Washout requirements, restored ovulation, OCP interaction, lactation, and post-partum considerations.
About this article
Washout before conception
- Semaglutide: stop ≥2 months before planned conception.
- Tirzepatide: stop ≥1 month before planned conception.
- Liraglutide: stop ≥1 week before planned conception.
Restored ovulation — the unexpected pregnancy risk
GLP-1 weight loss restores ovulation in many patients with weight-related anovulation (notably PCOS). Unexpected pregnancy is well documented. If pregnancy not desired, effective contraception is required.
Tirzepatide + OCP interaction
Tirzepatide label recommends backup contraception for 4 weeks at initiation AND after each dose escalation due to potential reduction in OCP absorption. Critical for women of reproductive age.
Pregnancy on GLP-1
Stop immediately, notify OB. Animal data suggest fetal harm. Human registry data is accumulating but inadequate to inform routine continuation.
Lactation
Limited data. Most guidance is to avoid initiation during lactation. Continuation during lactation is decided case-by-case with risk-benefit discussion.