Worsening vasomotor symptoms in the setting of estradiol and semaglutide: a case report.

OBJECTIVE: To encourage continued research of the delayed gastric emptying effect of glucagon-like peptide-1 receptor agonists and its effect on absorption of orally administered estrogen. METHODS: A case is reported of a 51-year-old postmenopausal female prescribed oral estrogen for the treatment of vasomotor symptoms of menopause. The patient reported mood changes and worsening of vasomotor symptoms during semaglutide dose titration. A search for current literature was conducted to investigate any possible connection between semaglutide and the patient's increased symptoms of menopause. RESULTS: During the semaglutide dose titration, the patient experienced changes in mood as well as increased incidence and intensity of vasomotor symptoms. After review of current available literature, a hypothesis was made that glucagon-like peptide-1 receptor agonists may temporarily decrease absorption of oral estrogen. The patient's semaglutide dose titration was slowed with subsequent resolution of mood changes and vasomotor symptoms. The patient's symptom resolution aligns with available literature suggesting that the absorption of some medications is impaired when a glucagon-like peptide-1 receptor agonist is first initiated or dose-increased due to delayed gastric emptying, which subsequently resolves after prolonged stimulation of glucagon-like peptide-1 receptors. CONCLUSIONS: Continued research should be considered to identify if there is an effect of the absorption of oral estrogen after the initial dose and/or after a dose titration of semaglutide.