The conversation that should happen on day one
For years, advice about GLP-1s and pregnancy was improvised — extrapolated from package inserts and general caution. In late July, an international group finally published consensus guidance covering contraception, trying to conceive, pregnancy, breastfeeding and after. Here is what it says, and what it openly admits nobody knows yet.
Before anything else
Guidance written for clinicians is not a set of instructions for you. It is a description of what good counselling looks like, which is useful mostly as a standard to hold your own care against. Do not start, stop, or change anything on the strength of a journal post — including this one.
On 29 July, a multidisciplinary group of experts across 23 institutions in Europe, North America and the Middle East published a systematic scoping review and consensus guideline in Obesity Reviews. It is, as far as we can tell, the first comprehensive clinical guidance on incretin-based medications — GLP-1s and their relatives — across the whole reproductive lifespan.
Thirty-four studies went into it: randomised trials, observational work, pharmacovigilance analyses, case reports. The output is a set of citable practice statements covering contraception, preconception care, pregnancy, breastfeeding and postpartum.
We have written about pieces of this before — most directly in The warning nobody reads aloud, about how a GLP-1 can change the way oral contraception works and restore a fertility nobody flagged. That post was assembled from prescribing information and scattered evidence, because that was all there was. Now there is something better.
What it says
Four things stand out to us.
Contraception is a day-one conversation, not a footnote. The clinicians commenting on the guidance were blunt about this: contraception counselling belongs at initiation and at every dose escalation, as routine, not something a patient has to raise herself. Gastrointestinal side effects can affect how oral contraception is absorbed, and weight loss itself can restore fertility faster than either patient or prescriber expects.
These medications should not be deliberately continued through pregnancy. That is the clearest statement in the document. It is not new advice in spirit, but it is now written down with an evidence review behind it rather than inferred from a manufacturer's caution.
If you conceived unexpectedly while taking one, the current data are reassuring. The review did not identify an increased risk of major congenital anomalies following inadvertent exposure in early pregnancy. Several of the pharmacists quoted on the guidance called this the single most useful part of it — because it means a frightened woman can be given a real answer at the appointment instead of spending three weeks in limbo waiting for a specialist.
Breastfeeding is case-by-case, because the evidence isn't there. The guidance declines to give a blanket answer, which we read as honesty rather than evasion.
There is also a note specific to this site's readers: the authors found that incretin-based medications may improve fertility-related outcomes in women with PMOS (PCOS) and obesity before pregnancy. May. Before. Both words are doing work.
Nearly half of the clinically important questions in this area remain unanswered. The authors say so themselves.
What it doesn't say
That last line is the one we would tattoo on the field. This is a consensus guideline that begins by counting how much it cannot tell you: long-term outcomes for mothers and children, exposure later in pregnancy, breastfeeding, the optimal timing to restart afterwards. A guideline that lists its own gaps at that scale is being straight with you, and we would rather have it than a confident document built on less.
One of the commenting clinicians put it in a way we keep repeating to each other: it won't change what gets prescribed, but it should change how women are counselled. The realistic gain is consistency — a reference point for the conversations that currently happen unevenly, or not at all.
What this means for choosing a provider
This is where a consensus document becomes a practical filter.
If you are a woman of reproductive age starting a GLP-1 through a telehealth platform, there is now a published international standard for the conversation you should be having. Did anyone ask about your contraception at intake? Did anyone mention it again when your dose went up? If you said you were hoping to conceive in the next year, did that change anything about the plan, or did the plan carry on unchanged?
The guidance also recommends that women of reproductive age on these medications be supported by a multidisciplinary team including a registered dietitian — which is a quiet indictment of the single-questionnaire, ship-the-vial model, and one reason clinical depth carries the weight it does in our Care Standard.
None of this makes a fast, cheap platform illegitimate. It does mean that if you might become pregnant, the cheapest option and the appropriate option are less likely to be the same thing, and it is worth knowing which one you are buying.
If you want to ask about it
What contraception do you recommend while I'm on this, and will we revisit it at every dose increase? If I want to try to conceive, how far in advance should I stop, and what's the plan for the gap? If I conceive unexpectedly, what do I do in the first 48 hours — who do I call? And if I'm breastfeeding, what's your reasoning, given that the evidence is thin?
A provider who has read this guidance will recognise every one of those questions. That, in itself, tells you something.
The honest disclaimer. This is general information from the women who write Selene — not medical advice, not a recommendation, and not a prediction about your results. Consensus guidance is written for clinicians and is not a substitute for a conversation with yours. No GLP-1 is FDA-approved specifically for PMOS (PCOS), and GLP-1 medications are not a treatment for endometriosis. Selene is editorial: we do not prescribe, sell, or dispense anything.
Sources. Maslin K, Shawe J, Blowers S, et al., "Incretin-based medications in women and reproduction: a systematic scoping review and consensus guidelines for clinical practice," Obesity Reviews, published 29 July 2026, doi:10.1111/obr.70203; The Pharmaceutical Journal, 4 August 2026; Marshall University Joan C. Edwards School of Medicine announcement, August 2026.