Who this is for:
Women considering or currently taking GLP-1 medications like Ozempic or Wegovy who want to support their gut, hormones, and long-term health.
GLP-1 medications like Ozempic and Wegovy have helped many women who have tried everything else – for the right person, they can be genuinely life-changing. But they do not come with any guidance on what your body actually needs while you are taking them. Yes, they work – and people do lose weight. But unless you support your body properly throughout, you are likely to experience unwanted side effects. The most common are digestive problems, vaginal and hormonal changes, and an overload of toxins released during weight loss.
You may have come across the term “Ozempic vulva.” It sounds dramatic, but it illustrates perfectly why this medication affects far more than appetite. When the gut changes, everything else follows.
What happens in your gut
GLP-1 medications slow gastric emptying. Food moves more slowly through your digestive system, which is why appetite reduces and you eat less. One direct consequence of this is constipation – and this is one of the first things many women notice.
I have already worked with several women who went more than a week without a bowel movement after starting Ozempic. Constipation is not just temporary discomfort. The bowel is one of your body’s primary elimination routes, and when it slows, you are also reabsorbing hormones, toxins, and metabolic byproducts that are meant to leave your body. Chronic constipation over many years is also a factor in serious conditions, including Parkinson’s disease.
One of the hormones not being properly cleared is oestrogen. When it recirculates, it leads to symptoms of oestrogen dominance – the most common being heavier periods, fatigue, anxiety, and bloating.
Bile also becomes thicker and more sluggish, affecting fat digestion and raising the risk of gallbladder issues. Bile is critical for absorbing fat-soluble vitamins, clearing toxins, and maintaining hormone balance.
Microbiome diversity shifts when food intake drops significantly, with knock-on effects throughout the body – including the immune system and vaginal health.
As you eat less, it becomes even more important to focus on nutrient-dense foods to ensure your body has everything it needs to stay healthy.
Restoring gut motility to ensure regular and daily elimination, supporting bile flow, maintaining good microbial diversity, and optimising nutrient intake are all foundational while on GLP-1 medications. You may benefit from taking probiotics, magnesium to keep the bowel moving, having sufficient fibre in your diet, and adequate hydration. I also recommend castor oil packs to support both gut motility and liver detoxification.
What happens to your hormones
Women’s metabolism is cyclical – this means that we are not meant to eat the same way every day. In the first half of the cycle leading up to ovulation, the body is more insulin sensitive and can actually handle more food including carbs, even as much as up to 300 calories more per day. Progesterone production also depends on adequate calories and dietary fat. When intake drops too low consistently, progesterone often drops with it – manifesting as heavier or more symptomatic periods, loss of ovulation, worsening PMS, or a general sense of hormonal imbalance. Low progesterone also affects sleep quality and tends to increase day-to-day anxiety. For women in perimenopause, where hormones are already shifting and unpredictable, eating in a way that considers the cycle matters even more.
GLP-1 medications suppress appetite daily, regardless of where you are in your cycle. This flatlines your biology and disrupts how hormones are made.
Supporting your hormones in this context means understanding your individual hormonal picture, adjusting nutrient and caloric intake across the cycle, and working with your cyclical metabolism – something that is unique to every woman.
What happens to your vagina
You may have heard the term “Ozempic vagina.” Dryness, altered discharge, and increased infections are increasingly reported alongside GLP-1 use.
When food intake drops significantly, gut microbiome diversity shifts – and this directly affects vaginal health. The gut and vaginal microbiomes are intrinsically connected. In my practice, I regularly see improvements in vaginal issues simply from working on gut health first, even in clients with chronic infections.
When oestrogen balance changes as a result of these gut shifts, vaginal tissue becomes more sensitive and less resilient. When nutrient intake is insufficient, tissue integrity and immune protection are compromised.
I typically test the vaginal microbiome and recommend probiotics tailored to each client. Ensuring that key nutrients including vitamins, omega-3 fatty acids, and compounds like lignan-rich flaxseeds – are part of your daily diet is also an important part of this support.
Environmental toxins and weight loss
This is one of the most overlooked aspects of significant weight loss – and one of the most important to address.
Fat tissue is where the body stores compounds it cannot easily eliminate: environmental toxins, plastics, heavy metals, and excess hormones including oestrogen. The more fat tissue there is, the more toxins accumulate. As weight is lost, these are released from cells and enter circulation. Unless they are properly bound and excreted, they can travel to other organs, including the brain.
Your liver needs to be in good shape to process them. Your gut needs to eliminate them daily – which is why complete daily elimination is essential whether you are on GLP-1 medication or not. I also recommend binders, which attach to toxins and remove them via the gut, preventing the toxic overload that can leave you feeling very unwell.
Supporting the liver with specific nutrients is something I build into every plan. I often use herbs like milk thistle to support liver function and bile flow, and foods like dandelion leaves or cruciferous vegetables, which are easy to incorporate into a daily routine.
Do you have an exit plan?
GLP-1 medications support weight loss, but they do not resolve the underlying reasons for previous weight gain – which typically include gut dysfunction, nutrient deficiency, toxic overload, metabolic and genetic patterns, or the lifestyle factors that influence all of these.
Research shows that only around 10 to 15% of people maintain long-term results from natural weight loss. Post-exit weight regain with GLP-1 medications is already well documented. What did that 15 percent do differently? They addressed and changed their diet, lifestyle, and underlying root causes for weight gain – rather than returning to previous patterns.
What this means for you
If you are already taking a GLP-1 medication, it is not too late to start supporting your body properly – and the difference in how you feel is often noticeable quite quickly.
This is whole-body women’s health support: looking at your gut, your hormones, your nutrients, your environment, and how they interact. If you would like to explore what that looks like for you specifically, I would love to hear from you.
References
Bartnicka, A. et al. (2025) ‘Effects of GLP-1 analogues and agonists on the gut microbiota: a systematic review‘, Nutrients, 17(8), p. 1303.
doi: 10.3390/nu17081303
Bone, M. (2024) ‘Gynecologist reveals Ozempic’s unexpected effects on your vagina [expert commentary]‘, Newsweek, 15 October 2024. [Clinician commentary; cited for the gut–vaginal axis mechanism and clinical observations on microbiome disruption. Not peer-reviewed.]
newsweek.com/gynecologist-ozempic-vagina-womens-health-weight-loss-1966954
Colleluori, G. and Villareal, D.T. (2023) ‘Estrogens in adipose tissue physiology and obesity-related dysfunction‘, Frontiers in Endocrinology [via PMC].
PMC10199553
Fénichel, P. et al. (2021) ‘Sustained bloodstream release of persistent organic pollutants induced by extensive weight loss after bariatric surgery: implications for women of childbearing age‘, Environment International, 151, p. 106400.
doi: 10.1016/j.envint.2021.106400
He, L. et al. (2022) ‘Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases: a systematic review and meta-analysis of randomised clinical trials‘, JAMA Internal Medicine, 182(5), pp. 513–519.
doi: 10.1001/jamainternmed.2021.8280
Wilding, J.P.H. et al. (2022) ‘Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension‘, Diabetes, Obesity and Metabolism, 24(8), pp. 1553–1564.
doi: 10.1111/dom.14725
