Oct. 18, 2023 – For ladies who’re overweight, every day life is wrought with landmines. Whether or not it’s the challenges of air journey as a result of airplane seats are too small, the necessity to protect themselves from the world’s discriminating eyes, or the nice lengths many will go to realize higher well being and the promise of longevity, navigating life as an overweight individual requires a thick pores and skin.
So, it’s no marvel so many are keen to pay greater than $1,000 a month out of pocket to get their palms on medication like semaglutide (Ozempic and Wegovy) or tirzepatide (Mounjaro). The advantages of those medication, that are a part of a brand new class known as GLP-1 receptor agonists, embody important and speedy weight reduction, blood sugar management, and improved life high quality; they’re unprecedented in a setting the place surgical procedure has lengthy been thought-about the simplest long-term choice.
On the flip aspect, the will for speedy weight reduction and higher blood sugar management additionally comes with an surprising price. Many ladies dwelling with weight problems who take oral contraceptives are unaware that these medication – particularly Mounjaro – can intervene with the absorption of contraception capsules and the way effectively they work, making an unintended being pregnant extra seemingly.
Neel Shah, MD, an endocrinologist and affiliate professor on the College of Texas Well being Science Heart at Houston, mentioned he has had a number of sufferers develop into pregnant with out desiring to.
“It was when Mounjaro got here out available on the market once we began utilizing it,” he mentioned of the drug the FDA accredited for sort 2 diabetes in 2022. “It [the warning] was within the product insert, however clinically talking, I don’t know if it was on the prime of suppliers’ minds after they have been prescribing Mounjaro.”
When requested if he believed that we have been going to be seeing a major enhance in so-called Mounjaro infants, Shah was certain in his response.
“Completely. We’ll as a result of the sheer quantity [of patients] will enhance,” he mentioned.
It’s All within the Intestine
One of many ways in which medication like Mounjaro work is by delaying the time that it takes for meals to maneuver from the abdomen to the small gut. Though knowledge continues to be evolving, it’s believed that this course of – delayed gastric emptying – might have an effect on the absorption of contraception capsules.
Shah mentioned one other idea is that vomiting, which is a typical aspect impact of these kind of medication, additionally impacts the capsules’ skill to stop being pregnant.
And “there’s a protracted interval of ramping up the dose due to the GI [gastrointestinal] unwanted effects,” mentioned Pinar Kodaman, MD, PhD, a reproductive endocrinologist and assistant professor of gynecology on the Yale Faculty of Drugs in New Haven, CT.
“Initially, on the lowest dose, there is probably not numerous potential impact on absorption and gastric emptying. However because the dose goes up, it turns into extra widespread, and it will possibly trigger diarrhea, which is one other situation that may have an effect on the absorption of any medicine,” she mentioned.
Unanticipated Outcomes, Further Prevention
Roughly 42% of girls within the U.S. are overweight, 40% of whom are between the ages of 20 and 39. Though these new medication can enhance fertility outcomes for ladies who’re overweight (particularly these with polycystic ovary syndrome, or PCOS), just one – Mounjaro – presently carries a warning about contraception capsule effectiveness on its label. Sadly, it seems that some medical doctors are unaware or not counseling sufferers about this danger, and the information is unclear about whether or not different medication on this class, like Ozempic and Wegovy, have the identical dangers.
“To this point, it hasn’t been a typical factor that we counsel about,” mentioned Kodaman. “It’s all pretty new, however when we’ve got sufferers on contraception capsules, we do overview different medicines that they’re on as a result of some can have an effect on efficacy, and it’s one thing to remember.”
It’s additionally unclear if different types of contraception – for instance, contraception patches that ship via the pores and skin – may carry related being pregnant dangers. Shah mentioned a few of his sufferers who grew to become pregnant with out desiring to have been utilizing these patches. This raises much more questions, since they ship medication via the pores and skin immediately into the bloodstream and never via the GI system.
What can ladies do to assist be sure that they don’t develop into pregnant whereas utilizing these medication?
“I actually suppose that if sufferers wish to defend themselves from an unplanned being pregnant, that as quickly as they begin the GLP receptor agonists, it wouldn’t be a nasty thought to make use of condoms, as a result of the onset of motion is fairly fast,” mentioned Kodaman, noting additionally that “on the lowest dose, there is probably not numerous potential impact on gastric emptying. However because the dose goes up, it turns into far more widespread or could cause diarrhea.”
Shah mentioned that in his apply, he’s “been telling sufferers so as to add barrier contraception” 4 weeks earlier than they begin their first dose “and at any dose adjustment.”
Zoobia Chaudhry, an weight problems drugs physician and assistant professor of drugs at Johns Hopkins Faculty of Drugs in Baltimore, recommends that “sufferers simply ensure that the injection and drugs that they take are no less than 1 hour aside.”
“More often than not, sufferers do take contraception earlier than bedtime, so if the 2 are spaced, it needs to be OK,” she mentioned.
Another choice is for ladies to talk to their medical doctors about different contraceptive choices like IUDs or implantable rods, the place gastric absorption shouldn’t be going to be a problem.
“There’s little or no analysis on this class of medication,” mentioned Emily Goodstein, a 40-year-old small-business proprietor in Washington, DC, who just lately switched from Ozempic to Mounjaro. “Being an individual who lives in a bigger physique is such a horrifying expertise due to the best way that the world discriminates in opposition to you.”
She appreciates the sensation of being proactive that these new medication grant. It has “opened up a bunch of alternatives for me to be seen as a full particular person by the medical institution,” she mentioned. “I used to be keen to take the danger, understanding that I might be on these medication for the remainder of my life.”
Along with being what Goodstein refers to as a guinea pig, she mentioned she made certain that her main care physician was conscious that she was not attempting or planning to develop into pregnant once more. (She has a 3 year-old baby.) Nonetheless, her physician solely talked about the commonest unwanted effects linked to those medication, like nausea, vomiting, and diarrhea, and didn’t point out the danger of being pregnant.
“Of us are actually not speaking in regards to the reproductive implications,” she mentioned, referring to members of a Fb group on these medication that she belongs to.
Like sufferers themselves, many medical doctors are simply starting to get their arms round these brokers. “Consciousness, schooling, supplier involvement, and having a multidisciplinary group may assist sufferers obtain the targets that they set out for themselves,” mentioned Shah.
Clear conversations are key.
