Postmenopausal bleeding associated with semaglutide: a diagnostic challenge.

Prasad S, Parmar V, Sharma A, Kaur N, Kothia D, Bavaria D

JCEM case reports16 Sept 2026

PMID42751094DOI10.1210/jcemcr/luag261PepBankPUB-42751094

Publisher page PubMedAsk about this study

Summary

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is widely used for obesity and type 2 diabetes management, but its gynecological adverse effects have not been systematically described. We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly. Hemoglobin fell from 12.9 g/dL (Système International [SI]: 129 g/L) to 10.8 g/dL (SI: 108 g/L) (reference range, 12.0-16.0 g/dL [SI: 120-160 g/L]). The serum follicle-stimulating hormone (FSH) concentration was elevated at 68.4 mIU/mL (SI: 68.4 IU/L; reference, >25 IU/L postmenopausal), and estradiol was suppressed at 3.5 pg/mL (SI: 13 pmol/L; reference, <5.4 pg/mL [SI: <20 pmol/L]), consistent with stable postmenopausal status throughout, without hormonal reactivation (no return toward a premenopausal pattern). Endometrial malignancy, structural pathology, and coagulopathy were excluded. The Naranjo Adverse Drug Reaction Probability Scale score was 6 ("probable"). Bleeding resolved completely within five weeks of discontinuation. We propose that rapid semaglutide-induced adipose loss may transiently alter peripheral estrogen metabolism, destabilizing the endometrium despite unchanged hormone levels. This case highlights postmenopausal bleeding as a rare but clinically important adverse effect of GLP-1 receptor agonist therapy warranting malignancy-first evaluation.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study6

6 results from studies that gave the peptide. 6 results from people.

01HumanCase report or seriesSafety outcome
A postmenopausal woman had new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction.
In plain wordsOne postmenopausal woman had vaginal bleeding about six weeks after starting semaglutide for weight loss.
Peptide
Semaglutide
Outcome
Not applicablePostmenopausal vaginal bleeding
Study
n = 1
Outcome group
Adverse events · Reproductive and sexual health
Studied dose
0.5 mg weeklyAs given in this study (human).
Source sentences
Summary
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109401
02HumanCase report or seriesSafety outcome
In a postmenopausal woman with bleeding on semaglutide, hemoglobin fell from 12.9 to 10.8 g/dL.
In plain wordsIn one postmenopausal woman with bleeding on semaglutide, blood hemoglobin fell.
Peptide
Semaglutide
Outcome
DecreaseHemoglobin
Study
n = 1
Outcome group
Adverse events · Whole body
Studied dose
0.5 mg weeklyAs given in this study (human).
Measurements
Hemoglobin
12.9 g/dL
before
Hemoglobin
10.8 g/dL
after
Source sentences
Summary
Hemoglobin fell from 12.9 g/dL (Système International [SI]: 129 g/L) to 10.8 g/dL (SI: 108 g/L) (reference range, 12.0-16.0 g/dL [SI: 120-160 g/L]).
1 context sentence(design, population, supporting numbers)
Summary · context
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109402
03HumanCase report or seriesSafety outcome
In a postmenopausal woman on semaglutide, serum FSH stayed in the postmenopausal range without hormonal reactivation.
In plain wordsIn one postmenopausal woman on semaglutide, hormone tests stayed in the postmenopausal range.
Peptide
Semaglutide
Outcome
No significant changeSerum FSH
Study
n = 1
Outcome group
Sex hormones and fertility · Endocrine and hormones
Studied dose
0.5 mg weeklyAs given in this study (human).
Measurements
FSH
68.4 mIU/mL
serum
Source sentences
Summary
The serum follicle-stimulating hormone (FSH) concentration was elevated at 68.4 mIU/mL (SI: 68.4 IU/L; reference, >25 IU/L postmenopausal), and estradiol was suppressed at 3.5 pg/mL (SI: 13 pmol/L; reference, <5.4 pg/mL [SI: <20 pmol/L]), consistent with stable postmenopausal status throughout, without hormonal reactivation (no return toward a premenopausal pattern).
1 context sentence(design, population, supporting numbers)
Summary · context
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109403
04HumanCase report or seriesSafety outcome
In a postmenopausal woman on semaglutide, estradiol stayed suppressed in the postmenopausal range without hormonal reactivation.
In plain wordsIn one postmenopausal woman on semaglutide, estradiol stayed at a low postmenopausal level.
Peptide
Semaglutide
Outcome
No significant changeSerum estradiol
Study
n = 1
Outcome group
Sex hormones and fertility · Endocrine and hormones
Studied dose
0.5 mg weeklyAs given in this study (human).
Measurements
Estradiol
3.5 pg/mL
serum
Source sentences
Summary
The serum follicle-stimulating hormone (FSH) concentration was elevated at 68.4 mIU/mL (SI: 68.4 IU/L; reference, >25 IU/L postmenopausal), and estradiol was suppressed at 3.5 pg/mL (SI: 13 pmol/L; reference, <5.4 pg/mL [SI: <20 pmol/L]), consistent with stable postmenopausal status throughout, without hormonal reactivation (no return toward a premenopausal pattern).
1 context sentence(design, population, supporting numbers)
Summary · context
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109404
05HumanCase report or seriesSafety outcome
In a postmenopausal woman with bleeding, the Naranjo score for semaglutide was 6, rated probable.
In plain wordsIn one postmenopausal woman, a standard scale rated the link between semaglutide and bleeding as probable.
Peptide
Semaglutide
Outcome
Not applicableNaranjo adverse drug reaction probability score
Study
n = 1
Outcome group
Adverse events · Reproductive and sexual health
Studied dose
0.5 mg weeklyAs given in this study (human).
Measurements
Naranjo score
6 points
semaglutide
Source sentences
Summary
The Naranjo Adverse Drug Reaction Probability Scale score was 6 ("probable").
1 context sentence(design, population, supporting numbers)
Summary · context
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109405
06HumanCase report or seriesSafety outcome
In a postmenopausal woman, bleeding resolved completely within five weeks of semaglutide discontinuation.
In plain wordsIn one postmenopausal woman, the bleeding stopped within five weeks after semaglutide was stopped.
Peptide
Semaglutide
Outcome
DecreaseResolution of bleeding after discontinuation
Study
n = 1
Outcome group
Adverse events · Reproductive and sexual health
Studied dose
0.5 mg weeklyAs given in this study (human).
Source sentences
Summary
Bleeding resolved completely within five weeks of discontinuation.
1 context sentence(design, population, supporting numbers)
Summary · context
We report a 58-year-old postmenopausal woman with new-onset vaginal bleeding six weeks after starting semaglutide for weight reduction, with onset following dose escalation to 0.5 mg weekly.
Show in the study text Report a problemFND-4275109406

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Version history

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Version 2Current
11 Oct 2026, 00:04 UTC
Study results updated
Version 1
9 Oct 2026, 03:06 UTC
First added · source update from Europe PMC

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