🧬 GLP-1 Agonists in PCOS Weight Management Simulator

Obesity, Anovulation & Hyperandrogenism in PCOS

Excess weight drives insulin resistance and androgen excess in PCOS.

• ~10%: Women with PCOS (of reproductive age)
• ~60–80%: Obesity overlap (of PCOS patients)
• 0–4/yr: Ovulatory cycles (typical anovulation)
• ↑1.5–2×: Free testosterone (vs normal range)

Why weight and ovulation are linked

Adipose tissue drives insulin resistance, which raises ovarian androgens.

Hyperinsulinemia feeds the ovary

Excess insulin amplifies LH-driven theca-cell androgen output.

The anovulation cycle

High androgens block follicle maturation, halting ovulation.

GLP-1 Agonist Start — Appetite Suppression Begins

Semaglutide and liraglutide slow gastric emptying and blunt hunger signals.

• GLP-1 RA: Drug class (sema / lira)
• 2–4 wks: Weight loss onset (first measurable drop)
• ↓ 20–30%: Caloric intake (reported average)
• 4–8 wks: Dose titration (to target dose)

Central appetite signaling

GLP-1 receptors in the hypothalamus dampen hunger drive.

Gastric emptying slows

Delayed stomach emptying prolongs fullness after meals.

Early metabolic shift

Modest early weight loss starts improving glucose handling.

5–10% Body Weight Reduction Over Months

Sustained weight loss meaningfully lowers visceral and ovarian fat signaling.

• 5–10%: Target loss (clinically meaningful)
• 3–6 mo: Time to target (typical trajectory)
• ↓ ~20%: Visceral fat drop (disproportionate loss)
• ↓ 4–8 cm: Waist circumference (average reduction)

Visceral fat falls first

Metabolically active visceral fat shrinks faster than subcutaneous.

Adipokine profile shifts

Falling leptin and rising adiponectin ease insulin resistance.

A threshold effect

Reproductive benefits accelerate past ~5% total loss.

Insulin Sensitivity Improves as Adiposity Falls

Reduced fat mass lowers circulating insulin, easing pressure on the ovary.

• ↓ 30–50%: HOMA-IR (typical improvement)
• ↓ significantly: Fasting insulin (vs baseline)
• ↑ rises: SHBG (binds free testosterone)
• improved: Glucose tolerance (OGTT normalizes)

Hyperinsulinemia recedes

Lower insulin reduces theca-cell androgen overproduction.

SHBG rebounds

Liver makes more SHBG, binding up free testosterone.

A virtuous cycle begins

Better insulin sensitivity further supports weight loss.

Ovulatory Cycles Restored, Androgens Normalize

Lower insulin and androgens let follicles mature and ovulation resume.

• 8–12/yr: Ovulatory cycles (from 0–4 at baseline)
• normalized: Free testosterone (within reference range)
• ↑ increases: Spontaneous pregnancy (reported in cohorts)
• restored: Menstrual regularity (in majority responders)

Follicle maturation resumes

Normalized hormones let a dominant follicle develop fully.

Regular cycles return

Monthly ovulation replaces sporadic, unpredictable cycles.

Durability depends on maintenance

Benefits persist only while weight loss is sustained.