*Content reviewed by HotPause Health medical advisor and Obesity and Family Medicine physician, Dr. Sejal Desai.

Exploring GLP-1s for Weight Management in Perimenopause and Menopause

Navigating the hormonal shifts during perimenopause and menopause can be challenging, especially when it comes to managing weight gain—a common concern for many women during this stage. One potential solution lies in the use of glucagon-like peptide-1 (GLP-1) receptor agonists, a class of medications that has transformed the approach to weight management and blood sugar control. You probably recognize brand names like Ozempic, Wegovy, Mounjaro, Zepbound or the generic name semaglutide or tirzepatide.Here’s what you need to know about GLP-1s, their benefits, risks, and considerations for women in perimenopause and menopause.

What Are GLP-1s?

GLP-1 receptor agonists, commonly referred to as GLP-1s, are a type of medication initially designed to treat Type 2 diabetes. GLP-1 medications work by imitating a natural hormone in your body that helps regulate blood sugar. They help your body release more insulin when needed, block a hormone that raises blood sugar, slow down how quickly your stomach digests food, and make you feel fuller longer. They can also help quiet “food noise”: the thoughts you have about food, when you’re going to eat, what you’re going to eat, and how much you’re going to eat. These actions help control blood sugar levels and support weight loss.

The Top Potential Benefits of GLP-1s in Menopause

• Weight Management: GLP-1s have shown significant efficacy in weight reduction, with patients experiencing a reduction of 5% to 20% of their body weight. This effect is achieved through the medication’s ability to enhance feelings of fullness and reduce appetite, making them particularly useful for women who struggle with weight gain during menopause.
• Improved Blood Sugar Control: Our risk for insulin resistance increases in perimenopause, which can lead to Type 2 diabetes; therefore, GLP-1s can help manage blood sugar levels effectively, reducing the risk of diabetes-related complications.
• Cardiovascular Health: Some GLP-1s have been noted to improve cardiovascular outcomes, which is vital as heart disease risk increases after menopause.

Potential Risks and Side Effects of GLP-1s in Menopause

While GLP-1s offer significant benefits, they are not without risks. Common side effects include gastrointestinal issues such as nausea, vomiting, and constipation. More serious but rare side effects can include gallbladder and pancreatic disease. It’s also crucial to note that rapid weight loss with or without the use of GLP-1s can exacerbate the loss of muscle mass and bone density, already a concern during menopause.

Considerations Before Starting GLP-1s in Menopause

Consultation and Monitoring: Before starting any GLP-1 regimen, it’s essential to consult with a healthcare provider who understands your overall health, menopausal symptoms, and medical history. Continuous monitoring is also crucial to adjust doses and manage any side effects.

Lifestyle Integration: GLP-1s work best when integrated with a healthy diet and exercise regimen. Women in perimenopause should focus on increasing protein intake and engaging in resistance training to counteract muscle and bone density loss.

Cost and Accessibility: Consider the cost and accessibility, as these medications can be expensive and sometimes not covered by insurance unless prescribed for diabetes. Your provider should also discuss other potential options if cost is a barrier. 

Who Should NOT Take GLP-1s

• People with a history of medullary thyroid carcinoma (MTC): In previous studies on mice, GLP-1s were shown to stimulate thyroid C-cell tumors, therefore, they are contraindicated in patients with a personal or family history of MTC.
• Individuals with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2): This is a genetic disorder that increases the risk of certain types of tumors, including thyroid cancer, making GLP-1s potentially unsafe for these individuals.
• People with a history of severe gastrointestinal diseases: Those with conditions like gastroparesis (delayed stomach emptying) or inflammatory bowel disease may experience worsening symptoms due to GLP-1s’ effects on gastric motility.
• Pregnant or nursing women: The effects of GLP-1s on pregnancy and nursing infants are not well-studied, so they are generally not recommended during these periods.
• Individuals with pancreatitis history: GLP-1s have been associated with an increased risk of developing pancreatitis, so those with a history of this condition should avoid these medications.

The Bottom Line

GLP-1s represent a promising tool for managing some of the more challenging aspects of menopause, particularly weight gain. However, like any medication, they require thoughtful consideration and should be used under the guidance of a knowledgeable healthcare provider. With the right approach, GLP-1s can be a valuable part of a comprehensive strategy to manage menopause weight gain.