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GLP-1 Medications, Birth Control and Pregnancy: What the Labels Say

Zepbound and Mounjaro labels advise a non-oral or backup contraceptive method for 4 weeks; Wegovy and Ozempic say stop 2 months before a planned pregnancy.

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By the Healthy Weight Loss 4 U Clinical Content Team · Published October 19, 2026 · Updated October 19, 2026 · 9 min read

In short

The Zepbound and Mounjaro labels say tirzepatide may reduce the effectiveness of oral hormonal contraceptives and advise switching to a non-oral method or adding a barrier method for 4 weeks after starting and after each dose escalation [1][2]. The Wegovy and Ozempic labels say to discontinue semaglutide at least 2 months before a planned pregnancy [3][4]. Human data on early-pregnancy exposure have not shown a clear rise in major birth defects, but they are limited [5][7].

Key takeaways

  • Zepbound and Mounjaro labels advise people using oral hormonal contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after starting and for 4 weeks after each dose escalation [1][2].
  • In the Zepbound label's drug-interaction study, a single 5 mg dose lowered peak levels of a combined pill's hormones by 55% to 66% and total exposure by 20% to 23% [1].
  • Wegovy and Ozempic labels say to discontinue at least 2 months before a planned pregnancy because of semaglutide's long half-life [3][4].
  • In a cohort of 938 GLP-1 exposed infants born to women with type 2 diabetes, the adjusted relative risk of major malformations versus insulin was 0.95 (95% CI 0.72 to 1.26) [5].
  • A meta-analysis of 11 trials in 840 women with polycystic ovary syndrome found a higher natural pregnancy rate with GLP-1 drugs (RR 1.72), but the total pregnancy rate was not statistically significant (RR 1.35) [8].

Can GLP-1 medications make birth control less effective?

For tirzepatide, the labels say yes, possibly. The Zepbound and Mounjaro labels state that tirzepatide may reduce the efficacy of oral hormonal contraceptives because of delayed gastric emptying, and they advise patients using oral hormonal contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after initiation and for 4 weeks after each dose escalation [1][2]. The Zepbound label adds that the delay is largest after the first dose and diminishes over time, and that hormonal contraceptives that are not administered orally should not be affected [1].

The advice rests on a drug-interaction study described in the Zepbound label. After a single 5 mg tirzepatide dose given with a combined oral contraceptive, peak levels (Cmax) of ethinyl estradiol, norgestimate and norelgestromin fell by 59%, 66% and 55%, and total exposure (AUC) fell by 20%, 21% and 23%. Time to peak was delayed by 2.5 to 4.5 hours [1].

What current labels say about oral contraceptives
LabelStatement
Zepbound (revised 8/2026) [1]May reduce oral hormonal contraceptive efficacy; switch to a non-oral method or add a barrier method for 4 weeks after initiation and after each dose escalation
Mounjaro (revised 01/2026) [2]Same statement and same 4-week advice
Wegovy (revised 05/2026) [3]No contraception section in the text reviewed; drug-interaction data list ethinyl estradiol and levonorgestrel among drugs with no clinically significant pharmacokinetic differences with semaglutide
Ozempic (revised 05/2026) [4]Oral contraceptive (ethinyl estradiol and levonorgestrel) assessed at steady state; no clinically relevant interaction and no dose adjustment required

Two limits are worth stating. These studies measure drug levels in the blood, not pregnancy rates, and the sources reviewed here do not report how often pregnancies occurred because of this interaction [1][9]. And the label advice is specific to oral hormonal products; the labels state that non-oral hormonal contraceptives should not be affected [1].

What do the labels say about stopping before a planned pregnancy?

The semaglutide labels give a specific interval: at least 2 months. The Wegovy label says to discontinue Wegovy in patients at least 2 months before they plan to become pregnant, to account for the long half-life of semaglutide [3]. The Ozempic label says to discontinue in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide [4].

The tirzepatide labels do not state an interval in the text reviewed. Section 8.3 of the Zepbound label contains the contraception statement but no washout or planned-pregnancy instruction, and the Mounjaro label's section on contraception likewise contains no pregnancy-planning text [1][2]. A 2026 narrative review states that an 8 to 10 week washout is required before conception for semaglutide and tirzepatide, but that is the review's statement, not a Zepbound label instruction [10].

Once pregnancy is recognized, the Zepbound highlights say to discontinue Zepbound [1]. The Wegovy label says to discontinue Wegovy in pregnant patients who are using it for weight reduction, and adds that weight loss offers no benefit to a pregnant patient and may cause fetal harm [3]. The abstract of a 2026 consensus guideline and scoping review from an international expert group states that pregnancy and breastfeeding are contraindicated during incretin-based medication use [7].

