based on the PICo strategy and directed at studies on the use of GLP-1 receptor agonists in women of reproductive age. The evidence suggests that metabolic benefits may favorably affect reproductive parameters, particularly in women with obesity, insulin resistance, and polycystic ovary syndrome. However, the possibility of ovulation recovery and unplanned conception reinforces the importance of contraceptive counseling. During pregnancy, the insufficiency of robust clinical evidence and uncertainties related to fetal safety support the recommendation to avoid these medications. It is concluded that the expanding use of GLP-1 receptor agonists among women of childbearing age requires integration between metabolic management, reproductive planning, effective contraception, and preconception guidance.