Is Ozempic better than metformin for PCOS?
Ozempic (semaglutide) and metformin are both used off-label to help manage PCOS (polycystic ovary syndrome), particularly when insulin resistance and weight issues are present. However, metformin is generally the first-line choice, while Ozempic may offer additional benefits for certain patients.
Are Ozempic and Metformin Approved for PCOS?
Neither Ozempic nor metformin is FDA-approved specifically for PCOS. Both medications are commonly prescribed off-label—Ozempic more recently, and metformin for decades, especially for PCOS-related metabolic symptoms like insulin resistance.
Mechanism of Action: How Do They Work?
Metformin helps lower blood sugar and improves insulin sensitivity, which can indirectly help with PCOS symptoms like irregular periods and excess androgen. Ozempic, a GLP-1 agonist, encourages the body to produce more insulin as needed, reduces appetite, and slows how quickly food leaves the stomach, often resulting in significant weight loss.
Weight Loss Comparison
Weight loss itself is known to improve PCOS symptoms—including regulating menstrual cycles and improving fertility potential. Both metformin and Ozempic are associated with weight loss.
Ozempic
- Clinical trials show average weight loss of about 15% of body weight over 18 months with semaglutide, the active ingredient in Ozempic.
- Most patients see greater weight loss with semaglutide than with metformin.
Metformin
- One study of 150 obese women showed a 10% decrease in BMI.
- Often regarded as “weight-neutral,” as patients in the Diabetes Prevention Study lost about 5 lbs on average.
Insulin Resistance and Metabolic Effects
Both medications improve insulin sensitivity, but metformin has a long-term safety and efficacy record in PCOS. Metformin has robust evidence for improving menstrual regularity and metabolic function, while Ozempic may have greater potency, especially when excess weight is a major factor.
Ovulation and Fertility Support
Neither metformin nor Ozempic is an FDA-approved fertility treatment, but improving metabolic health can support reproductive outcomes.
- Metformin: Can restore regular ovulation in some insulin-resistant women with PCOS; sometimes used together with fertility medications like clomiphene.
- Ozempic: Early evidence suggests that by improving weight and metabolic health, it may indirectly support ovulation, but it is not a fertility drug and should be stopped before trying for pregnancy.
Side Effects and Safety
Gastrointestinal side effects are common side effects of both metformin and Ozempic. Nausea, diarrhea, and stomach pain are frequently reported by patients taking these medications. Lactic acidosis is a possible serious side effect of metformin, though rare. There is a rare but possible risk of pancreatitis and gallbladder issues from taking Ozempic.
Ozempic is less tolerated initially for some people, but side effects mostly improve over time. Taking metformin with food or switching to the extended-release formulation can help mitigate stomach-related side effects.
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Accessibility and Cost
Metformin is widely available as a lower-cost generic medication, making it a more affordable option compared to Ozempic. Ozempic is currently available as a brand name only, and can be expensive without insurance (typically around $1,000 per month). Insurance coverage for PCOS is uncommon unless you have type 2 diabetes, and prior authorization is almost always required.
Who Might Benefit More from Each?
When choosing between metformin and Ozempic for PCOS, the “best” option often depends on individual goals, symptom patterns, and lifestyle factors. Each medication has advantages for specific types of patients or treatment priorities, such as weight loss, metabolic control, cost, or fertility support. Here’s how metformin and Ozempic compare for different needs.
| Metformin | Ozempic | |
|---|---|---|
|
First-line management PCOS with insulin resistance |
✔ | ✘ |
|
Strong weight-loss goal When weight loss is primary concern |
✘ (minimal) | ✔ (robust) |
|
Cost/accessibility Affordable, widely available |
✔ | ✘ (often costly) |
Final Takeaways
Metformin remains the go-to first-line medication for PCOS with insulin resistance, thanks to decades of research, safety, and accessibility. Ozempic may be preferable for those with significant weight loss goals or if metformin is not tolerated or effective. Ultimately, treatment should be individualized based on medical history, goals, and preferences. Always consult a healthcare professional before making changes to your PCOS management plan.
This is not all the information you need to know about metformin and Ozempic for safe and effective use and does not take the place of your doctor’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.
References
- American Society for Reproductive Medicine. 2023. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Accessed on August 4, 2025, from https://www.asrm.org/practice-guidance/practice-committee-documents/recommendations-from-the-2023-international-evidence-based-guideline-for-the-assessment-and-management-of-polycystic-ovary-syndrome/
- Attia, G. M., Almouteri, M. M., & Alnakhli, F. T. (2023). Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility. Cureus, 15(8), e44493. https://doi.org/10.7759/cureus.44493
- Carmina, E., & Longo, R. A. (2023). Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. Journal of Clinical Medicine, 12(18), 5921. https://doi.org/10.3390/jcm12185921
- Goldberg, A. S., & Boots, C. E. (2024). Treating obesity and fertility in the era of glucagon-like peptide 1 receptor agonists. Fertility and sterility, 122(2), 211–218. https://doi.org/10.1016/j.fertnstert.2024.05.154
- Lashen H. (2010). Role of metformin in the management of polycystic ovary syndrome. Therapeutic advances in endocrinology and metabolism, 1(3), 117–128. https://doi.org/10.1177/2042018810380215
- McGovern, G. 2025. GLP-1 Receptor Agonists May Alleviate Symptoms in Patients With PCOS. In: Pharmacy Times. Accessed on August 5, 2025 at https://www.pharmacytimes.com/view/glp-1-receptor-agonists-may-alleviate-symptoms-in-patients-with-pcos
- Saadati, S., Mason, T., Godini, R., Vanky, E., Teede, H., & Mousa, A. (2025). Metformin use in women with polycystic ovary syndrome (PCOS): Opportunities, benefits, and clinical challenges. Diabetes, obesity & metabolism, 27 Suppl 3(Suppl 3), 31–47. https://doi.org/10.1111/dom.16422
- Toosy, S., Sodi, R., & Pappachan, J. M. (2018). Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. Journal of diabetes and metabolic disorders, 17(2), 277–285. https://doi.org/10.1007/s40200-018-0371-5
- Yerevanian, A., & Soukas, A. A. (2019). Metformin: Mechanisms in Human Obesity and Weight Loss. Current obesity reports, 8(2), 156–164. https://doi.org/10.1007/s13679-019-00335-3
- Zhou, L., Qu, H., Yang, L., & Shou, L. (2023). Effects of GLP1RAs on pregnancy rate and menstrual cyclicity in women with polycystic ovary syndrome: a meta-analysis and systematic review. BMC endocrine disorders, 23(1), 245. https://doi.org/10.1186/s12902-023-01500-5
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