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The group at risk of endometrial hyperplasia are those women using a GLP-1 and also using TD oestrogen (which will be unaffected by the GLP-1 agonist) and an oral progestogen, as the absorption of the progestogen may be reduced while the oestrogen stays the same, leaving the woman with an unbalanced regime and an insufficient amount of progestogen to protect her endometrium from the oestrogen
Guidance such as the ADA/EASD Management of hyperglycaemia in type 2 diabetes consensus report (Davies et al, 2022) recommends early initiation of GLP-1 RAs or SGLT2 inhibitors along with metformin in those with established or high risk of cardiovascular disease, and it is usual practice to titrate one drug up fully before adding the second class, without waiting for further glycaemic assessment
All participants provided written informed consent
Specific gut bacteria play direct roles in GLP-1 secretion