What do the labels say about pregnancy and animal findings?

The labels base their pregnancy cautions mainly on animal studies, because human data are limited. The Wegovy label states that, based on animal reproduction studies, there may be potential risks to the fetus, and that clinical and pharmacovigilance data are insufficient to establish a drug-associated risk of birth defects, miscarriage or adverse maternal or fetal outcomes [3]. The Ozempic label says there are limited data with semaglutide in pregnant women [4]. For Zepbound, the label says available human data are insufficient to evaluate drug-related risk of major birth defects or miscarriage [1].

Animal findings described in the labels (not a prediction of human outcomes)
LabelSpeciesFinding
Wegovy [3]RatsEmbryofetal mortality, structural abnormalities and growth changes at clinically relevant maternal exposures
Wegovy [3]RabbitsEarly pregnancy losses and minor visceral and skeletal abnormalities
Wegovy [3]MonkeysSporadic skeletal abnormalities, coinciding with marked maternal weight loss
Zepbound [1]RatsIncreased external, visceral and skeletal malformations; decreased fetal weights coincided with reductions in maternal body weight
Zepbound [1]RabbitsMaternal gastrointestinal effects causing maternal mortality or abortion; reduced fetal weights with decreased maternal food intake and body weight

The labels themselves note that some animal findings coincided with maternal weight loss or reduced food intake [1][3]. The Zepbound label gives the background risk in the general U.S. population as 2% to 4% for major birth defects and 15% to 20% for miscarriage in clinically recognized pregnancies [1]. The Ozempic label gives a higher figure, 6% to 10% for major birth defects, for women with pregestational diabetes and a peri-conceptional HbA1c above 7 [4].

What do human studies say about exposure in early pregnancy?

So far, studies have not shown a clear increase in major birth defects, but the evidence is observational and incomplete. The largest is a JAMA Internal Medicine cohort of more than 3.5 million pregnancies from the Nordic countries, the U.S. and Israel. Among women with type 2 diabetes, major congenital malformations occurred in 8.3% of 938 infants exposed to GLP-1 receptor agonists around conception, and the adjusted relative risk versus insulin was 0.95 (95% CI 0.72 to 1.26). The authors said some estimates were imprecise and that confirmation is needed [5]. The exposed women had type 2 diabetes, so the findings do not directly describe people using these drugs for weight management alone.

A 2026 scoping review and consensus guideline in Obesity Reviews included 34 articles (11 randomized trials, 9 observational studies, 2 pharmacovigilance reviews, 9 case reports or series, 2 animal studies and 1 ex vivo study). It states that no studies reported an increase in congenital anomalies, found evidence for only 18 of 32 research questions, and noted few studies on contraception, lactation or postpartum use [7].

A different question is what happens when someone stops the drug around conception. A JAMA cohort at Mass General Brigham compared 655 pregnancies with a GLP-1 order from 3 years before to 90 days after conception to matched unexposed pregnancies (matched analyses included 442 to 566 exposed pregnancies). Exposed women, mostly with obesity, gained more weight in pregnancy, and some complications were more frequent [6].

Pregnancy outcomes after GLP-1 discontinuation, exposed versus unexposed (matched cohort, percent)

Source: [6] Maya et al., JAMA 2025 (retrospective cohort; observational, cannot show cause).

Average gestational weight gain was 13.7 kg versus 10.5 kg, a 3.3 kg difference (95% CI 2.3 to 4.2) [6]. The study is retrospective and observational, and after adjustment the intervals for preterm delivery (RR 1.21; 0.96 to 1.53) and gestational diabetes (RR 1.23; 0.95 to 1.58) included 1 [6]. It cannot show that stopping the drug caused these outcomes.

What about breastfeeding and the pregnancy registries?

Breastfeeding data are thin, and the labels differ. The Zepbound and Mounjaro labels report that tirzepatide concentration in breast milk was undetectable or low relative to the maternal dose, and that no data exist on effects on the breastfed infant or on milk production [1][2]. The Ozempic label says there are no data on semaglutide in human milk, and that it was present in the milk of lactating rats at levels 3 to 12 times lower than in maternal plasma [4]. For Wegovy tablets, the label says breastfeeding is not recommended during treatment because of an ingredient called SNAC, while for the injection it reports no data on human milk and advises weighing the benefits of breastfeeding against the mother's clinical need [3].

