If you’re going through perimenopause or menopause, you may notice changes in your body that you can’t control. Despite your best efforts, weight gain is inevitable, especially around the belly. You can eat the same things, move your body, do everything “right” and still watch your body change.
It’s not your fault.
Hormonal changes in midlife, especially the decline in estrogen, play an important role in where the body stores fat and how well your metabolism functions. Add to this a modern environment that promotes sedentary habits and overly processed foods, and you have a recipe for frustration and shame.
But here’s the good news: We now have the tools to help. The combination of GLP-1 drugs and hormone therapy (HT) is one of the most promising and effective strategies we have seen for controlling abdominal fat and improving metabolic health during menopause.
Let’s break down how these treatments work together to combat visceral fat, why this is important, and how to protect your muscles and metabolism in the process.
How menopause affects your weight and fat distribution
Up to 70% of women gain weight during the menopausal transition. But it’s not just about the number on the scale, it’s also about where the weight is going. Decreased estrogen levels can cause more fat to be stored in the abdominal area. This fat, called visceral fat, surrounds the organs and increases the risk of type 2 diabetes, fatty liver disease and cardiovascular disease.
But that’s not the whole story. Menopause also accelerates the natural loss of muscle mass (a condition called sarcopenia) and reduces total daily energy expenditure, making it more difficult to maintain a healthy weight or lose excess fat. These body composition changes can make people feel frustrated and out of control, but understanding them is the first step to regaining control.
I analyze this in more detail in this blog post about body composition changes during menopause.
HT can help. Research shows that estrogen treatment during menopause can reduce visceral fat gain by up to 60%, improve insulin sensitivity, and even help increase lean muscle mass.
Why GLP-1 and hormone therapy work better together
Here’s what’s exciting: 2024 research published in the journal menopause Postmenopausal women found taking two drugs (trade name: Ozempic) and HT lost significantly more weight than patients taking semaglutide alone.
At each checkpoint (three, six, nine and 12 months), women who received HT had a greater percentage of overall weight loss. They were also more likely to achieve clinically meaningful milestones, such as losing 5% or 10% of their starting weight. Importantly, metabolic health improved in both groups, but the HT + GLP-1 group fared better.
Why? Menopausal HT not only reduces visceral fat, it also improves sleep, improves mood and increases the likelihood of staying active, all key factors in sustainable weight loss.
Common side effects of GLP-1 and how to stay comfortable
As with any drug, GLP-1 has some side effects—the most common are nausea, constipation, and decreased appetite. These are usually mild and lessen over time, especially when the dose is titrated.
Some tips to support your body during treatment:
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Stay well hydrated. These medications reduce your thirst signals, so you may not feel thirsty even though your body needs fluids. Even if you don’t feel like drinking water, drink water regularly throughout the day.
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Get fiber easily. Fiber is your best ally in preventing constipation (a common side effect of GLP-1), but it must be added slowly. Because the digestion of these medications slows down, a sudden increase in fiber can cause bloating, burping, or gas. Gradually add fiber-rich foods or supplements and drink plenty of water to support digestion.
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Skip the carbonated drinks. They can increase bloating and discomfort when digestion is already slowed.
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Watch how quickly you lose weight. Losing more than one to two pounds per week increases the risk of gallstones, hair loss, and muscle loss.
If side effects persist or disrupt your daily life, talk to your health care professional. They can help you adjust your dosage or provide strategies to support digestion and hydration.
How to Prevent Muscle Loss While Using GLP-1
This is one of the biggest concerns I hear from women: “Will I lose muscle after taking GLP-1?”
Short answer: You probably do, unless you do it on purpose. Because these medications reduce your appetite, it’s easy to not eat enough protein, which your body needs to maintain muscle.
Here’s my suggestion:
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Aim for 1.5 to 1.8 grams of protein per kilogram of ideal body weight per day, especially if you are over 40. You can use our protein calculator to determine your protein range, but for many people this will be 80 to 120 grams of protein per day, depending on your muscle mass. Make sure you eat enough protein throughout the day, not just in one meal.
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Use a high-quality whey protein supplement. I like to give my menopause energy shake a shot in which I add fiber, protein, antioxidants, and anti-inflammatory ingredients.
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Perform resistance training two to three times a week. Building and maintaining muscle is an insurance strategy for long-term weight maintenance. You can start with this free workout created by my trainer and founder of The LIFTED Method, Holly Rilinger, for my Pause Power Challenge.
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Consider getting a DEXA scan or a home body composition scale like the InBody Dial H30 to track your body composition and guide your goals.
Remember: Muscle is the most metabolically active tissue in the body. The more you have, the better your metabolism will be. If you decide to stop GLP-1 treatment, building muscle will increase your chances of maintaining your weight loss.
It’s Not Your Fault: The Truth About Obesogenic Environments
We no longer live in the world our grandmothers lived in. In the 1950s, the obesity rate was less than 10%. Today, more than 40% of American adults are obese.
Why? Processed foods, sedentary jobs, endocrine disruptors and a 24/7 convenience culture make healthy living more difficult. It’s not a matter of willpower. This is a creature that fights against a toxic environment.
That’s why I believe in giving women the best tools possible. Currently, this means considering GLP-1 drugs and hormone therapy as part of a comprehensive, medically sound strategy.
This article first appeared on Dr. Mary Claire Haver’s website, Life on Pause.
The post The game-changing duo who gained weight in midlife appeared first on Katie Couric Media.