Weight gain during perimenopause and menopause is unfortunately a challenge that many women may be all too familiar with. Hormonal changes, a slower metabolism, and shifts in body composition, which are common during the menopause transition, may mean the strategies that once worked no longer deliver the same results, often leading to frustration and feeling less confident in your body.1
This often leads women to explore other options for weight management in addition to lifestyle changes, like modifying their diet and exercise routines. But when lifestyle changes aren’t enough, prescription medications may be looked to as an option for supporting weight management. One medication in particular, semaglutides —or brand name medications like Ozempic®, WeGovy®, and Mounjaro®—have become a central part of the conversation.2,3 So, what exactly is a semaglutide, how does it work, and what should you know in midlife before considering it?
Here we explore semaglutide’s role in the menopause journey, including its benefits, risks, and what you need to know to make informed health decisions for your long-term well-being.
Why Weight Changes During Menopause
It’s important to understand first why weight changes during menopause. As estrogen and progesterone levels decline and, in some cases, thyroid function slows, the body’s metabolism naturally shifts.4 Women also tend to lose lean muscle mass during this stage of life, which further reduces calorie burn.5 Muscle is a metabolically active tissue, meaning it requires more energy to maintain than fat.6 As muscle mass declines with age, the body burns fewer calories at rest, making it easier to gain weight even if your diet and activity levels remain the same.6
On top of these biological changes, insulin resistance may increase around midlife, making it easier to gain weight and harder to lose it.7 Insulin resistance holds the body in “store mode” instead of shifting it to “burn mode.” Add in lifestyle factors like stress, disrupted sleep, and shifting caregiving demands and it becomes clear why maintaining a healthy weight during menopause may feel like such a challenge.
What Does a Semaglutide Like Ozempic, Do?
Ozempic, as well as similar drugs like Wegovy and Mounjaro (semaglutides) were originally developed as injectable prescription medications for adults with type 2 diabetes to help them improve their blood sugar metabolism.8 This specific medication belongs to a class of drugs called GLP-1 receptor agonists and is FDA approved to be prescribed to overweight patients with multiple preexisting conditions, in addition to type 2 diabetes patients.9
These types of drugs mimic glucagon-like peptide-1 (GLP-1), which is a hormone naturally produced in the gut to help you control blood sugar and reduce appetite.10 Even though GLP-1 naturally occurs in the body, some people, such as those with type 2 diabetes, obesity, or metabolic challenges, don’t have enough of it that lasts long enough to regulate their blood sugar and appetites effectively. Semaglutides essentially boost and extend what your natural GLP-1 does.
How do semaglutides work – in three distinct ways: by slowing down stomach emptying, by reducing spikes in blood sugar through helping the pancreas to produce more insulin, and by helping the liver reduce how much sugar it makes and releases, thereby managing blood sugar levels.11 This may reduce food cravings and help you feel satisfied (for longer) with smaller portions.
While it’s true that semaglutides offer possibilities for weight loss support, they also raise important questions about who should use them and how. The reality is that many women may not respond effectively to this drug.12 Therefore, it’s important to remain open to different types of management options and to consider your own, personal health risk.