Both manufacturers sponsor pregnancy exposure registries. The Zepbound label and the registry website describe the MILE Registry, sponsored by Eli Lilly, which collects pregnancy outcomes through the baby's first year. It is intended for U.S. residents aged 18 and older, and you do not need to be taking the medicine to enroll [1][11]. The Wegovy Pregnancy Registry, from Novo Nordisk, enrolls pregnant women in the U.S. with obesity or overweight, whether or not they took Wegovy, and also collects newborn health information up to 1 year of age [3][12].

Registries are voluntary and observational. They exist because the labels say human data are insufficient, and results may eventually be added to product labeling [1][11].

What does the evidence say about fertility and "Ozempic babies"?

The evidence supports a plausible but indirect effect, mainly in polycystic ovary syndrome (PCOS), and it does not show that these drugs directly raise fertility. The term "Ozempic babies" arose from media and social media reports of unexpected pregnancies, and a 2026 narrative review describes it as media-driven and gives no incidence data for it [9].

The best controlled data are in PCOS. A 2023 meta-analysis of 11 randomized trials with 840 patients found a higher natural pregnancy rate with GLP-1 receptor agonists (RR 1.72; 95% CI 1.22 to 2.43), no significant difference in IVF pregnancy (RR 1.06; 0.69 to 1.64), and a total pregnancy rate that did not reach significance (RR 1.35; 0.96 to 1.91). Menstrual cyclicity improved, with very high heterogeneity. Several trials were open-label, several combined the drug with metformin, and pregnancy safety data were too scarce to analyze [8].

Why might unplanned pregnancies occur? Two hypotheses appear in the literature, and neither is proven as the cause of media-reported cases. One is that weight loss and improved insulin resistance restore more regular cycles and ovulation, especially in PCOS [9][10]. The other is that delayed gastric emptying with tirzepatide may lower oral contraceptive absorption, as the labels describe [1][9]. In animals, the Zepbound label reports no effects of tirzepatide on mating, fertility or conception in animal fertility studies [1]. A 47-study narrative review calls these drugs a promising preconception strategy in PCOS and obesity-related infertility, but describes the benefits as potential, and still recommends stopping them before pregnancy [10].

What this means in practice

  • Tell your prescriber at the start if you could become pregnant or are planning a pregnancy, because labels differ on contraception and timing [1][3].
  • If you use an oral hormonal contraceptive and are prescribed tirzepatide, the label advises a non-oral method or a barrier method for 4 weeks after starting and after each dose escalation, so ask how that applies to you [1][2].
  • If you take semaglutide and are planning a pregnancy, the labels say to discontinue at least 2 months beforehand; your prescriber decides the plan and timing [3][4].
  • Weight loss offers no benefit during pregnancy, and the labels direct discontinuation once pregnancy is recognized, so contact your prescriber promptly if you think you are pregnant [1][3].
  • Planning matters on the other side too: women who discontinued GLP-1 drugs before or early in pregnancy gained more weight on average in one cohort, which is worth discussing with a clinician or dietitian before conception [6].
  • If you become pregnant while exposed to a GLP-1 drug, ask your clinician about the manufacturer registries [11][12].
  • If you are breastfeeding or plan to, raise it before starting, since label statements differ by product and data are limited [1][3][4].

When to talk to a clinician

Talk to a clinician before starting a GLP-1 medication if you are pregnant, trying to conceive, breastfeeding, or using an oral contraceptive, and again if you stop a contraceptive, miss a period, or have a positive pregnancy test while on treatment. Severe nausea, vomiting or diarrhea is also worth raising, since a 2026 review recommends reliable non-oral contraception for people on tirzepatide or with severe gastrointestinal side effects [9].

At Healthy Weight Loss 4 U, every program begins with a clinician evaluation, and that evaluation is where to raise pregnancy plans, contraception, breastfeeding and your medical history. A licensed clinician decides what, if anything, is appropriate for you; this article does not give medical advice.

