Background/Objectives: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, characterised by hyperandrogenism, ovulatory dysfunction, and metabolic disturbances. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), has emerged as a promising therapeutic option for weight management and metabolic optimisation in PCOS. This scoping review evaluates the efficacy and safety of semaglutide in women with PCOS, with pre-specified primary outcomes (weight loss, metabolic parameters) and secondary outcomes (menstrual cyclicity, hormonal regulation, ovarian function, safety). Methods: A systematic literature search was conducted across four electronic databases (SciSpace Deep Search, SciSpace Full Text, Google Scholar, and PubMed) from inception through July 2026. Studies were included if they evaluated semaglutide in women with confirmed PCOS and reported outcomes related to weight loss, hormonal regulation, metabolic parameters, ovarian function, or safety. Two independent reviewers screened 356 unique records; 28 reports were assessed for eligibility, of which full-text access was confirmed for 5, and the remaining 23 were assessed using published abstracts or conference summaries. Two additional records were subsequently excluded due to unverifiable source identification, yielding a final corpus of 25 studies. The review adhered to the PRISMA-ScR reporting guidelines. Results: Twenty-five studies met the inclusion criteria. Semaglutide produced clinically relevant weight reduction (mean 7.6-11.5 kg over 3-6 months; ≥5% weight loss in approximately 80% of patients in responsive cohorts) with concurrent improvements in fasting insulin and HOMA-IR, based predominantly on observational and small-sample study designs. Improvements in menstrual regularity were reported by several studies; however, these data derive largely from conference abstracts or small pilot studies and should be interpreted cautiously. Gastrointestinal adverse events were the most frequent side effects, generally mild-to-moderate and transient. Important safety considerations include gallbladder disease, pancreatitis, and the risk of inadvertent pregnancy exposure following the potential restoration of ovulatory function; semaglutide must be discontinued before planned conception. Conclusions: Based on preliminary evidence from heterogeneous and predominantly low-quality studies, semaglutide shows potentially beneficial effects on weight, metabolic health, and menstrual regularity in women with PCOS. Confirmatory data on ovulation rates, reproductive outcomes, and long-term safety from large-scale RCTs with standardised endpoints are needed before definitive clinical recommendations can be made.
