This gets cited here weekly, usually second-hand, so it is worth setting out what it does and does not establish.
The class is not used in pregnancy, and the practical points are a washout before conception and the fact that reduced appetite is not contraception. Improved insulin sensitivity in PCOS can restore ovulation, so fertility frequently increases as a side effect — people conceive unexpectedly on these drugs, which is a reason to sort contraception out at the start rather than after.
Where I think it is weakest: the subgroup findings are the part I trust least — with enough subgroups something is always significant, and these were not all pre-registered.
The question I want answered is what the washout thinking is before trying to conceive, and why nobody mentions that fertility often increases as a side effect. Not looking for reassurance. Looking for the part I have got wrong.
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
MeganSA_TX said:The class is not used in pregnancy, and the practical points are a washout before conception and the fact that reduced appetite is not contraception.
MeganSA_TX said:...everyone should be on fertility and pregnancy...
I understand the enthusiasm, but "everyone" is too broad. Contraindications exist: personal/family history of MTC or MEN2, history of pancreatitis, pregnancy/breastfeeding, and certain GI conditions.
Beyond contraindications, clinical judgment matters. A 22-year-old with BMI 28 and no comorbidities has a different risk-benefit calculation than a 55-year-old with BMI 38 and metabolic syndrome.
Let's advocate for ACCESS without advocating for UNIVERSAL use. They're different things.
MeganSA_TX said:The class is not used in pregnancy, and the practical points are a washout before conception and the fact that reduced appetite is not contraception.
I read this differently from MeganSA_TX, on substance rather than tone. I would resist the confidence. Half of what this board was certain about two years ago has since been quietly dropped, and nobody went back to correct the threads.
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View ResultsShort answer first, then the reasoning. It helps to ask what evidence would change your mind before you look at any. If nothing would, the discussion is not about evidence, and it is better to say so early than to spend nine posts discovering it.
kate.chem said:MeganSA_TX said: ...everyone should be on fertility and pregnancy...
Mine went the same way, slower. The detail I would add is minor and it is already implied above.