Frequently asked questions

Does Zepbound make birth control pills less effective?
The Zepbound label says it may. It advises patients using oral hormonal contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after starting and after each dose escalation, citing delayed gastric emptying [1]. In the label's study, a single 5 mg dose lowered peak levels of a combined pill's hormones by 55% to 66% [1].
Do Wegovy and Ozempic affect birth control pills?
The labels reviewed include no instruction to change contraception. The Ozempic label reports no clinically relevant interaction with an ethinyl estradiol and levonorgestrel pill and no dose adjustment [4], and the Wegovy label lists those hormones among drugs without clinically significant pharmacokinetic differences [3]. Both labels still recommend discontinuing before a planned pregnancy [3][4].
How long before pregnancy should semaglutide be stopped, per the label?
The Wegovy label says to discontinue at least 2 months before a planned pregnancy to account for semaglutide's long half-life [3]. The Ozempic label gives the same interval, citing the long washout period [4]. Timing for your situation is a decision for your prescriber, not a label reading exercise.
Do the tirzepatide labels give a washout period?
Not in the text reviewed. The Zepbound and Mounjaro sections on females and males of reproductive potential address contraception but give no planned-pregnancy washout instruction [1][2]. One 2026 narrative review describes an 8 to 10 week washout for semaglutide and tirzepatide, but that statement is the review's, not the label's [10].
Is it safe to take a GLP-1 medication while pregnant?
The labels say no benefit is expected and advise discontinuing when pregnancy is recognized, citing animal findings and limited human data [1][3]. A consensus guideline states pregnancy and breastfeeding are contraindicated during incretin-based medication use [7]. Studies of accidental early exposure have not shown a clear rise in birth defects, but data are limited [5][7].
Are "Ozempic babies" real?
Media reports of unexpected pregnancies are real, but their cause is unproven. A 2026 review calls the term media-driven with no incidence data [9]. Plausible explanations include better cycle regularity after weight loss and reduced oral contraceptive absorption with tirzepatide [1][9]. In PCOS trials, natural pregnancy rates were higher (RR 1.72) [8].
Can I breastfeed while taking a GLP-1 medication?
Labels differ and data are limited. The Wegovy tablet label says breastfeeding is not recommended, while the injection label reports no human milk data and advises weighing benefits against need [3]. The Zepbound and Mounjaro labels report low or undetectable milk levels but no infant data [1][2]. Ask your clinician.
Is there a pregnancy registry for these medications?
Yes. The Zepbound label and Lilly's MILE Registry collect pregnancy outcomes through the baby's first year, for U.S. residents aged 18 and older [1][11]. The Wegovy Pregnancy Registry, from Novo Nordisk, enrolls pregnant women with obesity or overweight whether or not they took Wegovy [3][12]. Enrollment is voluntary.

Sources

  1. ZEPBOUND (tirzepatide) prescribing information (revised 8/2026). DailyMed, U.S. National Library of Medicine (Eli Lilly label), 2026. dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b&type=display
  2. MOUNJARO (tirzepatide) prescribing information (revised 01/2026). U.S. Food and Drug Administration (Eli Lilly label), 2026. www.accessdata.fda.gov/drugsatfda_docs/label/2026/215866s041lbl.pdf
  3. WEGOVY (semaglutide) injection and tablets prescribing information (revised 05/2026). U.S. Food and Drug Administration (Novo Nordisk label), 2026. www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s031lbl218316s003lbl.pdf
  4. OZEMPIC (semaglutide) prescribing information (revised 05/2026). U.S. Food and Drug Administration (Novo Nordisk label), 2026. www.accessdata.fda.gov/drugsatfda_docs/label/2026/209637s038lbl.pdf
  5. Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy. JAMA Internal Medicine (Cesta et al.), 2023. doi.org/10.1001/jamainternmed.2023.6663
  6. Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA (Maya et al.), 2025. jamanetwork.com/journals/jama/fullarticle/2841781
  7. Incretin-Based Medications in Women and Reproduction: A Systematic Scoping Review and Consensus Guidelines for Clinical Practice. Obesity Reviews (Maslin et al.), 2026. doi.org/10.1111/obr.70203
  8. Effects of GLP1RAs on pregnancy rate and menstrual cyclicity in women with polycystic ovary syndrome: a meta-analysis and systematic review. BMC Endocrine Disorders (Zhou et al.), 2023. dx.doi.org/10.1186/s12902-023-01500-5
  9. The "Ozempic babies" phenomenon: a narrative review of the impact of GLP-1 receptor agonists on fertility and early pregnancy. Medical Research Journal (Lason et al.), 2026. journals.viamedica.pl/medical_research_journal/article/view/113632
  10. GLP-1 Receptor Agonists and Fertility: What Is Known So Far?. JBRA Assisted Reproduction (Becker et al.), 2026. www.jbra.com.br/article/3105/glp-1-receptor-agonists-and-fertility-what-is-known-so-far
  11. MILE Registry: Tirzepatide Pregnancy Registry for Zepbound. Eli Lilly and Company, 2026. pregnancyregistry.lilly.com/zepbound
  12. Wegovy Pregnancy Registry. Novo Nordisk, 2026. www.wegovypregnancyregistry.com
General information, not medical advice. Results vary and treatment depends on evaluation by a licensed clinician. This article was prepared by the Healthy Weight Loss 4 U Clinical Content Team from the published sources listed above. Nothing here is a recommendation for a specific person, and no treatment is started without an evaluation by a licensed clinician.

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Questions about your own situation? A clinician can review your history and goals. Related: Personalized Weight Loss Counseling.

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