GLP-1 Medication and the Menopause

GLP-1 medicines such as Mounjaro (tirzepatide) and Wegovy (semaglutide) can be prescribed to women during and after the menopause if they meet the usual weight management criteria. They are not licensed specifically for menopause-related weight gain and do not treat menopausal symptoms such as hot flushes. Many women take them alongside HRT. Important considerations include contraception during the perimenopause, protecting bone and muscle, and making sure both your menopause care and your weight management are reviewed by a prescriber.

How the menopause affects weight

The menopause is when periods stop permanently, usually between 45 and 55 in the UK. The years leading up to it, the perimenopause, can last for several years and bring irregular periods and fluctuating hormone levels. The NHS lists common symptoms including hot flushes, night sweats, difficulty sleeping, low mood or anxiety, brain fog, joint aches and vaginal dryness.

Weight change is one of the most frequently reported concerns. Several things happen at once:

• Fat distribution shifts. As oestrogen falls, fat tends to be stored more around the abdomen and internal organs (visceral fat) rather than the hips and thighs. Visceral fat is more strongly linked with type 2 diabetes and heart disease.
• Muscle mass declines. Ageing brings gradual loss of muscle, which reduces the energy the body uses at rest.
• Sleep is disrupted. Night sweats and insomnia can affect appetite-regulating hormones, energy levels and motivation to be active.
• Life changes. Midlife often brings caring responsibilities, work pressures and changes in routine.

Research on women followed through the menopause has found that the increase in abdominal fat is linked to the hormonal transition, while overall weight gain is linked more to ageing and lifestyle. The practical result is that many women notice a change in body shape even if their weight changes little, and find that approaches that used to work are less effective.

None of this means weight gain is inevitable, or that medication is always the answer. But it helps explain why some women find weight management harder in midlife, and why some consider medical treatment.

Who can be prescribed GLP-1 medicines

GLP-1 medicines are licensed in the UK for adults who meet BMI criteria, alongside a reduced-calorie diet and increased physical activity. For Mounjaro and Wegovy, this typically means a BMI of 30 or above, or 27 or above with at least one weight-related health condition, with lower thresholds often considered for people from some ethnic backgrounds. Our guide to who can get weight loss injections explains the criteria, and our BMI calculator can give you a starting point, although it cannot tell you whether treatment is right for you.

Menopausal status does not change eligibility. A woman going through the menopause is assessed in the same way as anyone else. What it does change is the wider picture a prescriber should consider: contraception, HRT, bone health, mood and other medicines.

NHS and private routes

On the NHS, Wegovy is available through specialist weight management services under NICE TA875, and Mounjaro is being introduced in primary care in phases under NICE TA1026, starting with people with the highest clinical need. Privately, these medicines are prescribed through regulated online pharmacies, online doctor services and clinics. Our guide to private vs NHS weight loss treatment compares the two routes.

What the evidence says

Trials in women of menopausal age

The large weight-loss trials did not focus specifically on menopausal women, but they enrolled many women in their forties, fifties and sixties. SURMOUNT-1, which tested tirzepatide, and the STEP trials, which tested semaglutide, had majority-female populations with an average age in the mid-forties, so a substantial proportion of participants would have been perimenopausal or postmenopausal. Weight loss in these groups was broadly consistent with the overall trial results, although analyses by menopausal status are limited.

HRT and GLP-1 medicines together

The question of whether HRT changes the response to GLP-1 treatment has attracted interest.

A retrospective study by Hurtado and colleagues at the Mayo Clinic, published in the journal Menopause in 2024, looked at the medical records of around 100 postmenopausal women with overweight or obesity who had taken semaglutide for at least three months. Women who were also using menopausal hormone therapy were more likely to achieve at least 10% weight loss at 12 months than those who were not. The same research group later reported a similar pattern in women taking tirzepatide.

There is a plausible biological reason why the two might work together. Oestrogen influences fat distribution, insulin sensitivity and muscle, and some research suggests HRT may reduce the build-up of abdominal fat during the menopause. However, the extent to which this adds to GLP-1 treatment in practice is uncertain.

Do GLP-1 medicines help menopausal symptoms?

At the time of writing, there is no good evidence that GLP-1 medicines treat hot flushes, night sweats or other menopausal symptoms directly. Some research links higher body weight with more troublesome hot flushes, so weight loss might ease symptoms for some women, but this has not been tested properly for GLP-1 treatment.

NICE guideline NG23 on menopause, updated in 2024, sets out the established options for symptoms, including HRT and, for those who cannot or do not wish to use it, some non-hormonal treatments and cognitive behavioural therapy. Weight management is a separate question.

