• Female

• Ages 12-35 years

• Sedentary- less than 2 hours of moderate (jogging, swimming etc.) exercise a week.

• Oligomenorrhea, on or off metformin, as defined per age category in the most recent 2018 PCOS international guidelines

• Initial BMI based on age and weight:

‣ If \<18 years, initial BMI percentile ≥95

⁃ If 18-35 years, initial BMI ≥30 kg/m2 OR initial BMI ≥27 kg/m2 with at least one weight-related comorbid condition, e.g., hypertension or dyslipidemia

⁃ Must be weight stable within ±5kg in the 3 months prior to enrollment

• Diagnosed with PCOS per the most stringent NIH criteria with adaptation for adolescents (oligomenorrhea \>24 months post-menarche or primary amenorrhea after age 15 years and clinical/ biochemical hypertestosteronemia

• Participants cannot be on hormonal contraception, so participants should remain abstinent or use reliable non-hormonal contraception (e.g., copper IUD) for the entire study period. For participants who receive semaglutide, they should avoid pregnancy for at least 2 months after stopping medication to avoid fetal exposure to the medication.

• For participants in the metformin + semaglutide group, participants must have been stable on ≥ 1500 mg of metformin a day for at least 3 months by time of screening