GLP-1 Receptor Agonists and Hormonal Contraception: What You Need to Know
The Faculty of Sexual and Reproductive Healthcare (FSRH) has issued guidance on how glucagon-like peptide-1 (GLP-1) receptor agonists interact with hormonal contraception. As the use of GLP-1 receptor agonists for weight management and type 2 diabetes increases, understanding their impact on contraceptive effectiveness is essential for both healthcare professionals and individuals using these treatments.
How Do GLP-1 Receptor Agonists Affect Hormonal Contraceptives?
GLP-1 receptor agonists slow gastric emptying, which can influence the absorption of oral medications, including hormonal contraceptives. However, not all GLP-1 receptor agonists pose the same level of risk. Some, particularly tirzepatide, can significantly delay gastric emptying, potentially reducing the effectiveness of oral contraceptives (OCPs).
Key Considerations for Contraceptive Use with GLP-1 Agonists
Tirzepatide and Oral Contraceptives: Take Extra Precautions
Individuals taking tirzepatide should consider additional contraceptive precautions, as its effects on gastric emptying may compromise oral contraceptive absorption. The FSRH recommends:
✔ Switching to a non-oral contraceptive method, such as the contraceptive implant, intrauterine system (IUS), or contraceptive injection.
✔ Using a barrier method (e.g., condoms) for at least four weeks after starting tirzepatide.
✔ Continuing additional precautions for four weeks following each dose increase to ensure contraceptive efficacy.
This advice applies to both combined oral contraceptives (COCs) and progestogen-only pills (POPs).
Other GLP-1 Agonists: No Additional Contraceptive Precautions Required
Current evidence suggests that other GLP-1 receptor agonists, including:
- Semaglutide (Ozempic, Wegovy)
- Dulaglutide (Trulicity)
- Exenatide (Byetta, Bydureon)
- Lixisenatide (Lyxumia)
- Liraglutide (Saxenda, Victoza)
do not significantly impact oral contraceptive effectiveness, meaning no additional precautions are needed when using these medications.
What If You Experience Severe Diarrhoea or Vomiting?
Although most GLP-1 receptor agonists do not require additional contraceptive precautions, common side effects such as nausea, vomiting, and diarrhoea can affect medication absorption.
👉 If severe vomiting or diarrhoea occurs within three to four hours of taking an oral contraceptive pill, absorption may be incomplete, reducing contraceptive protection. In such cases, individuals should:
✔ Follow standard guidance for missed pills, as advised by the FSRH guidelines.
✔ Use a backup contraceptive method (e.g., condoms) until they have taken their pill correctly for seven consecutive days.
✔ Seek advice from a healthcare professional if unsure about contraceptive efficacy.
Alternative Contraceptive Options for Those Taking GLP-1 Agonists
For individuals prescribed tirzepatide or those concerned about gastrointestinal side effects affecting contraceptive absorption, non-oral contraceptive options may be preferable. These include:
✔ Long-acting reversible contraceptives (LARC):
- Intrauterine device (IUD) – A hormone-free, copper-based method.
- Intrauterine system (IUS) – Releases progestogen for long-term contraception.
- Contraceptive implant (Nexplanon) – Provides up to three years of protection.
✔ Injectable contraceptives (Depo-Provera, Sayana Press)
✔ Vaginal ring or contraceptive patch – Avoids gastrointestinal absorption issues.
These methods offer reliable contraception without being affected by gastric emptying delays or gastrointestinal side effects.
FSRH Guidance and Recommendations
The FSRH guidelines provide detailed recommendations on drug interactions with hormonal contraception, including GLP-1 receptor agonists. Healthcare professionals should ensure patients receive appropriate contraceptive advice when initiating GLP-1 therapy.
🔹 Key Takeaways:
✔ Tirzepatide may reduce oral contraceptive effectiveness, requiring additional precautions.
✔ Other GLP-1 receptor agonists do not impact contraception, so no extra measures are necessary.
✔ Severe vomiting or diarrhoea can affect contraceptive absorption, requiring backup methods.
✔ Non-oral contraceptives provide a more reliable option for those taking GLP-1 receptor agonists.
For comprehensive guidance, refer to the latest FSRH guideline on contraception and drug interactions.
Final Thoughts: Should You Change Your Contraceptive Method?
If you take tirzepatide and rely on oral contraception, switching to a non-oral method or using a backup barrier method will help maintain contraceptive effectiveness.
For those using other GLP-1 receptor agonists, standard contraceptive use remains effective, unless severe vomiting or diarrhoea occurs.
Speak to a Healthcare Professional
If you are unsure whether your current contraceptive method is suitable while using a GLP-1 receptor agonist, consult your GP, pharmacist, or sexual health specialist for personalised advice.
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