Everything You Need to Know About Ozempic

Introducing Hot Shots, a series that examines how Ozempic and other GLP-1 drugs have transformed the way we think about our bodies, weight loss, and wellness.

Ozempic and other GLP-1 drugs like it have become so pervasive in the zeitgeist that it’s likely even your most social media-averse relative knows what they are. Celebrities and influencers tout them in interviews and social media, and even Oprah admitted to using one to aid in her weight loss journey. Despite these medications having their moment in the sun, there are still many unanswered questions surrounding them.

ELLE editors went on a deep dive to answer all of the most common questions about Ozempic and other similar drugs. Below, what there is to know about Ozempic, from the nuts and bolts (like what it is and how it works) to the more complex nuances (like whether it affects fertility and menopause).

Ozempic is a semaglutide, or an anti-diabetic medication, a peptide that mimics the actions of a hormone called GLP-1 (Glucagon-Like Peptide-1), which is found naturally in your body, according to reproductive endocrinologist, infertility specialist, and obstetrician and gynecologist Lucky Sekhon, MD, RMA of New York. GLP-1 helps regulate blood sugar, digestion, and appetite. By acting like GLP-1 in your system, this class of drug makes you feel full quickly.

In the same way that Botox has become a catchall term for anything that freezes wrinkles or is a neuromodulator, Ozempic has become a synonymous word for any anti-diabetic drug with associated weight loss potential. “It’s like saying Kleenex, instead of tissue,” confirms endocrinologist Caroline K. Messer, MD. However, there are other drugs like Ozempic, which function slightly differently; among them, brand names like Mounjaro, Zepbound, and more. Throughout this story, we will focus on Ozempic, but note when there are differences with other drugs.

Ozempic and Wegovy are both semaglutides or GLP-1 drugs, made by different brands, but they “are identical,” Messer says. Their slight difference is in their dosage. “The max dose of Ozempic is two milligrams, but the max dose of Wegovy is 2.4,” she adds. Because of the difference in dosage, Ozempic is FDA-approved only to treat type 2 diabetes, while Wegovy is FDA-approved for weight loss.

Likewise, Mounjaro and Zepbound are also identical, even in their dosage, but made by different brands. They are double agonist drugs, also known as tirzepatides, meaning that they are both GLP-1 and Glucose-Dependent Insulinotropic Polypeptide (GIP) drugs. Only Zepbound is FDA-approved for weight loss. Compared to GLP-1 drugs or Ozempic, studies show that you can lose more weight, with fewer side effects, on these double agonists, Messer says. Triple agonist drugs are also in the pipeline, and experts are hoping that they could be released in 2025.

Ozempic is mainly used for treating type 2 diabetes (its off-label use is for weight management). But it and other anti-diabetic drugs can be a good option for weight loss under the supervision of a doctor. “It stimulates the body to produce more insulin, but it also slows down stomach emptying,” says plastic surgeon Steven Williams, MD. “[Ozempic is] great for controlling blood sugar and great for weight loss, because we feel less hungry and consume fewer calories.”

Not only do drugs like Ozempic make you feel more satiated, but their effect on insulin can assist with weight loss as well. “A lot of people who struggle with their weight can have a tendency to have insulin resistance,” Sekhon says. “[Ozempic] stimulates insulin production, it reduces cravings, and it lowers your blood sugar.”

Yes, in an off-label use, because it is not FDA-approved for weight loss. The only anti-diabetic drugs that are approved for weight loss are Wegovy and Zepbound. If the goal is simply weight loss, doctors will usually prescribe one of these two drugs.

You need a prescription. If you’re interested in trying Ozempic or other similar drugs, it’s best to talk to your doctor to see if it’s right for you. Technically, any type of doctor is able to prescribe it, but “it’s important to go to a medical office, like a plastic surgery office, an endocrinology office, or a primary care office,” Williams says. “Someone who’s not only going to just give [a patient] the medication, but follow their progress and try to minimize or manage side effects.” You may see online retailers such as Hers or WeightWatchers Clinic, but these also require a prescription.

Your insurance coverage will largely determine what drug you will get, whether it be Ozempic versus Mounjaro. “A lot of the better plans are covering the Zepbound, but it is more expensive, so some plans are only covering Wegovy,” Messer says.

When it first became widespread knowledge that Ozempic and other similar drugs could work well for weight loss, it caused a frenzy that led to a worldwide shortage. Now, it’s much easier for patients to get these type of drugs. “When there’s demand, the people who make it are not going to miss an opportunity, so [companies have] upped the production,” says plastic surgeon David Shafer, MD.

However, Messer notes that she has noticed supply dwindling slightly. “There was no shortage from August onwards. It’s very anecdotal, but different pharmacies are starting to say that they don’t have it.” She isn’t entirely sure why, but has a feeling that it’s because increasing studies are showing that these drugs can be used to treat other things. The FDA recently cleared Zepbound to treat sleep apnea.

