Semaglutide side effects in women: How they differ and how to manage them

Semaglutide has become one of the most talked-about GLP-1 medications of the past few years, as the active ingredient in Ozempic^®. Ozempic^® was approved for type 2 diabetes treatment first and is now regularly prescribed off-label for weight loss. It is also in the FDA-approved weight loss medication Wegovy^® and in pill form as Rybelsus^®, a drug approved to treat type 2 diabetes. 

One of the biggest topics of conversation is whether men and women experience semaglutide differently. Clinical data says yes, they do. From how much weight is lost to the side effects felt while taking it, sex can play a big role in your experience with GLP-1 medication.

Official guidelines don’t currently break down semaglutide side effects by sex, but growing evidence suggests that biological differences may influence how people respond to GLP-1 medications like semaglutide. 

For women, semaglutide can come with unique challenges, like more frequent gastrointestinal symptoms and changes in menstrual cycles. But there are upsides, too. Some research suggests women may experience greater weight loss than men on semaglutide, and may also benefit from improved insulin sensitivity and cardiometabolic health, and possibly increased fertility.

We’ll walk you through what women commonly report, what might be behind those differences, and how to manage unique side effects.

How semaglutide affects you and why it causes side effects 

Semaglutide mimics a naturally occurring hormone in your body, called GLP-1. This hormone is released when you eat and exercise and serves to regulate appetite, blood sugar, and slow digestion. Because of these effects, semaglutide can help people lose weight and help with blood sugar control. 

But these actions can also bring on side effects, especially when you first start the medication or your dose is increased. The most common side effects reported by people taking semaglutide are nausea, vomiting, diarrhea, constipation, abdominal pain, and headache. 

Slower digestion can cause you to feel nauseous, or have diarrhea or constipation as your system adjusts. Your blood sugar and energy levels also shift, which can lead to headaches and fatigue. Most of these improve over time as your body gets used to the medication.

And, all semaglutide medications are started at a low dose and increased gradually to minimize side effects. 

Do women experience stronger side effects with semaglutide?

Growing research suggests that women may be more likely to experience certain side effects more strongly than men—especially when it comes to digestive issues.

• Stronger gastrointestinal side effects: A study found that women not only lost more weight on GLP-1 medications but also reported more stomach-related side effects, including nausea and vomiting. This may be due to differences in hormones, body composition, and digestive function.
• Slower digestion: Another study found that semaglutide significantly delayed stomach emptying in women—by as much as four hours—compared to men. While this may enhance feelings of fullness, it can also lead to bloating and nausea.
• Higher drug concentration and estrogen sensitivity: These sex-based differences may be due to higher drug levels in smaller bodies and how estrogen interacts with GLP-1 signaling, which could heighten sensitivity to side effects.
  

These findings suggest that it may be beneficial for women to stay on a lower dose for a bit longer, allowing the body time to adjust to minimize side effects.

Do women lose more weight with semaglutide?

Across several major clinical trials, women consistently lost more weight than men while taking semaglutide. In one study, women lost an average of 14% of their body weight, while men lost around 8%. Another study showed an even bigger difference: 16% average weight loss for women, compared to 9% for men.

While the exact reasons aren’t clear, researchers point to things like body weight, side effect sensitivity, and hormonal factors. But regardless of the why, the pattern holds: sex seems to play a role in how semaglutide affects weight loss.

Other things women report while taking semaglutide

Some changes in women may stem from hormone shifts and metabolism differences caused by rapid weight loss itself.

• Cycle changes: A study of women with PCOS found that after six months of semaglutide treatment, almost 80% regained regular menstrual cycles, suggesting the medication’s weight loss and insulin effects can restore hormonal balance.
• Fertility surprises: There have been reports of unplanned pregnancies after starting semaglutide, especially among women with PCOS or irregular cycles. Weight loss can help restore ovulation, so it’s a good time to revisit birth control if you’re not planning to conceive. And be sure to stop semaglutide at least two months before trying to conceive.
• Losing hair: In one analysis, women were twice as likely to report hair thinning or loss while taking a semaglutide medication. 
• Facial volume loss (“Ozempic face”): Some women notice a more gaunt facial appearance as they lose weight. Staying hydrated and aiming for slower, steady progress (1 to 2 pounds per week) may help preserve skin elasticity.
• Shifts in sex drive: A few women report changes in libido or sexual sensation. These may relate to hormone fluctuations or emotional changes, and often even out as the body adjusts.

Severe side effects and warnings

Semaglutide is considered safe for most people, but it’s still important to know the rare side effects that require prompt medical attention. These potential complications apply to anyone taking semaglutide, whether for diabetes or weight management.

Here are a few severe conditions that require immediate medical attention:

• Pancreatitis: Ongoing stomach pain that spreads to your back, especially with nausea or vomiting, could signal pancreatitis. Stop the medication and get medical care right away.
• Gallbladder issues: Pain in the upper right abdomen, fever, nausea, or yellowing of the skin or eyes may point to gallstones or gallbladder inflammation.
• Kidney problems: Vomiting or diarrhea can lead to dehydration, which may strain your kidneys. Look out for fatigue, swelling, or less frequent urination.
• Severe allergic reactions: Though rare, symptoms like facial swelling, trouble breathing, or a full-body rash need emergency attention.
• Low blood sugar (hypoglycemia): This reaction is more likely if you’re also taking insulin or sulfonylureas for type 2 diabetes. Signs of hypoglycemia include shakiness, sweating, confusion, or fainting.
• Thyroid tumors: Semaglutide carries an FDA boxed warning about a possible risk of thyroid C-cell tumors found in animal studies. It’s unclear if this applies to humans.

