Hormonal contraceptive users more likely to initiate semaglutide

Clinical takeaway: A history of hormonal contraceptive use may help identify patients who are more likely to pursue pharmacologic weight management, creating an opportunity for earlier counseling about evidence-based obesity treatment.

Weight concerns are a common reason women discontinue or switch hormonal contraception, even though evidence linking most hormonal contraceptives to meaningful weight gain remains inconsistent. A large Danish registry study suggests that women with a history of hormonal contraception are more likely to later initiate semaglutide therapy, highlighting the potential influence of weight perceptions and health-seeking behavior.

Researchers compared 22,694 first-time semaglutide users aged 12 to 49 years with 226,940 age-matched controls who had never used glucose-lowering medications. Across every hormonal contraceptive pattern examined, prior contraceptive use was associated with a greater likelihood of later semaglutide initiation than never using hormonal contraception.

Among women who had used a single contraceptive type, the adjusted likelihood of later semaglutide initiation was 42% higher for combined oral contraceptive users and 63% higher for progestin-only intrauterine device users than for women who had never used hormonal contraception. Women who had used two or more contraceptive types were 64% to 111% more likely to later initiate semaglutide than women who had never used hormonal contraception.

Adjustment for body mass index (BMI) reduced the strength of these associations but did not eliminate them, suggesting that factors beyond body weight—such as perceived weight changes, dissatisfaction with contraception, or greater engagement with healthcare—may contribute. Similar findings were observed across most age, socioeconomic, parity, and BMI subgroups.

The findings suggest that hormonal contraceptive use may serve as a marker for women who are more likely to pursue pharmacologic weight management. Whether this reflects perceived weight changes, greater healthcare engagement, or other factors, contraceptive care may offer an early opportunity to align counseling with patients' long-term weight-management goals.

Source: Bager MD, et al. (2026 Jul 22) JAMA Netw Open. Hormonal contraception and initiation of semaglutide therapy