Using GLP-1s for Obesity During Menopause: Benefits and Risks

For women with obesity, GLP-1 medications like Ozempic and Wegovy may help address the metabolic challenges that often intensify during midlife. The hormonal shifts of perimenopause and menopause can increase the risks of chronic diseases like diabetes and heart disease that GLP-1 drugs can help prevent or treat.

“Menopause isn’t a disease; it’s just a normal stage of life,” says Judi Chervenak, MD, a reproductive endocrinologist at Montefiore Health System in New York City. “However, as a woman matures, body fat increases and lean muscle decreases.” This shift makes metabolic complications even more likely.

GLP-1 medications may help improve key cardiovascular risk factors, such as cholesterol levels and abdominal fat. However, they aren’t without risks, some of which may be particularly relevant for women experiencing menopause, including gastrointestinal side effects and bone and muscle loss. Research on the interplay between menopause and these weight loss drugs is ongoing, so working with your doctor is essential when deciding whether these medications are right for you.

This pattern commonly starts in perimenopause, when estrogen levels drop and the body begins storing fat differently. “The body shifts from a pear shape to an apple shape, with more fat accumulating around the belly,” says Dr. Chervenak. This visceral fat settles around the organs and is associated with greater risks of inflammation, insulin resistance, and cardiovascular disease.

Hormone therapy isn’t intended for weight loss, but scientists continue to study whether it may affect how these medications work during the menopausal transition.

Heart disease can affect people at any stage of midlife, but a woman’s risk increases significantly after menopause. This rise is partly due to natural aging, but the drop in estrogen also plays a key role, says Chervenak.

Estrogen normally helps keep blood vessels flexible, so when levels fall, vessels can become stiffer, making them more prone to damage. And in blood vessels that are already less flexible or have cholesterol plaques, reintroducing estrogen in the form of hormone replacement therapy can increase the force and speed of blood flow with each heartbeat, sometimes causing a plaque in a vessel to break off and raising the risk of serious problems like heart attack, stroke, or blood clots, says Chervenak.

As women navigate the menopausal transition, their ovaries produce less 17-beta-estradiol, the body’s primary form of estrogen, says Chervenak. “When estrogen levels drop, bad cholesterol (LDL and triglycerides) tends to rise, good cholesterol (HDL) can fall, and insulin resistance increases,” she says.

GLP-1 medications can help counter these changes. “They help you feel full, slow gastric emptying, and support weight loss, in turn improving blood sugar control, pancreatic efficiency, and insulin response,” says Chervenak.

Blood pressure often becomes harder to manage during menopause as well. Since estrogen helps keep blood vessels flexible, arteries can stiffen when levels drop, resulting in a rise in blood pressure that forces the heart to work harder.

Rapid weight loss with GLP‑1 medications affects more than just body fat; it also reduces fat-free mass, including muscle, bone, connective tissue, and fluids. Typically, about 75 percent of weight loss comes from fat, with roughly 25 percent coming from fat-free mass, says Sriram Machineni, MD, an endocrinology, diabetes, and metabolism expert at Montefiore Health System in New York City.

Menopause already increases a woman’s risk of muscle loss (sarcopenia) and bone thinning (osteoporosis), so women using GLP‑1 medications during this transition should be especially vigilant. “Weight plays a tremendous role in bone density,” says Chervenak. “Women who lose large amounts of weight are at an increased risk for bone loss.”

Muscle loss is also a concern, particularly when physical activity is low, as there’s less stimulus for muscles to grow, says Dr. Machineni.

To minimize the risks of bone and muscle loss, experts recommended focusing on both protein intake and strength training.

Not eating is particularly risky during midlife. Menopause brings an enhanced need for specific nutrients, like protein for muscle and calcium for bones, that must be prioritized even when your appetite is low, says Chervenak. Most people can manage or even avoid these side effects with a few strategies, including staying hydrated and eating small, vitamin- and protein-rich meals throughout the day, even when the medication reduces your appetite.

Because GLP-1 receptors influence mood and factors like blood sugar, appetite, and sleep, and because rapid body changes also play a role, experiences vary widely. That’s why doctors stress pairing these medications with balanced nutrition, healthy lifestyle habits, and regular check-ins regarding your mood.

“I’ve had many patients thank me, saying they feel like they’ve gotten their lives back,” says Chervenak. “They’re sleeping better because they’re happier, and they feel like themselves again.”

She reminds patients, though, that medication alone isn’t enough. “This medication isn’t going to be the cure for everyone,” she says. “Without changing diet and lifestyle, these drugs aren’t going to work.”

• GLP-1 medications like Wegovy and Zepbound can help women combat weight gain and body composition changes often triggered by the hormonal shifts of perimenopause and menopause.
• These drugs may also improve heart health in perimenopausal and menopausal women by lowering blood pressure, reducing LDL cholesterol, and increasing insulin sensitivity, counteracting the increased risk of heart disease that occurs as estrogen levels decline.
• A primary concern for menopausal GLP-1 users is the potential for accelerated bone thinning and muscle loss, which is why experts emphasize the necessity of a high protein intake and consistent strength training to mitigate these risks.
• While GLP-1s can offer significant metabolic relief and even mood improvements in some users, doctors stress that they must be paired with healthy lifestyle habits and medical supervision to function optimally.