What should peri- and postmenopausal women know before starting a GLP-1

KEY TAKEAWAYS

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A GLP-1 medication mimics a hormone your body already makes that signals fullness and helps manage blood sugar. Ashley Koff, RD, a weight health nutritionist and author of Your Best Shot, says that before pursuing these medications, we need to understand whether our hormones aren't working well, similar to thyroid or estrogen.

“When we don't understand that it has to do with what our body is signaling, we tend to look at a goal, a destination, something like weight loss, a certain amount on the scale, or blood sugar. And we're missing what it means for our bones, our muscle, our fat, our cognitive function.”

Our own GLP-1 and GIP and the medications are “massively different,” adds Koff. Ours are active for only about 2 to 5 minutes after we eat, while the medications keep a steady level going for a full day or a full week, even at the lowest dose. 

Koff says the number on the scale was never meant to be used as an indicator of anything related to our health: “What is an indicator is our bone, muscle, fat, and water content, the type, location, and amount. We're not supposed to carry excess weight in certain places in the body. We're not supposed to have bone and muscle loss or breakdown or inability to build it. If we decode the right signals, we can actually understand what our body is telling us.”

As our bodies shift in perimenopause and menopause, we begin to carry more weight around our middle, a change linked to higher heart and metabolic risk. “If you suddenly have 10 pounds on you that you didn't have before, those are signals. So I don't dismiss that,” says Koff. “If somebody decides to go on a GLP-1 agonist to help their body work better, I want to work with that person and say, now what we want to do is use the GLP-1 correctly for your body.”

For women who start a GLP-1, Dr. Santiago Palacios, treasurer of the International Menopause Society, says menopausal status seems to affect how much weight women lose, but results are good at every stage. And hormone therapy may help.

In a 2024 Mayo Clinic study of 106 postmenopausal women taking semaglutide, those using hormone therapy lost 16% of their body weight at 12 months, compared with 12% for women not using it. A 2026 Mayo Clinic study of 120 postmenopausal women taking tirzepatide found a similar pattern: 19.2% weight loss with hormone therapy versus 14.0% without, over about 18 months. Both studies were observational, so they can't show that hormone therapy caused the extra weight loss.

“The first thing I'm going to do is assess digestive function because I know it's going to change on the GLP-1,” says Koff. “The second thing I'm going to do is evaluate your total nutrition and see if your nutrient levels from food and supplements together are actually delivering your body what it needs so that it doesn't have to deprioritize any tasks because of lack of nutrients.” 

That review covers nutrients like vitamin D, vitamin K, magnesium, and amino acids such as L-cysteine for hair, especially if you've already been restricting what you eat. Then Koff puts together a plan to make sure using a GLP-1 doesn’t create other problems.

Palacios says that many women believe the drug alone is enough and that eating less is always better. “In reality, eating too little protein while doing no strength training is exactly how you lose muscle you can’t easily rebuild at 55,” he adds. And it should be no surprise that protein and strength training are the two best-supported ways to protect muscle during GLP-1 treatment, according to a 2025 joint advisory.

Palacios also recommends monitoring: get a baseline body composition and grip strength or a chair-stand test, and watch your rate of weight loss. If it’s very fast, ask your clinician about increasing the dose more slowly.

Palacios flags these side effects:

Regaining weight after stopping is part of most people’s experience. "You cannot use this tool like a diet," Koff says. While you're on it, the medication covers your body's hormone needs. Stopping suddenly takes you from a signal that lasts all week back to one that lasts a few minutes. That's why the long-term plan belongs in the conversation before your first dose, with a clinician who pays attention to what you keep, not just what you lose.

"What we've been sold is that there's an optimal external," Koff says. "What we really need to understand is there's an optimal internal." A GLP-1 is one tool out there that might help you get there, as long as you know your end goal and how that impacts your long-term health.

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