GLP-1 medicines work in perimenopause and after menopause. In a Lilly-funded analysis of the SURMOUNT-1 trial, women lost about 23% of their body weight on tirzepatide (Zepbound) over 72 weeks whether they were perimenopausal or postmenopausal, versus about 3% on placebo. Two small Mayo Clinic records studies found that postmenopausal women also using hormone therapy lost more weight on semaglutide and tirzepatide, but they were not randomized, so they cannot show that hormone therapy caused it. Hormone therapy is a separate decision to make with your clinician, and protecting muscle and bone matters more in midlife.
Key takeaways
- In SURMOUNT-1, weight fell about 26% on tirzepatide in premenopausal women and about 23% in both perimenopausal and postmenopausal women, compared with 2 to 3% on placebo.
- In the SWAN study of 1,246 women, the rate of fat gain went from about 1.0% to about 1.7% a year during the menopause transition, while lean mass started to fall, even though weight on the scale kept rising at the same steady pace.
- In a Mayo Clinic study of 106 postmenopausal women on semaglutide, those on hormone therapy lost about 16% of their weight at 12 months versus about 12% without it. Only 16 women were on hormone therapy.
- In a Mayo Clinic study of 120 postmenopausal women on tirzepatide, those on hormone therapy lost about 19% versus about 14% without it. Neither study was randomized.
- The 2025 joint advisory on GLP-1 nutrition lists perimenopause and menopause among the things that raise the risk of losing too much muscle, so protein and strength training matter more.
- Fatigue is a listed side effect on the Wegovy and Zepbound labels and a common menopause symptom, so it is worth tracking when it happens.
Why does weight change in perimenopause and menopause?
Body composition shifts during the menopause transition, even when the scale does not move much. The Study of Women's Health Across the Nation (SWAN) followed 1,246 women with yearly body scans. Starting about two years before the final period, the rate of fat gain went from about 1.0% to about 1.7% a year, and lean mass began to fall by about 0.2% a year. These changes leveled off about one and a half to two years after the final period.
Weight on the scale kept rising at a steady rate the whole time, with no jump at menopause. That is why many women say their clothes fit differently even though their weight barely changed: more fat and less lean tissue can add up to about the same number. SWAN was an observational study, so it shows what tends to happen, not exactly why.
This matters on a GLP-1 because you start from a body that is already losing some lean mass. Our guide on muscle loss covers how much of the weight lost on a GLP-1 is lean mass in the trials.
Do GLP-1 medicines work as well after menopause?
Yes, in the analysis that looked at this directly, weight loss on tirzepatide was large at every reproductive stage. Researchers went back through the SURMOUNT-1, -3 and -4 trials, sorted women by stage after the fact, and compared tirzepatide (15 mg or the highest dose each person tolerated) with placebo.
| Stage (SURMOUNT-1) | Weight change on tirzepatide | Weight change on placebo | Waist change on tirzepatide | Lost 5% or more on tirzepatide |
|---|---|---|---|---|
| Premenopause | About −26% | About −2% | About −22 cm (8.7 in) | 97 to 98% |
| Perimenopause | About −23% | About −3% | About −20 cm (7.9 in) | 97 to 98% |
| Postmenopause | About −23% | About −3% | About −20 cm (7.9 in) | 97 to 98% |
The authors reported similar results in SURMOUNT-3 and SURMOUNT-4. A few cautions: this was a post hoc analysis funded by Eli Lilly, the trials were not designed to compare stages, and menopausal stage was assigned from records rather than measured. It also included only women without type 2 diabetes.
We did not find a matching published analysis of semaglutide (Wegovy) by menopausal stage from its main trials, so we have left that out rather than guess.
Does hormone therapy change how much weight you lose on a GLP-1?
It might, but the evidence so far is limited. Two studies from Mayo Clinic looked back through medical records of postmenopausal women with overweight or obesity and compared those who were also using menopause hormone therapy with those who were not.
| Study | Medicine | Women | Weight change with hormone therapy | Weight change without |
|---|---|---|---|---|
| Hurtado et al., Menopause 2024 | Semaglutide | 106 (16 on hormone therapy) | About −16% at 12 months | About −12% at 12 months |
| Castaneda et al., Lancet Obstetrics, Gynaecology & Women's Health 2026 | Tirzepatide | 120 (40 on hormone therapy) | About −19% at last visit | About −14% at last visit |
Both teams adjusted for differences between the groups, and the tirzepatide study matched women by age, BMI and other factors. Still, neither study randomly assigned hormone therapy, so the women who used it may have differed in ways the records did not capture. Both groups of authors called for randomized trials.
Hormone therapy is not a weight-loss treatment. Whether it is right for you depends on your symptoms, your age, how long since your last period and your personal risks, including blood clots, stroke and breast cancer. That is a conversation with your clinician.
