Most patients taking popular weight loss and diabetes medications such as Ozempic and Wegovy can safely continue them before gynecologic surgery, according to a new journal article from ChristianaCare published in Obstetrics & Gynecology. The review found that serious anesthesia risks linked to these drugs are uncommon for most patients and can usually be managed through individualized planning rather than stopping the medication.
The paper is the first to take a focused look at glucagon-like peptide-1 receptor agonists, commonly called GLP-1 drugs, in gynecologic surgery. These medications were first approved to treat diabetes and are now widely used to support weight loss and metabolic health, which refers to how the body processes sugar and energy.
“Our study shows that the evidence does not support routinely stopping these medications before surgery and that the actual risk is low for most patients,” said Michelle Pacis, M.D., MPH, senior author of the study and a minimally invasive gynecologic surgeon at ChristianaCare.
Why these medications raised concerns
GLP-1 drugs work in part by slowing how quickly the stomach empties. This helps patients feel full longer, but it also raises concerns for surgery. Doctors worry that food remaining in the stomach could increase the risk of aspiration, when stomach contents enter the lungs during anesthesia.
Because of this, early recommendations often advised stopping GLP-1 medications before surgery. The ChristianaCare review found that this approach was largely based on caution rather than strong evidence.
The authors reviewed data from multiple studies, including large patient groups, that examined outcomes in people taking GLP-1 drugs during procedures. While some studies showed higher amounts of stomach contents, aspiration events were rare and occurred at rates similar to patients who were not taking the medications.
New guidance reflects a change in thinking
Recent national guidance from several medical societies now recommends a more tailored approach. Most patients can continue GLP-1 medications before surgery. For patients with higher risk factors, such as significant stomach symptoms or known delayed digestion, simple precautions can reduce risk.
These precautions may include a clear liquid diet for 24 hours before surgery or closer monitoring during anesthesia. A clear liquid diet includes fluids like water, broth and clear juices.
“This shift recognizes both the benefits of these medications and the importance of patient-specific decision making,” Pacis said.
Why this matters for gynecologic surgery
Many gynecologic surgeries require patients to be positioned in ways that can affect breathing and circulation. At the same time, many patients needing these procedures also have obesity or diabetes, which can increase surgical risk.
GLP-1 medications can improve blood sugar control and support weight loss, helping patients enter surgery in better overall health and enhance recovery. Stopping these drugs without a clear reason may work against those benefits.
Practical steps to support patient safety
The study outlines several strategies care teams can use when patients remain on GLP-1 medications. These include thoughtful anesthesia planning, careful monitoring of heart and lung function, and, in select cases, the use of ultrasound to check stomach contents before surgery.
“The goal is not to ignore risk, but to manage it wisely,” Pacis said. “For many patients, continuing these medications supports safer surgery and better recovery.”
The authors note that more research is needed, particularly studies focused specifically on gynecologic surgery. Still, the findings offer clarity for patients and clinicians navigating a rapidly changing area of care.
“This review helps bring evidence and balance to an issue that has caused a lot of confusion,” Pacis said. “It supports keeping patients on therapies that benefit their health whenever it is safe to do so.”
