Thinking About GLP-1 Medications During Menopause? Here's What You Need to Know

If you've been scrolling through your social media feed lately, you've probably seen plenty of talk about GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound. These medications are everywhere right now, especially in conversations about weight loss and diabetes management. And if you're in perimenopause or menopause and feeling frustrated that nothing seems to be working anymore, I completely understand why these medications might sound appealing.

The menopause transition brings changes that can make you feel like your body is working against you: increased appetite and cravings, stubborn weight gain (especially around your middle), worsening insulin resistance, and increased risk of Type 2 diabetes and cardiovascular disease. GLP-1 medications work by affecting the signals between your gut and brain that control hunger, appetite, and satiety. They help you feel less hungry, more satisfied after eating, and slow down stomach emptying to help control blood sugar. For women dealing with the relentless food noise and increased cravings that often come with menopause, that can sound like exactly what you need.

But here's the thing I want you to understand: these medications can be a helpful tool, but they're not a magic solution. And for women navigating hormonal changes, there are some specific considerations you need to know about before jumping in.

Why Women at Menopause Might Be Interested in GLP-1 Medications

Before we dive deeper into what you need to know, let's acknowledge why these medications might seem appealing at this stage of life.

Metabolic health changes. Around menopause, your risk of cardiometabolic health issues like high blood pressure and cardiovascular disease increases due to hormonal changes, accumulation of visceral fat, and aging. Blood sugar control can worsen, insulin resistance increases, and your risk of developing Type 2 diabetes rises. GLP-1 medications were originally developed to treat Type 2 diabetes and are showing promise for cardiovascular health as well.

The appetite and craving chaos. The transition to menopause often changes how you experience hunger, appetite, and satiety. This can be a direct result of changing sex hormones, but it's also a secondary effect of poor sleep (which is incredibly common during menopause). Many women feel hungrier at midlife and notice more intense cravings. The constant food noise can be exhausting. Because GLP-1 medications affect the gut-brain circuits that influence hunger and appetite, they can help quiet that noise and give you a break from feeling constantly hounded by cravings.

Weight and body composition frustration. You might be doing everything you used to do that worked in your 30s, but now nothing seems to make a difference. The scale is creeping up, your clothes don't fit the same, and you feel like you're fighting an uphill battle. These medications can help with losing weight and visceral abdominal fat, and they can improve insulin sensitivity.

I want you to know: I get it. I understand why these medications seem like they could solve the problems you're facing. And for some women, in the right circumstances with comprehensive support, they can be a helpful tool. But they're not a substitute for addressing the root causes of what's happening in your body during this transition.

Why the Medication Alone Isn't Enough

Research shows that GLP-1 medications work best when combined with lifestyle support. A study presented at the 2023 Obesity Week annual meeting found that when these medications were paired with one-on-one coaching, small lifestyle adjustments, and tracking tools, participants achieved an average weight loss of 15.6% over 12 months, with results maintained up to 24 months.

That's impressive, right? But here's what they don't tell you in the advertisements: without those lifestyle changes and ongoing support, weight regain is extremely common once you stop taking the medication. And let's be real, most people don't want to be on these medications forever.

The other concerning issue? Right now, fewer than 2% of qualifying adults actually receive these medications paired with the lifestyle intervention support they need to maintain weight loss. Between insurance barriers, high costs, and doctors who aren't trained in comprehensive obesity management, most people are getting the prescription without the support system that makes it actually work long-term.

This is where specialized coaching makes all the difference.

The Muscle Loss Problem (This Is Critical for Menopausal Women)

Here's something you absolutely need to know: rapid weight loss from GLP-1 medications can lead to significant muscle loss. Research shows that about 15-20% of weight lost with these medications is muscle mass. In general diet studies, people may lose as much as half of their weight as lean body mass, which includes skeletal muscle. Without resistance training and adequate protein, up to 35% of the weight you lose could be muscle, not just fat.

And for women in perimenopause and menopause? This is a massive concern.

You're already dealing with declining estrogen levels that naturally lead to muscle loss (women lose about 3-8% of muscle mass per decade after age 30, and this accelerates at menopause). You're also already at increased risk for bone density loss. The last thing you need is to accelerate that process with rapid weight loss that strips away even more muscle and bone.

Losing muscle doesn't just slow your metabolism and make weight regain more likely. For women at midlife, muscle loss means:

• Dramatically increased risk of osteoporosis and fractures. About 40% of women will have an osteoporotic fracture after menopause. Hip fractures increase your risk of early death by 15-20% within a year.

• Reduced strength and mobility as you age. This affects your quality of life and independence.

• Lower metabolic rate. Making it even harder to maintain weight loss and body composition.

• Worse menopause symptoms. Research shows that maintaining muscle mass is associated with fewer hot flashes, better sleep, less pain, and better overall quality of life.

