The Future of PMOS Care: GLP-1 Therapy and Weight-Loss Caution

Welcome back to this Contemporary OB/GYN, Contemporary Pediatrics, and Patient Care Online Special Report series, exploring the global consensus on renaming polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome (PMOS). Across 5 episodes, our host and experts examine what this shift means for diagnosis, management, and patient care across the reproductive lifespan.

Early trial data show that injectable semaglutide can cut free testosterone by more than half in adolescents with polyendocrine metabolic ovarian syndrome (PMOS), but the same rapid weight loss came with a complication researchers didn't expect, said Melanie Cree, MD, PhD. Cree, whose preliminary findings from 8 adolescents with PMOS were published last month in Fertility and Sterility, said insurance still doesn't cover GLP-1 receptor agonists for PMOS specifically, even as demand for the medications grows.

Cree said semaglutide produces weight loss in about 75% of adolescents, though not everyone responds, and she remains an advocate for older options such as phentermine/topiramate for patients who need an alternative. Heather Appelbaum, MD, said the growing role of GLP-1 therapy in PMOS comes with real tradeoffs for menstrual function, bone health, and an adolescent population already at elevated risk for distorted body image.

In this episode, the expert panel discuss what her trial data revealed, and why they're urging caution about how fast weight loss should happen in teenagers.