Kate, a 54-year-old hairstylist from New York, found herself grappling with night sweats, unpredictable mood swings, and notably, hair loss when she visited her doctor in her late 40s. She received an estrogen patch, and it helped her regain her sense of self. “I felt like myself again,” she recalls. “I could sleep better, my mood stabilized, but I still struggled with my weight.” No matter how healthy she ate or how much she exercised, that stubborn extra weight lingered. Then she turned to Wegovy to help. Similarly, Shelby Meade, 55, a publicist in LA, found that while estrogen managed her lengthy periods, it didn’t tackle her chronic bloating. “I was the heaviest I’d ever been, with constant pressure in my abdomen,” she shared. She also led a healthy lifestyle, and after her family doctor suggested Wegovy, she felt it was a turning point. “It completely changed everything for me.”
While symptoms like hot flashes and night sweats frequently dominate menopause discussions, weight gain is equally common. About 60 percent of women experience weight increases during this period, averaging 1.5 pounds each year in their 40s and 50s. “I see around 16 patients daily, and nearly all mention weight gain,” notes Dr. Tara Iyer, who oversees the Menopause and Midlife Clinic at Brigham and Women’s Hospital in Massachusetts. “Many hadn’t struggled with weight before, yet find themselves gaining 15 to 20 pounds.” This increase can occur despite no shifts in diet or activity. “It’s quite an unfair situation,” Dr. Caroline Messer, an NYC endocrinologist, adds. Often, this weight gain settles in the abdomen, unflatteringly termed “meno belly.”
The phenomenon can be attributed to several factors. As estrogen levels, akin to collagen in our skin, drop sharply during midlife, it plays crucial roles related to weight and body composition. Specifically, it helps maintain muscle mass and regulates appetite and metabolism. “Women essentially lose muscle and gain fat, shifting where they store weight,” Dr. Iyer explains. Reduced estrogen also can result in insulin resistance, complicating sugar regulation, leading to glucose being converted into fat for many women.
The fight against excess midsection weight isn’t purely cosmetic; it also relates to health. Increased abdominal fat can lead to metabolic issues like fatty liver disease and hypertension. Dr. Reena Bose from the Cleveland Clinic highlights that a mere 10-pound gain can raise hypertension risk by nearly 30 percent. The American Heart Association identifies menopause as a critical period for women’s cardiovascular health.
GLP-1s, a drug class including semaglutide marketed as Ozempic and Wegovy, as well as tirzepatide like Mounjaro, “interact with estrogen receptors in the body and enhance insulin resistance,” states Dr. Judi Chervenak, a reproductive endocrinologist focused on menopause. They also delay gastrointestinal movement, which helps with the feeling of fullness. “This is crucial since many women feel hungrier during menopause,” Dr. Bose notes, emphasizing that estrogen balances hunger-related hormones like ghrelin and leptin. Given that hormonal fluctuations make weight gain tougher to tackle with conventional methods, Dr. Cabandugama suggests GLP-1s may offer significant support, as a recent study in the journal Obesity has shown.
There’s an increasing interest in using GLP-1s alongside traditional menopausal hormone treatment (MHT), which has long been recommended. Alloy Women’s Health, for instance, a digital platform dedicated to menopause care, introduced GLP-1s after initially offering estrogen patches and creams. “There was a clear demand from women,” cofounder Monica Molenaar noted. Presently, 35 percent of Alloy clients are on both GLP-1 and hormone treatments. Another service, Noom, which started as a weight management app, began providing semaglutide in 2023 and has recently expanded to include hormonal treatments.
“These medications address different issues yet complement each other, especially in reducing inflammation,” Dr. Karen Mann from Noom explains. Dr. Messer is an advocate for combining these approaches and suggests lower doses of tirzepatide, which may entail fewer side effects than semaglutide. A recent Mayo Clinic study highlighted that postmenopausal women who used both hormonal therapy and semaglutide lost around 30 percent more weight than those on semaglutide alone. Chrisandra Shufelt, a women’s health specialist at the Mayo Clinic and a study author, insists these results don’t imply hormones boost semaglutide’s effects but rather help the body respond more effectively to medication. (A broader study is forthcoming.) Essentially, it makes sense: Disruptions from hot flashes, night sweats, mood changes, joint discomfort, and sleep issues can adversely affect quality of life and contribute to weight gain.
Some doctors remain cautious about prescribing GLP-1s to those who don’t meet specific criteria. “There’s a need for caution against indiscriminately prescribing these medications,” Dr. Chervenak points out. “They aren’t without risks.” Common side effects of GLP-1s include gastrointestinal discomfort, nausea, and abdominal pain, so it’s important for women to discuss any risks with their healthcare providers before beginning treatment.
