Hello everyone,
Today I bring you Angela Grassi | PCOS, Honestly , a Registered Dietitian Nutritionist (RDN) and founder and CEO of the PCOS Nutrition Center.
Angela recently shared that she has been taking GLP-1s to help her PCOS and perimenopause symptoms, and I couldn’t pass on the opportunity to chat about these medications with a dietitian who has been working in this space for over 26 years.
This conversation is for those who have heard about GLP-1 medications and aren’t sure what to make of them, whether they’re curious or quietly wondering if they might be an option.
GLP-1 medications are everywhere right now, and women with PCOS are increasingly taking them or thinking about them. This conversation cuts through the noise and gets into what these medications actually do, who they might help, what the risks are, and where the research still needs to catch up.
PS: Angela takes them herself, and her experience was not what she expected.
We cover:
What GLP-1 medications are and how they work
How they apply specifically to PMOS
Angela’s personal experience taking them
Nutrient deficiencies and muscle loss, the risks we aren’t talking about enough
The stigma around taking them (and the stigma around weight)
The connection between body image, eating disorders, and GLP-1s
What the future of GLP-1s in PMOS might look like
This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.
If you want to see some of the snippets from these conversations on Instagram, give us a follow:
What are GLP-1 medications and how do they work?
GLP-1 medications mimic a signalling hormone called GLP-1, which does two main things: it slows down how quickly food moves through your digestive system, and in doing so, it slows the release of glucose into the bloodstream. This makes you less hungry and as a result you eat less. They were originally developed for type 2 diabetes because of how effectively they lower blood glucose levels. From there, researchers started to notice broader metabolic benefits, and their use in women with PMOS has risen sevenfold since 2021.
They are not currently approved specifically for PMOS, which means most women taking them for that reason are paying out of pocket.
I have an article on how they work that goes into more depth if you are interested:
What can GLP-1s actually do for PMOS?
Beyond blood glucose, there is emerging evidence that GLP-1 medications can help with several things that are directly relevant to PMOS: lowering cholesterol, reducing blood pressure, decreasing inflammation, and even improving sleep apnea. Sleep apnea is more common in PMOS than many people realise, and it appears linked to elevated androgens rather than weight alone.
There is also a small amount of evidence suggesting improvements in cycle regularity and androgen levels, the kind of knock-on effects you would expect if insulin resistance is being addressed at the root. Lower insulin tends to mean lower androgens, which can mean fewer symptoms across the board. The studies are still small and we need more, but the mechanism makes sense.
Angela’s view is clear: GLP-1s could become a genuine treatment tool for PMOS. The research just needs to catch up.
Angela’s personal experience, and why it matters
Angela was initially against GLP-1 medications. Her background is in treating eating disorders, and her work is rooted in weight-neutral, health-centred care. She changed her mind after seeing the results in her own clients, including reduced food noise, less binge eating, lower inflammation, and a real improvement in how they felt day to day.
She decided to try one herself as she entered perimenopause and began gaining weight unexpectedly. Her experience? She did not lose significant weight. Around 15% of people lose less than 5% of their total body weight on these medications, and she appears to be in that group.
What she did notice was an improvement in her autoimmune condition, likely through reduced inflammation. But the side effects have been significant, particularly gastrointestinal, and she has developed an iron deficiency serious enough to require iron infusions.
She shared this publicly for the first time recently. I think it is worth saying out loud: here is someone who has spent decades understanding nutrition and PMOS, who has all the knowledge, and whose body still needed additional support. That is not a personal failing. That is biology.
The nutrient deficiency conversation we need to have
This is the part of the GLP-1 conversation that Angela feels is not getting enough attention. Women with PMOS are already more likely to be deficient in vitamin D, iron, magnesium and B12. Adding a medication that reduces appetite, and therefore food intake, without proper monitoring could compound those deficiencies significantly.
Angela’s recommendation is to get full blood work done before starting a GLP-1: iron status, vitamin D, and other key markers. And then to work with a PMOS-informed dietitian who can help you optimise your nutrition around the medication rather than just hoping for the best.
On muscle loss: Angela lifts weights at least twice a week and has not experienced significant muscle changes herself. But she is clear that prioritising strength training and adequate protein intake while on these medications is essential, especially because GI side effects can suppress appetite in ways that make it genuinely hard to eat enough.
The body image problem hiding inside the GLP-1 conversation
GLP-1 medications arrived just as the body positivity movement was gaining ground, and in Angela’s words, the culture “slid right back.” They are known as weight loss drugs, even though that was never their primary purpose. Celebrities have used them to become thinner. Thin people are taking them to become even thinner. And women with PMOS, who already have higher rates of eating disorders, are caught in the middle.
What should be a metabolic treatment tool has become tangled up in everything our culture projects onto women’s bodies. The number on the scale becomes the measure of whether the medication is “working.” People receive compliments for losing weight and their self-worth becomes tied to whether that continues. Angela has seen this play out in her clinical work and felt it herself.
The quality of life data is startling: research has shown that the quality of life impact of PMOS, much of it related to weight and how women are treated because of it, is comparable to that of cancer patients.
What should you do if you are considering GLP-1s?
Angela’s advice is to go in with an open mind and with realistic expectations. Not everyone will have a dramatic response. Some people will see significant weight loss. Others, like Angela, will see different benefits entirely. Neither experience is wrong.
Her practical checklist:
Get your labs done first, including vitamin D, iron, and other key nutrients
Work with a PMOS-informed dietitian to support your nutrition throughout
Start on a low dose and increase slowly
Prioritise protein and strength training to protect muscle mass
Keep your expectations anchored to health markers, not the scale
And if you decide not to take them, that is equally valid. These are tools, not mandates.
See you next Sunday,
Francesca
Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.