• Increased risk of falls and injuries. Loss of muscle affects balance, stability, and bone strength.

This is why strength training isn't optional if you're considering these medications. It's absolutely essential. You need to actively work to preserve and build muscle mass while you're losing weight, or you're setting yourself up for serious problems down the road.

What Actually Supports Long-Term Success

If you're considering GLP-1 medications, or if you're already taking them, here's what needs to be part of your approach:

Hormone-Smart Nutrition

The medication will reduce your appetite, which sounds great until you realize you might not be eating enough to support your body's needs. Research shows that people taking GLP-1 medications often eat 16-39% fewer calories each day. That's a significant reduction.

Here's the challenge: If you're eating a lot less food, it's really easy to miss out on key vitamins and minerals that are especially important during menopause. We're talking about calcium and vitamin D for bone health, iron, magnesium, zinc, B vitamins, and vitamins A, C, E, and K. Many of these nutrients are crucial for maintaining bone density, supporting energy levels, and managing menopause symptoms.

The protein challenge gets even trickier: During menopause, your protein needs actually increase (research suggests 0.64-1.0 grams per pound of body weight daily, or about 1.4-2.2 grams per kilogram). You need this protein to combat the muscle loss that's already happening due to declining estrogen. But many people on GLP-1 medications report developing food aversions, particularly to high-protein foods like meat. Some describe it as "meat ick" where foods that used to be appealing now taste metallic or just feel unappealing. This makes it even harder to get the protein you desperately need.

You need to prioritize high-quality protein at every meal: lean meats, fish, eggs, beans, lentils, tofu, quinoa, Greek yogurt. This isn't about restriction; it's about nourishment and protecting your muscle and bone mass.

Beyond protein, you need:

• Balanced meals with healthy fats and fiber-rich carbohydrates to keep blood sugar stable and energy consistent

• Fiber and fermented foods to support gut health (which is often already compromised during menopause and can be further affected by these medications)

• Adequate hydration. This is critical because GLP-1 medications can affect your thirst mechanism, making you less thirsty and more at risk for dehydration. You might need to be more intentional about drinking water throughout the day, even when you don't feel thirsty.

The digestive issue you need to know about: These medications can cause nausea, vomiting, diarrhea, and constipation, especially when starting or increasing doses. This happens because they slow down stomach emptying and affect gastrointestinal motility. The problem? Many women already experience digestive changes during menopause due to hormonal shifts. Adding medication side effects on top of existing bloating and sluggish digestion can compound the problem, making it even harder to get adequate nutrition and potentially worsening the quality of life issues you're already dealing with.

Strength Training (Non-Negotiable for Menopausal Women on GLP-1s)

I cannot emphasize this enough: resistance training is critical when you're in menopause, and it's absolutely essential if you're using GLP-1 medications.

Here's what's at stake: women lose 3-8% of muscle mass per decade after age 30 if they don't stay active, and this loss accelerates during the menopause transition. When you combine natural age-related muscle loss with the accelerated muscle loss from rapid weight loss on medications, you're facing a perfect storm for losing the muscle and bone mass that keeps you strong, independent, and healthy as you age.

The good news? Strength training combined with adequate protein can actually reverse age-related muscle loss, even after menopause. Yes, it's possible for women in their 50s, 60s, and beyond to build muscle. It's more challenging than at 25, but it's absolutely possible.

You need to be doing resistance training at least 2-4 times per week. This means lifting weights, doing bodyweight exercises, or using resistance bands. This isn't about getting bulky (you don't have the hormonal profile for that). This is about:

• Protecting and potentially increasing your bone density. Studies show that strength training can actually increase bone density in postmenopausal women, not just slow the loss. This dramatically reduces your risk of osteoporosis and fractures.

• Preserving and building muscle mass to protect your metabolism and functional strength

• Improving insulin sensitivity and helping reduce stubborn belly fat

• Reducing menopause symptoms. Research shows strength training is associated with fewer hot flashes and night sweats, better sleep, less pain, and improved quality of life.

• Maintaining independence and quality of life for decades to come. Building strength now means you can continue doing everything you love without limitation.

If you're new to strength training, start gradually and focus on consistency over perfection. Aim for full-body routines with compound movements (like squats, deadlifts, rows, and presses). Do at least 8 sets per muscle group per week. Train until you're close to failure (1-2 reps in reserve) on at least one set per movement. The goal is to make this a sustainable part of your life, not something you do for a few weeks and then quit.

Addressing the Emotional Side

Here's what the medication can't fix: your relationship with food, emotional eating patterns, stress responses, body image struggles, and the identity shifts that come with menopause.

If you've been using food to cope with stress, boredom, anxiety, or the emotional upheaval of this life transition, the medication will suppress your appetite but it won't address why you're eating when you're not hungry. Those patterns will still be there, waiting to resurface.

