I have really bad endometriosis. It causes me extreme pain that keeps me up at night and impacts my ability to do day-to-day tasks. I can’t take hormonal treatments for it. I’ve tried various hormones in the past (birth control and otherwise), and they really affect my mood terribly. I’m also terrified of surgery because of previous bad surgical experiences. I’m desperate to find an alternative. I have read a little bit about people using GLP-1 medications to treat endometriosis with very positive results. I am on the upper end of normal BMI, so I’m not a candidate for a GLP-1 based on weight. Might a GLP-1 agonist be an option for me?
—Anonymous
In the past several years, research into using GLP-1 agonists to treat diseases other than diabetes and obesity has exploded. As more patients take medications like Ozempic, Wegovy, and Mounjaro, doctors have more opportunities to notice unexpected effects of these medications. As a result, there are many early studies popping up in the literature using GLP-1 agonists such as semaglutide to treat alcohol addiction, infertility, and various types of cancer.
The key with many of these possible uses of GLP-1 agonists is that they seem to reduce inflammation throughout the body. Endometriosis is associated with inflammation, and reducing that inflammation may in turn reduce the pain that many women experience from endometriosis. In a recent study, researchers found that GLP-1 was one of a number of proteins that were decreased in the fluid that surrounds the organs in the abdomen. They also found that a protein made by cells that cleans up inflammation was increased compared to women without endometriosis.
The best data we have regarding the effects of GLP-1 agonists on endometrial cells is actually related to endometrial cancer. A recent study found that in endometrial cancers grown in a lab, GLP-1 agonists decrease the cells’ viability — that is, their ability to grow and divide.
However, at this point we do not have any data from women with endometriosis who have been treated with GLP-1 agonists. A study that randomizes women with endometriosis to receive a GLP-1 agonist or a placebo would tell us if GLP-1 agonists are effective for treating endometriosis. This step is important not only to be sure we are using effective treatments, but also because these medications are very expensive, and a trial that shows a medication is effective increases the likelihood that insurance companies will cover the cost of it for patients with endometriosis. Currently most insurance companies cover GLP-1 agonists only for patients with Type 2 diabetes, and overweight and obesity.
The takeaway: There are many diseases, including endometriosis, for which GLP-1 agonists may prove to be an effective treatment, but there isn’t enough evidence at this time to say they are effective for endometriosis.
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