HRT and GLP-1 treatment in practice

Can they be taken together?

The SmPCs for Mounjaro and Wegovy do not list HRT as an interacting medicine, and many women take both. It is still important that both prescribers know about each treatment, particularly if they are different services, such as a GP for HRT and an online provider for weight management.

Oral HRT and slowed stomach emptying

GLP-1 medicines slow stomach emptying, which can affect how some oral medicines are absorbed. This is the reason for the specific MHRA advice about tirzepatide and the contraceptive pill. Whether this has any meaningful effect on oral HRT tablets has not been established. Many women use HRT as patches, gels or sprays, which are absorbed through the skin and would not be affected by stomach emptying. If you notice your menopausal symptoms returning after starting a GLP-1 medicine, mention it to your prescriber.

The progestogen part of HRT

Women who have a womb and use oestrogen need a progestogen as well, to protect the lining of the womb. This may be a tablet, part of a combined patch, or a hormonal coil (IUS). If you rely on progestogen tablets, discuss with your prescriber whether any change in absorption could matter. Report any unexpected bleeding on HRT to your GP, as this always needs assessment.

Contraception during the perimenopause

This is one of the most important practical points for women in their forties and early fifties.

Why it matters

Fertility falls during the perimenopause, but pregnancy is still possible until the menopause is confirmed. GLP-1 medicines should not be used during pregnancy or while trying to conceive, because there is not enough safety data and harm to a developing baby cannot be ruled out. In June 2025 the MHRA reminded patients and prescribers of this and of the need for effective contraception.

Tirzepatide and the pill

The MHRA advises that tirzepatide may reduce the effectiveness of oral contraceptives in people with overweight or obesity. For those using oral contraception, it recommends switching to a non-oral method or adding a barrier method, such as condoms, for four weeks after starting tirzepatide and for four weeks after each dose increase.

HRT is not contraception

HRT does not prevent pregnancy. Some women use a hormonal coil (IUS), which can provide both contraception and the progestogen part of HRT. Your GP or a sexual health service can advise on the most suitable combination.

How long to continue contraception

Guidance from the Faculty of Sexual and Reproductive Healthcare generally advises continuing contraception until a year after the last period if you are over 50, or two years if under 50, or until age 55. The details depend on your method and circumstances, so check with your GP or contraception service.

Our guides to GLP-1s and contraception and GLP-1 medication, pregnancy and fertility cover this in more depth.

Protecting bone and muscle

Bone

Bone density falls more quickly in the years after the menopause because of the drop in oestrogen, raising the risk of osteoporosis and fractures. Substantial weight loss by any method can also reduce bone density, partly because bones carry less load. The combination is worth taking seriously.

Steps that help include:

• weight-bearing exercise such as brisk walking, and resistance exercise such as lifting weights or using resistance bands
• enough calcium from food, and vitamin D, which the NHS advises many adults in the UK consider supplementing in autumn and winter
• adequate protein
• avoiding smoking and keeping alcohol within recommended limits
• discussing your fracture risk with your GP, especially if you have had a fracture, take steroids or have a family history of osteoporosis

HRT helps maintain bone density in women for whom it is suitable, which is one reason a joined-up view of menopause and weight management is valuable.

Muscle

Some of the weight lost on GLP-1 medicines comes from lean tissue, including muscle. After the menopause, muscle loss is already accelerating, so protecting it is important. Our guides to preserving muscle on GLP-1 treatment, protein intake and strength training for beginners offer practical guidance.

Mood, sleep and wellbeing

The menopause can bring low mood, anxiety and poor sleep, and these can interact with eating patterns and weight. GLP-1 medicines reduce appetite and food preoccupation for many people, which some find helpful. Regulators have reviewed reports of mood changes and suicidal thoughts with GLP-1 medicines; current reviews have not established a causal link, but anyone with a history of depression or who notices changes in mood should tell their prescriber. Our guide to GLP-1 medication and mental health discusses the evidence.

Poor sleep can make side effects such as fatigue feel worse. If night sweats are disrupting your sleep, treating them may help your overall wellbeing during weight management.

Side effects to know about

The side effects of GLP-1 medicines are the same regardless of menopausal status. The most common are nausea, diarrhoea, constipation, vomiting, indigestion and reduced appetite. Others to be aware of:

Our guides to Mounjaro side effects and Mounjaro hair loss go into more detail.

