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Obesity Management During Reproductive Years
Clinical Queries: Expert Insights to Improve Obesity Management During Reproductive Years 

Released: January 20, 2026

Celia Egan
Celia Egan, MD, MSCP, DABOM
Kimberley Sampson-Paine
Kimberley Sampson-Paine, MD, MSc, FACOG, DipABLM, DipABOM, MSCP, FOMA
Samantha B. Schon
Samantha B. Schon, MD, MSTR
Activity Information

Activity

Progress
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Course Completed

Case Conclusion
Michelle initially asked you about weight management during her well woman visit. Her weight, BMI, and waist circumference were 199 lb (90 kg), 33.1 kg/m2, and 49 in (124 cm), respectively. She was diagnosed with PCOS in her teens and has metabolic syndrome, including hypertension, dyslipidemia, and elevated blood glucose. Michelle was recently married and wanted to reach 20% weight loss to improve her cardiometabolic health, regulate her menstrual cycle, and optimize her chances of conceiving in the next few years. She was hoping to achieve this goal through intensive lifestyle modifications alone. After discussing the likelihood of reaching this goal and the benefits of modest weight loss, you and Michelle decided that a target of 5% to 10% weight loss with lifestyle modifications would be a good start. After 6 months, Michelle lost 5% of her body weight and saw some health improvements, but she decided to continue treatment with an AOM. Michelle chose tirzepatide—an affordable option for her—and achieved a total 18% weight loss from baseline, as well as significant health benefits, over the next year. She discontinued tirzepatide 1 month before trying to conceive and focused on maintaining her weight with intensified lifestyle modifications to mitigate weight regain. Within 2 months, she and her partner conceived.

Discussion Summary
Identifying realistic goals is central to obesity management for women during their reproductive years and should be part of shared decision-making. Moderate weight loss (5%-10%) can meaningfully improve other comorbidities like hyperglycemia, hypertension, dyslipidemia, and PCOS. However, patients should not be discouraged from trying to lose more weight because greater weight loss can provide more substantial health benefits.1

Patients with obesity and weight-related comorbidities who are early in their reproductive years and flexible regarding the timing of their pregnancy have multiple interventions available to them. Lifestyle modifications should always be a key component of obesity management, but this approach generally leads to modest weight loss when used alone, with few patients achieving ≥20% weight loss.2 MBS offers the greatest level of weight loss—in the range of 20% to 40%, depending on the type of surgery—but not all patients are eligible for this approach. Furthermore, MBS may be a suboptimal choice for patients who are trying to become pregnant in a short timeframe (ie, <1-2 years). In addition to the need for referral to surgical specialists and the risks associated with surgery, the decision to undergo MBS must consider the possibility of nutritional deficiencies that can impact maternal and/or fetal health and guideline recommendations to postpone pregnancy for 1-2 years after the surgery.3,4

AOMs are treatment options that OB/GYN specialists can provide to patients in their practices, and newer incretin-based AOMs are associated with robust weight loss. In a head-to-head trial, semaglutide and tirzepatide treatment led to mean weight loss of 13.7% and 20.2%, respectively, at 72 weeks (P <.001), making them attractive alternatives for women who want to lose weight in the year before they try to conceive.5 Each agent is FDA-approved for weight loss and chronic weight management in adults with obesity, but they have additional indications that should be considered as part of individualized care. Tirzepatide is approved to treat moderate to severe OSA in adults with obesity, and semaglutide is approved to reduce the risk of major adverse cardiovascular events in those with established cardiovascular disease who have obesity or overweight and to treat noncirrhotic metabolic dysfunction–associated steatohepatitis with moderate to advanced liver fibrosis, regardless of obesity status.6,7 Neither agent is indicated to treat PCOS specifically, yet incretin-based AOMs may improve this disorder by reducing insulin resistance and inflammation alongside weight loss.8 Of note, documenting patients’ additional health issues that can be treated with an AOM may help them access these therapeutic options.

Regarding safety, AOMS are not recommended for use during pregnancy. HCPs and patients should refer to prescribing information for agent-specific guidance related to pregnancy, including exposure risks, discontinuation timing, contraception requirements, and pregnancy registry reporting. There are several notable points for newer incretin-based AOMs. Semaglutide has a long half-life (approximately 1 week), so it should be stopped 2 months before attempting to conceive.6,7 Although the US prescribing information for tirzepatide does not specify discontinuation timing, it has a long half-life of 5-6 days, so stopping at least 1 month before attempting to conceive is advisable, and this approach is recommended in Canadian and European product information.9,10 Tirzepatide US prescribing information also includes particular recommendations on contraceptive use after treatment initiation and dose escalation, and both agents have a pregnancy exposure registry.6,7 Finally, patients should be informed that stopping incretin-based AOMs may lead to weight regain, but evidence suggests their weight loss can be maintained through strict adherence to lifestyle modifications.11

For more educational activities and resources on this topic, including downloadable slides, a text module, and additional case challenges, please visit the program website: “Clinical Queries: Expert Insights to Improve Obesity Management During Reproductive years”.