If something doesn’t feel right, don’t wait it out. Reach out to a healthcare provider.

Who shouldn’t take semaglutide?

Semaglutide isn’t right for everyone. Certain health conditions and risk factors may make this medication unsafe.

You should not take semaglutide if:

• You or a family member has a history of medullary thyroid carcinoma (MTC) or MEN 2.
• You have a known allergy to semaglutide or any of its ingredients.

Your doctor will decide if semaglutide is right for you if you have a history of:

• Pancreatitis.
• Serious digestive issues like gastroparesis, since semaglutide slows stomach emptying and may worsen symptoms.

You should also not take semaglutide if you are pregnant or breastfeeding.

Always talk with your healthcare provider about your medical history before starting semaglutide. They can help you decide if it’s the right option based on your needs and goals.

For more information, visit the safety pages for Wegovy^®, Ozempic^®, and Rybelsus^®.

Frequently asked questions about fertility and semaglutide 

If you’re thinking about getting pregnant, understanding how semaglutide fits into your reproductive health plans is important. From conception to breastfeeding, here are some questions women ask about this medication.

Is semaglutide safe to take while pregnant?

No. It’s not safe during pregnancy. You’ll need to stop semaglutide at least two months before trying to conceive so it has time to fully clear from your system.

Will semaglutide impact my fertility?

Not directly, based on current research. What we do know is that it can help regulate hormones and ovulation, especially in people with conditions like PCOS. Still, the medication itself hasn’t been shown to boost or reduce fertility rates.

Can I keep using semaglutide while breastfeeding?

No. While data in humans is lacking, studies in animals show that semaglutide passes into breast milk in small amounts. Until we know more, you shouldn’t use it while nursing.

Does semaglutide interfere with birth control?

Probably not. Research shows that semaglutide does not change the absorption or effectiveness of common oral contraceptives. If you’re using them, there’s no need to make changes unless advised by your provider.

Managing side effects: Strategies for women

Semaglutide works by altering appetite, digestion, and blood sugar response—but those same mechanisms can also trigger side effects. For women, hormonal cycles, slower gastric emptying, and shifts in nutrient intake during weight loss can make some symptoms more noticeable. Most are manageable. Here’s how to handle the most common ones:

Side effect	Who it affects	Management tips
Nausea	Common in both sexes, but tends to be more intense for women	Stick to light, bland meals. Avoid greasy or spicy food, and sit upright after eating.
Constipation	More often reported by women	Boost water and fiber gradually. A gentle laxative or magnesium may also help.
Diarrhea	Affects men and women, especially in the early stages	Rehydrate with electrolyte-rich fluids and stick to low-fat, low-fiber meals.
Fatigue	May occur more frequently in women	Make sure you’re getting enough calories, protein, and rest. Watch for low blood sugar.
Dyspepsia	Seen in both sexes	Eat smaller portions, stay upright after meals, and ask about antacids if needed.
Bloating	Especially common in women with sensitive digestion	Cut back on carbonated drinks and eat slowly to reduce swallowed air.

Managing other possible side effects:

Beyond the standard side effects, some people report additional issues that may be linked to semaglutide or rapid weight loss. Here’s how to monitor and address these:

Side effect	Who it affects	Management tips
Hair loss	Often noted by women during periods of rapid weight loss	Prioritize protein-rich foods and talk to your provider about whether you need supplements.
Period changes	Common in reports from women	Track your cycles and consult your OB-GYN if irregularities persist.
Gaunt face	Can be seen in both sexes	Stay hydrated, support skin health with nutrition, and aim for gradual weight loss (1 to 2 pounds per week)..
Mood shifts or anxiety	May feel stronger for women due to hormone fluctuations	Keep a consistent sleep routine, manage stress, and seek support when necessary.

When to contact your provider

• If symptoms continue beyond a few weeks or interfere with daily life
• If your cycle, mood, or energy level changes in unexpected ways
• If you’re unsure whether a symptom is from semaglutide or something else

Your provider can offer tailored guidance and help adjust your treatment plan so you feel supported every step of the way.

Semaglutide side effects in women: Navigating the differences

Semaglutide medications like Ozempic®, Wegovy®, and Rybelsus® can help people lose weight and manage blood sugar, but they don’t affect everyone the same way. Women may be more likely to experience stronger side effects like nausea, bloating, or even changes in their menstrual cycle.

Staying at a lower dose for longer, keeping track of how you feel, and making changes to your diet and routine can all help. These steps give your body time to adjust and can make side effects easier to manage.

If you want more personalized support, see if you qualify for Noom Med. You’ll be connected with a clinician who can assess your needs, find the right medication for you, and prescribe it if needed. You’ll also get on-demand support and tools to help you build the plan that works best for your body and goals.

Note: Ozempic^® and Rybelsus^® are not FDA-approved for treating obesity or weight loss.