Perhaps you’re considering glucagon-like peptide-1 (GLP-1) treatment for blood sugar control or weight loss. But if you’re using birth control, it's important to know potential medication interactions. 

While not all GLP-1s interact with birth control pills, several of the most popular treatment options can reduce the pill’s effectiveness. Here’s what you need to know about GLP-1s and birth control, including the non-oral contraceptive methods that can help you avoid this issue entirely. 

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Do GLP-1 medications affect how well birth control pills work?

Yes, GLP-1s can make birth control pills less effective. But whether or not this will happen depends on the medication. 

GLP-1 treatments mimic GLP-1, a natural hormone that your gut produces. Among other things, GLP-1s slow how long it takes for your stomach to empty. This is called delayed gastric emptying. 

Birth control pills prevent ovulation. They supply a steady level of synthetic hormones that tell your ovaries not to release an egg. 

Delayed gastric emptying can interfere with oral birth control. When your stomach empties more slowly, oral medications take longer to reach the intestines, where the body absorbs them. This delay can lower the level of contraceptive hormones in your bloodstream enough to trigger ovulation.

Each GLP-1 medication slows stomach emptying to a different degree. Studies have tested several of the most common GLP-1 drugs, including semaglutide, dulaglutide, and liraglutide. Results show that the majority don’t lower contraceptive pill absorption enough to impact its effectiveness. This means someone taking Wegovy® or Ozempic® and birth control pills may not need to switch contraceptive methods. 

The main exceptions are Mounjaro® and Zepbound® (tirzepatide) and Foundayo® (orforglipron). Both Mounjaro® and Zepbound®’s medicine labels say people on oral birth control should use barrier methods for four weeks after starting the GLP-1s and four weeks after every dose increase. Switching to a non-oral contraceptive is also an option. 

Foundayo®’s label is similar. It recommends women use alternative contraceptive methods for 30 days after their initial dose and after every dose increase.

Can GLP-1 side effects impact how well oral birth control works?

Vomiting and severe diarrhea are common side effects of all GLP-1 RAs. Since both symptoms can expel birth control before the body has had a chance to absorb it, they might impact birth control pills’ efficacy. 

If you vomit or have diarrhea within three hours of taking a pill, the Centers for Disease Control and Prevention (CDC) recommends that you treat it as a missed dose and take another as soon as you can keep it down. If your symptoms last 48 hours or longer, it’s wise to use backup contraception until you’ve taken your pill for seven consecutive days without incident.

How does tirzepatide affect birth control pills?

In one study, a single 5 mg dose of tirzepatide lowered the peak levels of contraceptive pill hormones in women’s blood by 55–66%, and the total amount absorbed by roughly 20%.

Because of these findings, tirzepatide medicines, such as Mounjaro® and Zepbound®, instruct women who wish to avoid pregnancy to consider a non-oral birth control method instead. This includes an implant, a vaginal ring, or condoms. They should keep using non-oral contraception methods for four weeks after starting tirzepatide, and again after each dose increase.

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What birth control can you use while taking a GLP-1?

The simplest way to avoid disruption to your birth control is to rely on a non-oral contraceptive method rather than the pill.

These non-oral methods bypass the stomach while still providing steady contraceptive hormone levels that prevent ovulation: 

• Hormonal intrauterine devices (IUDs): For treatments like Mirena® and Kyleena®, a healthcare provider places a device in the uterus that releases synthetic progesterone directly.
• Implants: Nexplanon® is a small rod your healthcare provider implants under the skin of your arm. There, it releases synthetic progesterone directly into your bloodstream.
• Injections: Depo-Provera® delivers synthetic progesterone through a shot every three months.
• Vaginal rings: Placed inside the vagina, NuvaRing® and Annovera® deliver estrogen and synthetic progesterone through the vaginal lining.

Note: While contraceptive patches like Xulane® and Twirla® also don’t pass through the digestive tract, they can cause issues in people with a BMI of 30 or above. Patches deliver higher estrogen levels than pills, and studies have found that patch users face 1.2 to 2.2 times the blood clot risks of pill users, with obesity tripling that risk. 

