Reproductive and Gynecologic Effects of Glucagon-Like Peptide-1 Receptor Agonists in Women With Polycystic Ovary Syndrome: A Scoping Review.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by metabolic dysfunction, hyperandrogenism, ovulatory dysfunction, and infertility. Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated efficacy in promoting weight loss and improving insulin resistance, their effects on reproductive and gynecologic outcomes in women with PCOS have not been comprehensively summarized. This scoping review aimed to evaluate the available evidence regarding the reproductive and gynecologic outcomes associated with GLP-1 RA therapy in women with PCOS. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Nursing & Allied Health Premium. Original studies evaluating GLP-1 RA therapy in women with PCOS and reporting reproductive or gynecologic outcomes were eligible for inclusion. Following duplicate removal, studies underwent title/abstract screening, full-text review, and standardized data extraction. Outcomes of interest included menstrual function, ovulation, fertility and pregnancy outcomes, hyperandrogenism, reproductive hormone profiles, ovarian function, and secondary metabolic outcomes. Twenty-eight studies met the inclusion criteria. Across the available literature, GLP-1 RA therapy was consistently associated with improvements in biochemical markers of hyperandrogenism, including reductions in total testosterone, free testosterone, free androgen index, and androstenedione, and increases in sex hormone-binding globulin. Improvements in menstrual regularity and reductions in amenorrhea were also frequently reported. Evidence regarding ovulation, fertility, and pregnancy outcomes was more limited but generally suggested improved ovulation rates and increased pregnancy rates in selected populations, particularly when GLP-1 RAs were combined with metformin. Nearly all included studies also demonstrated significant improvements in body weight, body mass index, and insulin resistance. Considerable heterogeneity in study design, interventions, and reported outcomes precluded quantitative synthesis. The overall findings suggest that GLP-1 RAs may provide reproductive and gynecologic benefits in women with PCOS in addition to their established metabolic effects. The most consistent improvements were observed in hyperandrogenism and menstrual function, whereas evidence supporting effects on fertility and pregnancy outcomes remains comparatively limited. Further high-quality prospective studies with standardized reproductive outcome measures are needed to better define the role of GLP-1 RAs in the management of PCOS.