This is where mindset work and emotional support become crucial. You need strategies for:

• Recognizing emotional eating triggers

• Developing healthier coping mechanisms

• Building a positive relationship with food and your body

• Practicing self-compassion through the changes

• Honoring your hunger and fullness signals

Many women also struggle with body image as their bodies change during menopause. The number on the scale might go down with the medication, but if you haven't done the internal work, you'll still be battling the same negative self-talk and dissatisfaction.

Tracking Your Experience

If you decide to try these medications, one of the most valuable things you can do is collect data about your experience. This is a strategy I recommend for anyone experiencing perimenopausal symptoms, and it's especially important if you're taking medications.

Track things like:

• Metabolic health indicators (if you're comfortable with this, track changes in body weight, measurements, how clothes fit)

• Lifestyle behaviors (sleep quality, food intake, energy levels, exercise)

• Any symptoms related to menopause or medication side effects

• How you're feeling mentally and emotionally

This data helps you gain insight into what's going on in your body and sets you up to have productive conversations with your healthcare providers and coach. It helps you see what's working, what's not, and what adjustments might be needed.

Working With Your Healthcare Team

These medications require medical supervision. You should have a doctor who understands obesity management and menopause, and potentially a therapist if emotional eating or disordered eating patterns are present.

As a coach, I work alongside your medical team to provide the nutrition and lifestyle support that makes these medications actually work long-term. I don't prescribe or manage medications, but I help you build the daily habits, mindset shifts, and nutrition strategies that support your success. I help you navigate the side effects, stay consistent with your strength training, optimize your protein intake and meal planning for your hormonal stage, and address the emotional patterns that medication alone can't fix.

A key part of coaching is helping you shift to self-supportive eating patterns. This might be a major change if you're used to eating patterns that were automatic or reactive (based on the demands of work or caregiving), or if you've spent years focused on diet culture and "just getting skinny" rather than truly caring for your body.

During this menopause transition, you need to move into a new and more self-supportive way of thinking about food. Instead of restriction and deprivation, we focus on eating in a way that:

• Supports your changing hormonal needs

• Provides adequate protein to preserve muscle

• Gives you enough energy to function well and train effectively

• Addresses nutritional needs while taking medications that reduce appetite

• Honors your body's signals while building sustainable habits

If I see signs of disordered eating or unhealthy patterns developing, I'll refer you to the appropriate specialists. Your safety and well-being always come first.

The Real Question: What Happens When You Stop?

This is the conversation nobody's having enough: what's your plan for when you stop taking the medication?

Because here's the reality: if you haven't built sustainable habits around nutrition, strength training, stress management, and emotional health, the weight will likely come back. And it might come back faster than it left.

The goal isn't just to lose weight while you're on the medication. The goal is to use this window of reduced appetite to build habits and skills that will serve you for the rest of your life. To learn what truly nourishing yourself looks like. To develop strength and resilience, both physical and mental. To address the root causes of weight gain and metabolic dysfunction, not just suppress the symptoms.

My Approach for Menopausal Women Considering GLP-1s

If you're thinking about these medications, I want you to go into this with your eyes wide open and a comprehensive support system in place.

Here's what I recommend:

Before you start: Get clear on your "why." What do you actually want from this? Is it just a number on the scale, or is it energy, strength, confidence, and vitality? Make sure you're working with a doctor who understands menopause and obesity management, not someone who's just writing prescriptions.

While you're taking it: Commit to the lifestyle piece just as much as the medication. Prioritize protein at every meal. Start or continue strength training consistently. Work on your mindset and relationship with food. Track more than just your weight (energy levels, strength gains, how your clothes fit, symptom improvements, sleep quality). Stay connected with your support system and coach.

As you transition off: Have a plan. Don't just stop cold turkey and hope for the best. Work with your healthcare team and coach to gradually taper off while maintaining the habits you've built. This is where the real work pays off.

You Deserve Comprehensive Support

The bottom line is this: GLP-1 medications can be a useful tool for some women, but they're not a substitute for addressing the underlying factors that affect your metabolic health during menopause.

Your changing hormones, declining muscle mass, increased insulin resistance, sleep disruption, stress levels, and emotional relationship with food all need attention. The medication might help you lose weight in the short term, but without comprehensive support, you're likely setting yourself up for frustration and weight regain.

You deserve better than that. You deserve an approach that treats you as a whole person, not just a number on a scale. An approach that recognizes your unique hormonal situation and supports you in building strength, vitality, and sustainable habits that will serve you for decades to come.

If you're considering GLP-1 medications and want support that goes beyond the prescription, I'm here to help you navigate this journey with compassion, evidence-based strategies, and a focus on your long-term health and well-being.

Want to learn more about building a sustainable approach to health during menopause, with or without medication? Let's talk about how personalized coaching can support you in creating lasting transformation that doesn't depend on a prescription bottle. Book a free Menopause Body Reset Strategy Session today.