Eating well in midlife on reduced appetite

GLP-1 medicines reduce appetite, which is how they help with weight loss. In midlife, when nutritional needs for bone and muscle are rising, eating less can make it harder to get enough of certain nutrients. A few principles can help:

• Protein at every meal. Eggs, fish, poultry, lean meat, dairy, tofu, beans and lentils help protect muscle. Some women find it easiest to start a meal with the protein portion before appetite fades.
• Calcium-rich foods. Dairy products, calcium-fortified plant drinks, tinned fish with soft bones and some green vegetables contribute to bone health.
• Fibre and fluids. Wholegrains, fruit, vegetables and pulses, with plenty of fluids, help with constipation, a common GLP-1 side effect.
• Smaller, regular meals. Large or fatty meals are more likely to trigger nausea and reflux. Smaller portions spread through the day are often better tolerated.
• Alcohol. Alcohol can worsen hot flushes, sleep, nausea and reflux, and contributes to bone loss when consumed heavily.

Our guides to what to eat on GLP-1 medication and vitamins and supplements give more detail. If you have a complex medical history, a registered dietitian can provide individual advice.

Activity: what matters most in midlife

The UK Chief Medical Officers' physical activity guidelines recommend that adults do at least 150 minutes of moderate activity a week, plus muscle-strengthening activities on at least two days a week. For women around and after the menopause, the strength component deserves particular emphasis because of its benefits for muscle, bone, balance and blood glucose.

This does not have to mean a gym. Body-weight exercises at home, resistance bands, carrying shopping, gardening, stair climbing and classes such as Pilates can all contribute. Starting gently and building up is sensible, particularly if you have joint pain or have been inactive. Our exercise guide offers a practical starting point.

Questions to ask your prescriber

Before starting or during treatment, it can help to ask:

• Am I eligible for any NHS weight management services locally?
• Given my HRT and contraception, is there anything I should change before starting?
• Should I have a bone density assessment or other tests first?
• How will we monitor my muscle strength, mood and bone health during treatment?
• What should I do if my menopausal symptoms change after starting?
• What is the plan if I want to stop treatment in future?

A good prescriber will welcome these questions. If a service cannot answer them, or does not ask about your HRT and contraception, consider whether it is the right fit.

Practical steps if you are considering treatment

1. Talk to your GP about the menopause. Symptoms, HRT options and bone health deserve attention in their own right.
2. Check your eligibility for weight management treatment. Ask whether NHS options are available locally, and understand the criteria.
3. Sort contraception first if you could still become pregnant, especially if considering tirzepatide and currently using the pill.
4. Share your full medication list with any prescriber, including HRT, contraception and supplements.
5. Plan for muscle and bone, with protein, strength exercise, calcium and vitamin D.
6. Set realistic goals. Our guide to realistic weight loss expectations explains what trials show and how much individual results vary.

If you are considering private treatment, our provider comparison explains how regulated services differ in their consultations and follow-up, and our price comparison explains what affects cost. A responsible provider should ask about your menopausal status, contraception and HRT.

Other conditions that overlap

Midlife can also bring other conditions that affect weight management and treatment choices:

• Polycystic ovary syndrome (PCOS), which often continues to affect metabolic health after the reproductive years. See our guide to GLP-1 medication and PCOS.
• Type 2 diabetes and prediabetes, which become more common with age and weight. See our guide to GLP-1 medication and type 2 diabetes.
• Underactive thyroid, which can cause tiredness and weight gain, and which your GP may test for.
• Obstructive sleep apnoea, which becomes more common in women after the menopause.

For related reading, browse our guides for specific groups, or visit our hubs for weight loss injections and oral GLP-1 tablets.

When to speak to a professional

Speak to your GP, practice nurse or pharmacist if:

• menopausal symptoms are affecting your daily life
• you are considering a GLP-1 medicine and are unsure about contraception or HRT
• your periods change or you have unexpected bleeding, whether or not you take HRT
• you notice low mood, anxiety or thoughts of self-harm, at any stage of treatment
• you have had a fracture or are worried about your bone health

Seek urgent medical help (call NHS 111, or 999 in an emergency) if you have:

• severe, persistent abdominal pain, which may spread to your back, with or without vomiting
• pain in the upper right abdomen with fever or yellowing of the skin or eyes
• signs of severe dehydration, such as very little urine, confusion or fainting
• thoughts of harming yourself; you can also contact Samaritans on 116 123
• signs of a severe allergic reaction, such as swelling of the face or throat, or difficulty breathing

If you think you might be pregnant while taking a GLP-1 medicine, contact your prescriber or GP promptly. The product information advises that treatment should be stopped if pregnancy occurs. Suspected side effects can be reported to the MHRA through the Yellow Card scheme.