It was night sweats, wild mood swings, and, ironically, significant hair loss that first sent Kate, 54, a New York–based hairstylist, to her doctor in her late 40s looking for relief; she was prescribed an estrogen patch. “It made me feel like myself again,” says Kate, whose name has been changed to protect her privacy. “I was sleeping, I wasn’t losing my temper, and my mood really evened out, but I was still overweight.” Despite a healthy diet and regular exercise, there were a dozen or so pounds that just wouldn’t budge. So she started taking Wegovy, part of a new class of medications known as GLP-1s, now being explored for menopausal weight gain. For Shelby Meade, 55, an LA-based publicist, regular doses of estrogen helped temper her sometimes 30-day periods but did nothing for her perpetually bloated state. “I was heavier than I’d ever been and there was a constant pressure on my lower abdomen,” says Meade, who, like Kate, exercised regularly and had a healthy diet. A family doctor suggested Wegovy. “I just wanted to feel better in my body, and that flipped a switch,” says Meade. “It was a game changer.”
While vasomotor symptoms like hot flashes and night sweats are recurring topics in conversations about menopause, weight gain is just as pervasive: Around 60 percent of women gain weight during this transition, putting on an average of 1.5 pounds per year throughout their 40s and 50s. And that will happen to women without any changes in diet or exercise. Much of that midlife weight gain tends to be concentrated in the midsection, earning the unfortunate moniker “meno belly.”
This happens due to a combination of factors. Estrogen has many important functions related to weight and body composition: It helps women maintain muscle mass, and it contributes to the regulation of appetite and metabolism. A drop in estrogen can lead to insulin resistance, meaning that it becomes more difficult for the body to regulate sugar, and for many women that glucose gets turned into fat.
Addressing excess weight around the midsection isn’t just about vanity, it can pose a health risk: Associated metabolic complications can include fatty liver disease and hypertension, the latter of which, says Reena Bose, MD, an internal medicine and obesity medicine specialist at Cleveland Clinic, increases almost 30 percent with even a 10-pound weight gain.
The hormonal changes of menopause can make the weight gain more resistant to traditional diet and lifestyle adjustments, says Peminda Cabandugama, MD. But studies have found that GLP-1s can be a very effective reinforcement of diet and exercise.
GLP-1s—that is, the class of drugs that includes semaglutide, packaged in brand-name form as Ozempic and Wegovy, and tirzepatide, like Mounjaro—act on estrogen receptors in the body, and they improve insulin resistance. They also slow GI motility so you feel full. That last part “can be essential because women are often simply hungrier during the menopause transition,” says Bose, adding that estrogen is also responsible for keeping the body’s hunger-balancing hormones, ghrelin and leptin (which tell us when we’re full), in check.
Research is also growing about the potential benefits of combining GLP-1s with the menopausal hormone treatment(MHT) that has long been recommended, and there are new companies to support the regimen. Alloy Women’s Health, an expansive digital menopause platform that connects board-certified physicians to women across the country (a boon in health care deserts), launched with estrogen creams and patches, but earlier this year they started offering GLP-1s as well. “Women really wanted it,” says Monica Molenaar, cofounder and co-CEO of Alloy. Now 35 percent of Alloy’s customers are on both a GLP-1 and hormonal treatment.
A recent study by the Mayo Clinic found that overweight or obese postmenopausal women using hormonal treatments and semaglutide lost about 30 percent more weight than those using semaglutide alone. Chrisandra Shufelt, MD, an internal medicine doctor specialising in women’s health at the Mayo Clinic and one of the authors of the study, emphasizes that the findings don’t necessarily mean that hormone therapy supercharges the effects of semaglutide, but rather that hormones help the body respond more optimally to the drugs. (A larger study is expected to be published soon.) In lay terms, it makes sense: Hot flashes, night sweats, mood shifts, joint pain, and sleep disruptions—all of that can dramatically impact your quality of life and, in turn, lead to weight gain.
There are doctors, of course, who remain conservative about prescribing GLP-1s to women who don’t fit a specific set of criteria. There are the common side effects of GLP-1s, like gastrointestinal issues, abdominal pain, and nausea, and women should assess their risk factors with their doctor before starting any treatment.
There is also the ever-present threat of the now infamous Ozempic face, which experts describe as rapid weight loss in the face and loss of skin elasticity, creating a significantly older appearance. “Ozempic face can look gaunt, deflated, and saggy,” New York facial plastic surgeon Jennifer Levine previously told Vogue. Something that would, then, exacerbate other symptoms of menopause and aging. Additionally, there’s growing claims from people who are noticing that Ozempic and similar GLP-1 drugs are affecting their hairlines, and possibly, causing muscle loss.
But there is also a growing sense that women no longer want to suffer silently. “We have this societal norm where we make women in particular wait until they get diseased or are in crisis before we say, ‘Here’s a treatment,’ ” says Alloy cofounder Molenaar. For some women the benefits of these drugs far outweigh any potential risks. Carolyn Chang, MD, 58, a plastic surgeon in San Francisco, experienced some of the expected negatives of Ozempic when she added it to her hormonal regimen but says it’s been worth it: Her mood has improved, her joint pain is gone, and she is no longer prediabetic. That threat of diabetes was part of the reason Chang decided to start taking Ozempic, but the other was, she admits, her appearance. “I’m a plastic surgeon so, yes, my presentation matters to me,” says Chang. Many women may feel shy to express it in such blunt terms, but put in other words, it has a straightforward appeal: There doesn’t need to be a divide between feeling better in one’s body and feeling better about it.
This article was first published on Vogue.com.
