A LARGE Danish study has revealed that hormonal contraception use is associated with subsequent initiation of GLP-1 receptor agonists, particularly among women with a history of using multiple contraceptive types, raising new questions about weight management in women.
Use of semaglutide, a GLP-1 receptor agonist, has increased substantially among women of reproductive age, yet its association with hormonal contraception use had remained unexplored.
Researchers conducted a nested case-control study using Danish health registers to identify all females aged 12 to 49 years between January 1996 and December 2023. Semaglutide users were females who filled their first semaglutide prescription with no prior use of glucose-lowering drugs, with the index date set as the date of first fill. Each user was matched by birth year to 10 nonuser controls with no prior glucose-lowering drug use. Hormonal contraception use was summarised by the chronological order of contraceptive prescriptions filled from age 12, or study entry, until the index date.
A total of 22,694 cases and 229,640 matched controls (249,634 participants; median age 37 years, IQR 30 to 44) were included. All hormonal contraception utilisation patterns were associated with semaglutide initiation compared with nonuser controls. Among patterns involving a single contraceptive type, adjusted hazard ratios ranged from 1.42 (95% CI, 1.34 to 1.51) for combined oral tablets to 1.63 (95% CI, 1.46 to 1.82) for progestin-only intrauterine devices. For patterns involving two or more contraceptive types, adjusted hazard ratios ranged from 1.64 (95% CI, 1.47 to 1.82) for combined oral tablets followed by progestin-only oral tablets to 2.11 (95% CI, 1.97 to 2.25) for other patterns. Adjustment for body mass index attenuated but did not eliminate the associations, and subgroup analyses by age, education, income, parity, immigrant status, and semaglutide type showed consistent associations across most patterns.
These findings have highlighted that hormonal contraception use is associated with subsequent semaglutide initiation across all utilisation patterns studied. As this was an observational case-control study, causality cannot be established. The authors have called for further research into the factors driving pharmacologic weight management in women.
Reference
Bager MD et al. Hormonal contraception and initiation of semaglutide therapy. JAMA Netw Open. 2026;9(7):e2624382.
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