Ozempic is most commonly prescribed for type 2 diabetes and off-label weight loss. “It’s helped a lot of people who have type 2 diabetes, which is driven by insulin resistance, and it’s helped a lot of people with weight loss who have traditionally struggled with other measures,” Sekhon says.

Still, there are many potential benefits of GLP-1s outside of weight loss or diabetes management, which are still being studied. Among them, sleep apnea and cardiac health. “It also has some pretty effective mechanics for reducing addictive types of traits like alcoholism or gambling,” says Williams, noting that more research is needed.

This is a murky question, and it depends on whether or not your insurance will cover Ozempic or GLP-1 drugs. Williams says that there’s no cut-and-dry criteria for whether or not your insurance will cover Ozempic, and it differs from insurance company to insurance company.

“If their insurance covers Ozempic, they pay somewhere around $12,” Shafer says. “It can get priced [up to] $800 a month. It really depends on your dose and your insurance coverage.”

Ozempic and other similar drugs must be injected. Messer describes the needle as “small, the size of two human hairs.” Oftentimes, her office will teach the patient how to inject it the first time, and the patient can do it themselves from then on. There is also hope that the new class of triple agonists coming out can be taken orally.

No matter which drug you are on, the side effects will be similar (but Messer notes that it is slightly less intense with double agonists, such as Zepbound). Most of them are gastrointestinal, including a risk of nausea, reflux, burping, dyspepsia, stomach pains, constipation, and diarrhea. According to Messer, she estimates that people have side effects about 30 percent of the time. People with certain underlying conditions will have worse side effects, such as those with gastroparesis, hiatal hernias, and gallstones.

She also notes that any patients with compulsive eating disorders tend to feel more nausea as their feelings of satiation might be confused, and they may not stop eating even when they are full. Typically, the side effects do lessen over time. However, if dosage of the drugs is increased, a resurgence of symptoms may occur.

Due to creating insulin resistance, excess weight can impact your ability to ovulate, which can negatively affect your fertility. “High insulin acts like a growth factor on the ovaries, and it causes your ovaries to over produce testosterone-like hormones called androgens,” Sekhon says. “That leads to a tendency toward not ovulating at all, or ovulating really infrequently, or in a way that’s really unpredictable. If you don’t know when you’re ovulating or you’re not ovulating, you’re not in the game when it comes to trying to get pregnant.”

Sekhon says that when people who have had irregular menstrual cycles start using Ozempic, their cycles become very predictable, which makes managing fertility easier. “If you’re overweight and you lose some body weight, it’s going to help mitigate insulin resistance,” Sekhon says. “If that was causing your cycles to be irregular, then your cycles can become more regular, and therefore you become more fertile.” Robbins adds that women who have PCOS, which is often associated with infertility, might be able to get pregnant after decreasing their insulin resistance through drugs like Ozempic.

On the opposite end of the spectrum, Sekhon cautions that going overboard and taking GLP-1 drugs when you don’t need them can actually negatively impact fertility. If you lose too much weight, your body doesn’t have enough energy to sustain itself, which can lead to your body shutting down ovulation. “They may never go back to ovulating regularly,” Sekhon cautions.

For women who are going through perimenopause or menopause, GLP-1 drugs might be helpful. During menopause, women often become more insulin resistant, as estrogen levels lower and a pituitary hormone called FSH rises, which can also lead to weight gain. “Twenty percent of women gain about 10 pounds or more during their menopause transition,” says obstetrician, gynecologist, and certified menopause practitioner Alicia Robbins, MD. These anti-diabetic drugs can help with the hormonal changes and weight. “Estrogen is really important for where you distribute your fat. When you start to lose estrogen and go into perimenopause in your 40s, you end becoming more insulin resistant,” Robbin says.

Everyone’s personal experience will be different, but Shafer says that you can expect to lose around 10 to 15 percent of your body weight. “You have to look at your total body weight, your total muscle weight, fat weight, and water weight,” he explains. “If you gain muscle weight, your total weight change may not be as dramatic as you were expecting.”

Messer says that the risks are minimal or that they outweigh the risks associated with obesity. On the Ozempic website, there is a warning that it causes thyroid cancer in mice. However, experts like Messer believe that in humans Ozempic could lower the risk of cancer, particularly in those types associated with weight. According to a recent study, GLP-1 drugs reduced the risk, for those in the study, for over 13 different obesity-related cancers such as gallbladder, stomach, kidney, and ovarian.

However, Messer would not prescribe it to certain types of people, including those with active gallstones, pancreatitis, anybody with an eating disorder, or those with a personal and family history of medullary thyroid cancer. “But short of that, I have a low threshold for prescribing.”