Oct. 18, 2023 – For ladies who’re overweight, day by day life is wrought with landmines. Whether or not it’s the challenges of air journey as a result of aircraft 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 particular person 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 fingers on medication like semaglutide (Ozempic and Wegovy) or tirzepatide (Mounjaro). The advantages of those medication, that are a part of a brand new class referred to as GLP-1 receptor agonists, embrace vital 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 best long-term choice.
On the flip facet, the will for speedy weight reduction and higher blood sugar management additionally comes with an sudden price. Many ladies residing with weight problems who take oral contraceptives are unaware that these medication – particularly Mounjaro – can intervene with the absorption of contraception tablets and the way properly they work, making an unintended being pregnant extra probably.
Neel Shah, MD, an endocrinologist and affiliate professor on the College of Texas Well being Science Middle at Houston, stated he has had a number of sufferers change into pregnant with out meaning to.
“It was when Mounjaro got here out available on the market once we began utilizing it,” he stated of the drug the FDA permitted for kind 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 big enhance in so-called Mounjaro infants, Shah was certain in his response.
“Completely. We are going to as a result of the sheer quantity [of patients] will enhance,” he stated.
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 remains to be evolving, it’s believed that this course of – delayed gastric emptying – might have an effect on the absorption of contraception tablets.
Shah stated one other concept is that vomiting, which is a typical facet impact of these kind of medication, additionally impacts the tablets’ capacity to forestall being pregnant.
And “there’s a protracted interval of ramping up the dose due to the GI [gastrointestinal] unwanted side effects,” stated Pinar Kodaman, MD, PhD, a reproductive endocrinologist and assistant professor of gynecology on the Yale College of Drugs in New Haven, CT.
“Initially, on the lowest dose, there will not be lots of potential impact on absorption and gastric emptying. However because the dose goes up, it turns into extra frequent, and it could possibly trigger diarrhea, which is one other situation that may have an effect on the absorption of any treatment,” she stated.
Unanticipated Outcomes, Further Prevention
Roughly 42% of ladies 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 tablet effectiveness on its label. Sadly, it seems that some medical doctors are unaware or not counseling sufferers about this danger, and the info 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,” stated Kodaman. “It’s all pretty new, however when we’ve got sufferers on contraception tablets, we do evaluate different drugs 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 by way of the pores and skin – may carry comparable being pregnant dangers. Shah stated a few of his sufferers who grew to become pregnant with out meaning to have been utilizing these patches. This raises much more questions, since they ship medication by way of the pores and skin immediately into the bloodstream and never by way of the GI system.
What can ladies do to assist be certain that they don’t change into pregnant whereas utilizing these medication?
“I actually assume that if sufferers need to defend themselves from an unplanned being pregnant, that as quickly as they begin the GLP receptor agonists, it wouldn’t be a nasty concept to make use of condoms, as a result of the onset of motion is fairly fast,” stated Kodaman, noting additionally that “on the lowest dose, there will not be lots of potential impact on gastric emptying. However because the dose goes up, it turns into far more frequent or could cause diarrhea.”
Shah stated that in his observe, 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 medication physician and assistant professor of medication at Johns Hopkins College of Drugs in Baltimore, recommends that “sufferers simply guarantee that the injection and medicine 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 ought to be OK,” she stated.
Another choice is for ladies to talk to their medical doctors about different contraceptive choices like IUDs or implantable rods, the place gastric absorption is just not going to be a difficulty.
“There’s little or no analysis on this class of medicine,” stated 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 way in which that the world discriminates towards 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 stated. “I used to be keen to take the chance, realizing that I’d be on these medication for the remainder of my life.”
Along with being what Goodstein refers to as a guinea pig, she stated she made certain that her major care physician was conscious that she was not making an attempt or planning to change into pregnant once more. (She has a 3 year-old little one.) Nonetheless, her physician solely talked about the most typical unwanted side effects linked to those medication, like nausea, vomiting, and diarrhea, and didn’t point out the chance of being pregnant.
“Of us are actually not speaking in regards to the reproductive implications,” she stated, 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 staff may assist sufferers obtain the targets that they set out for themselves,” stated Shah.
Clear conversations are key.