What a Semaglutide Does for a Woman’s Body in Midlife
Semaglutides affect more than weight for women in midlife. By helping regulate appetite and feelings of fullness, the medication may ease some of the increased hunger and cravings that can accompany the hormonal changes experienced during perimenopause and menopause.13 It also improves insulin sensitivity, which may counteract the metabolic shifts that make weight management more difficult during this transitional time.14
In addition to supporting weight loss, research suggests that semaglutides reduce the risk of diabetes and improve markers of cardiovascular health, which are two areas of growing importance during the menopause journey.15 Still, it’s important to recognize that taking a semaglutide may influence your metabolism, cardiovascular health, gut function, and even your musculoskeletal integrity.16
Since it influences multiple systems of the body along with their functions—including digestion, blood sugar metabolism, and how the body processes energy—its impact on health is broad, and requires thoughtful consideration.17
Risks of Semagludites for Menopausal Women
Like any medication, semaglutides, like Ozempic may cause side effects, especially for women navigating menopause. The most common semaglutide side effects include nausea, constipation, diarrhea, and fatigue, which can range from mild to disruptive.18 More serious risks, though less common, may include gallbladder problems, pancreatitis, and muscle or bone loss if weight is lost too quickly.19 Semaglutides are not suitable for everyone, particularly women with certain thyroid conditions, a history of pancreatitis, or other specific health concerns.209
For women in midlife, there are additional factors to keep in mind when considering semaglutides. Menopause already increases the risk of bone density decline and muscle loss, and rapid, or unmonitored weight loss may compound those vulnerabilities.21 Hormonal changes may also heighten digestive sensitivities, making gastrointestinal side effects more noticeable.22 Ensuring adequate protein intake, along with enough vitamins and minerals in your diet, is important for protecting overall health while using the medication.23
Questions to Ask Before Considering Semaglutides
Before starting a semaglutide, it’s important to have an open conversation with your healthcare provider. A few key questions you should consider asking include:
- Is a semaglutide right for my body based on my health history?
- How should I protect my bone and muscle health while losing weight?
- What’s the long-term plan if I stop taking the medication?
These questions will help you understand not only whether a prescription semaglutide is a safe choice for you, but also, how to approach weight management in a way that supports your overall health.
The Bigger Picture: How Semaglutides Fit into Overall Menopause Health
Semaglutides may be a valuable option for managing weight during menopause, but it isn’t a complete solution on its own. Long-term success comes from pairing the medication—if you and your provider decide it’s right for you—with healthy lifestyle habits like resistance training, to preserve muscle and bone, balanced nutrition with adequate protein, stress management, and consistent sleep.
As menopause also can cause changes in bone density, metabolism, and heart health, it’s important to view semaglutide use as one part of a bigger, multifaceted picture.
In the end, semaglutides are just one tool with a specific benefit. Remember, your menopause journey isn’t defined by the number on the scale—it’s about feeling strong, protecting your health, and making informed choices that will support you beyond this stage of your life.
Resources
- https://www.ncbi.nlm.nih.gov/books/NBK507826/
- https://www.ozempic.com/why-ozempic/what-is-ozempic.html
- https://journals.lww.com/menopausejournal/fulltext/2025/05001/treating_obesity_to_optimize_women_s_health.5.aspx?context=latestarticles
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3113168/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7956097/
- https://www.massgeneral.org/news/article/why-muscle-mass-matters-and-how-to-keep-it.
- https://gremjournal.com/journal/02-03-2023/metabolic-syndrome-insulin-resistance-and-menopause-the-changes-in-body-structure-and-the-therapeutic-approach/
- https://www.ozempic.com/why-ozempic/how-ozempic-works.html
- https://www.ncbi.nlm.nih.gov/books/NBK551568/
- https://www.ncbi.nlm.nih.gov/books/NBK551568/
- https://www.ozempic.com/why-ozempic/how-ozempic-works.html
- https://journals.lww.com/menopausejournal/fulltext/2024/04000/weight_loss_response_to_semaglutide_in.4.aspx
- https://www.menopausesolutions.org/post/weight-management-in-menopause-how-ozempic-can-support-your-goals
- https://www.ozempic.com/why-ozempic/how-ozempic-works.html
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10092593/
- https://www.ozempic.com/how-to-take/side-effects.html
- https://www.ozempic.com/why-ozempic/how-ozempic-works.html
- https://www.ozempic.com/how-to-take/side-effects.html
- https://www.ozempic.com/how-to-take/side-effects.html
- https://www.roswellpark.org/cancertalk/202409/ozempic-thyroid-cancer
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7296268/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3322543/
- https://pubmed.ncbi.nlm.nih.gov/26620911/
