Can GLP-1 Weight Loss Drugs Help Treat Menopause Weight Gain?

Weight gain is a common occurrence during menopause — and often an unwelcome one. The extra pounds, which usually appear around the belly, can be especially hard to shed.

But there’s good news for women who are battling their own menopausal weight gain. The new wave of injectable weight loss drugs — including semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) — may help some women fight against unwanted menopause weight gain.

“I see a lot of women in this phase of life who have worked out and been healthy their whole lives and are frustrated with the weight gain they’re experiencing now,” says Disha Narang, MD, an endocrinologist and the director of obesity medicine at Endeavor Health in Skokie, Illinois. “Starting medication is not a failure.”

What Causes Menopausal Weight Gain?

Women tend to notice some weight gain starting in the years leading up to menopause, a period called perimenopause, and it’s common for women to gain about 1.5 pounds each year of her fifties.

Menopause causes a significant and permanent shift in hormones. This altered hormone ratio is why menopausal weight gain usually collects around the belly, says Joanne Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center in Boston.

“That type of central distribution of body fat is associated with your body being less responsive to insulin, and that can contribute to trouble with weight loss,” she says. Female sex hormones, such as estrogen, also protect against insulin resistance; when menopause leads to declining estrogen levels, weight gain often follows, and the risk of conditions such as type 2 diabetes and metabolic syndrome rises.

At the same time, both women and men experience a slowing metabolism as they get older, says Dr. Dushay, an additional cause of weight gain in the forties and beyond.

Can Tirzepatide and Semaglutide Help With Menopausal Weight Gain?

It is well known now that glucagon-like peptide-1 receptor agonists (GLP-1s) are highly effective weight loss treatments. These drugs, particularly semaglutide and tirzepatide, help people lose weight in several ways, primarily by suppressing the appetite and slowing intestinal transit. GLP-1s don’t work for everybody, but most users who are overweight or have obesity find themselves eating less food and shedding pounds.

Though many postmenopausal women have taken part in large GLP-1 weight loss trials, very little study has concentrated on how the drugs affect them in particular. One 2024 analysis of about 100 postmenopausal women found that semaglutide drove significant weight loss and improvement in cardiovascular risk factors; the benefits were even stronger for the subset of women who were receiving hormone therapy for menopause.

GLP-1 drugs help reduce fat mass all over the body — including the belly fat that is so common in menopause. They “definitely result in decreased abdominal/visceral fat,” says Dushay. GLP-1s are also known to directly improve insulin resistance, which could potentially combat some of the effects of menopause’s hormonal changes.

To put it simply, there’s no reason to suspect that GLP-1s would be any less effective for women at this stage of life than they are for anyone else: “I wouldn't say there is a physiological argument for postmenopausal women responding in a less robust way to GLP-1 agonists,” says Dushay.

At the same time, Dushay cautions that postmenopausal women using a new GLP-1 drug shouldn’t necessarily expect extraordinary weight loss. “I would say the postmenopausal women I treat are not typically super responders,” she says.

GLP-1 Drugs and Risks for Postmenopausal Women

Older women have a few extra factors to consider when they begin taking a GLP-1 drug.

Dushay says that some users need to be particularly careful about bone and muscle loss as they’re losing weight with a GLP-1. Body composition changes with age — muscle mass and bone density tend to peak in our thirties, after which they steadily decline. Menopause accelerates these declines. The loss of muscle mass and bone density associated with menopause can lead to both sarcopenia (serious muscle loss) and osteoporosis (fragile bones).

Narang says when a person loses a substantial amount of weight, they don’t just lose fat, they also lose muscle and bone mass. Weight loss drugs, therefore, can exacerbate the natural muscle and bone density loss in postmenopausal women.

“You have to take active steps to maintain your muscle mass as you age,” Dushay says. “That is especially true with a medication such as a GLP-1 agonist that has the potential to cause significant and at times rapid weight loss.”

“Something we emphasize with medical weight management is the importance of resistance exercise,” Narang says. Adding weight training or body weight exercises to your workout routine as you age is important for everyone, but especially people who use weight loss drugs. Eating enough protein can help preserve lean muscle mass, too.

“At the end of the day, the medication is just a resource and the lifestyle aspect — exercising and eating well — is incredibly important to sustain over time,” she says.

The Takeaway

• Menopause and aging often bring weight gain, particularly around the belly, that can seem especially difficult to lose.
• GLP-1 weight loss medications such as semaglutide (Wegovy) and tirzepatide (Zepbound) are an effective way to lose weight, and there is no reason to suspect that they don’t work for postmenopausal women.
• GLP-1 drugs should always be supported with healthy diet and exercise habits, perhaps especially when used by older women.