Several non-oral methods prevent pregnancy without the use of hormones, such as:

• Copper IUDs: Rather than using hormones, Paragard® and Miudella® release copper into the uterus. This creates an environment that’s toxic to sperm.
• Condoms: Male and female condoms create a physical barrier that prevents sperm from reaching the egg.

Remember, your healthcare provider can help you choose the best birth control method for you based on your health history, preferences, and which GLP-1 you take.

Can GLP-1 medications affect fertility or pregnancy?

If you’re planning a pregnancy, work with your healthcare provider to pause your GLP-1 treatment ahead of time. Semaglutide (Ozempic®, Wegovy®) takes up to five weeks to clear from your body, and FDA labels recommend stopping treatment at least two months before conception. Most other GLP-1 medication labels don’t specify a time window. However, the American Diabetes Association (ADA) and the Endocrine Society advise stopping any GLP-1 treatment at least two months before attempting to conceive.

It’s also important to be aware that GLP-1 medications can also make pregnancy more likely. Excess weight increases insulin levels, and high insulin can make the ovaries produce too much testosterone, disrupting ovulation. This pattern is particularly common for women with Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly PCOS). Weight loss—with or without the help of a GLP-1 RA—can disrupt this cycle and restart ovulation. Though GLP-1 RAs and fertility are linked, keep in mind that GLP-1 medications aren’t fertility treatments.

If you do become pregnant, most doctors and GLP-1 RA labels recommend you stop treatment. There are two main reasons: 

• Doctors generally advise not trying to lose weight during pregnancy. Weight loss won’t reduce the potential for complications. It could also mean your baby won’t receive adequate nutrition. 
• Some animal studies associate GLP-1 RA use with low fetal weight and birth defects. But mothers in these trials ate less and lost weight themselves. It’s difficult to determine whether the medication or maternal behaviors affected fetuses. In addition, these results don’t necessarily apply to humans.

Because the animal studies aren’t conclusive, researchers are looking into GLP-1 RAs’ effects on pregnant people. One review analyzed whether exposure during the first trimester caused major birth defects. It compared 168 pregnant women on GLP-1 RAs to 156 with diabetes and 163 with obesity or overweight. Findings were reassuring; early exposure to GLP-1 RAs weren’t associated with birth defects when evaluated against the two other groups. But the researchers acknowledged that the cohort was small. They’ve called for larger studies to back up these findings.

Be sure to raise any family planning and contraception concerns with your care team before starting any GLP-1 treatment. If you become pregnant while taking a GLP-1 RA, contact your healthcare provider right away.

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What should you do if you take birth control and a GLP-1 RA?

If you’re already on a birth control pill and are considering GLP-1 treatment, make sure to speak to your clinician. This conversation is especially important when:

• You’re starting or increasing tirzepatide or orforglipron: Choose non-oral or barrier contraceptive methods before your first dose and after any dose change.
• You’re experiencing vomiting or severe diarrhea: Treat any episode within three hours of taking your pill as a missed dose, and use backup contraception if symptoms last 48 hours or longer.
• You're switching contraceptive methods: Make sure the new method is active before you stop the old one so there are no gaps in your contraceptive coverage.
• You’re planning a pregnancy: Work with your clinician to time your GLP-1 treatment discontinuation at least two months before conception.

Avoid stopping or switching GLP-1 and contraception medication without speaking to your clinical team. Changes to one can affect how the other works, and the consequences aren’t always obvious without careful medical monitoring.

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How Maven Clinic supports your GLP-1 and reproductive health journey

GLP-1 treatments and reproductive health shouldn’t be separate conversations. Maven Clinic’s GLP-1 Care connects you with clinicians who look at both together, from how your medication might affect birth control to whether you’re hoping to get pregnant down the road. 

They look at the full picture of your health, help you choose a contraception option that fits your family planning goals, and adjust your care as your needs change. 

Learn more here, and get started with Maven Clinic today.