The Menopause Society's 2022 position statement says that for women younger than 60 or within 10 years of menopause who have no reasons to avoid it, the benefits of hormone therapy generally outweigh the risks for bothersome hot flashes and to prevent bone loss. It also says the type, dose and route should be individualized and reviewed over time. If you are already using hormone therapy, or are thinking about it, tell the clinician who prescribes your GLP-1 so they have the full picture.
How do you protect muscle and bone on a GLP-1 in midlife?
Eat enough protein, do strength training at least two days a week and ask your clinician about your bone health. The 2025 joint advisory on GLP-1 nutrition names being perimenopausal or menopausal as one of the factors that raise the risk of losing too much muscle, along with being older, inactive or low on protein. It also notes that weight loss that is both large and fast is linked to more bone loss.
Protein. The 2025–2030 Dietary Guidelines for Americans suggest 1.2 to 1.6 g of protein per kg of body weight a day, and Morning's default is 1.4 g. For a 170 lb (77 kg) woman, that is about 108 g a day. Eating protein first at meals helps on days when your appetite is small. The protein calculator gives your own number.
Strength training. The US Physical Activity Guidelines recommend muscle-strengthening activity for all major muscle groups on at least 2 days a week; the advisory aims for 3. Walking is good for your heart but does much less for muscle. Our exercise guide has a simple starting routine.
Bone. Calcium, vitamin D and whether you need a bone density (DXA) scan are questions for your clinician, not something to guess at. Bring them up if you have had a fracture, have a family history of osteoporosis, or are losing weight quickly.
Pace. The dose plan is for you and your prescriber to set. If you feel you are losing very fast, eating very little or getting weaker, raise it at your next visit.
Is it menopause or the medicine?
Often it is hard to tell, because several common menopause symptoms overlap with GLP-1 side effects or with eating much less. Fatigue is listed on both labels: in the main weight trials, about 11% of people on Wegovy 2.4 mg reported it versus 5% on placebo, and 5 to 7% on Zepbound versus 3% on placebo.
| What you notice | Can come from menopause | Can come from a GLP-1 or eating less | What helps you sort it out |
|---|---|---|---|
| Tiredness | Yes, often with poor sleep or night sweats | Yes, listed on the labels | Note which days it happens and how much you ate and drank |
| Hair thinning | Yes | Yes, linked to weight loss on the Zepbound label, reported more in women | Track when it started relative to your weight loss |
| Mood changes or low mood | Yes | Can come with low intake or poor sleep | Tell your clinician, especially if it lasts |
| Dizziness | Less typical | Yes, listed on the labels; dehydration can add to it | Check your water and food on those days |
A pattern helps your clinician more than a guess. If tiredness clusters in the two days after your shot, that points one way; if it follows bad nights, that points another. Our guide on fatigue goes deeper.
Contact your clinician or seek care if you have severe stomach pain that will not go away, pain that spreads to your back, vomiting you cannot keep fluids down through, signs of dehydration such as fainting or very dark urine, a lump in your neck, or signs of an allergic reaction. Vaginal bleeding after menopause is not a GLP-1 side effect and should always be checked.
How Morning helps
Morning's side-effect check-ins show whether tiredness, nausea or other symptoms cluster around your shot day, which helps separate medicine effects from menopause ones. The food photo scan counts protein toward your daily target, and weight and progress charts sync with Apple Health. You can keep lab results in context and bring a doctor report to the appointment where you talk about hormone therapy, bone health or your dose plan.
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Questions
Does menopause make GLP-1s work less well?
In a SURMOUNT-1 analysis, women lost about 23% of their weight on tirzepatide whether they were perimenopausal or postmenopausal, versus about 26% before menopause. The difference was small, and the analysis was not designed to compare stages directly.
Should I start hormone therapy to lose more weight on a GLP-1?
No study has shown that hormone therapy causes more weight loss; the two Mayo Clinic studies only found an association. Hormone therapy has its own benefits and risks, so decide about it with your clinician based on your symptoms and health.
Can I take a GLP-1 and hormone therapy together?
Women in both Mayo Clinic studies used them together. Whether the combination fits you is a question for the clinicians who prescribe each one, so make sure both know about all your medicines.
Why am I so tired on a GLP-1 during menopause?
Both can cause fatigue, and eating much less can add to it. Tracking when it happens, along with your sleep, food and water, helps you and your clinician find the main cause.
Do I need extra calcium or vitamin D on a GLP-1?
That depends on your diet, your bone health and your lab results. Ask your clinician before adding supplements, and ask whether a bone density scan makes sense for you.
Is muscle loss worse on a GLP-1 after menopause?
Menopause on its own is linked to some loss of lean mass, and the 2025 GLP-1 nutrition advisory lists it as a risk factor for losing too much muscle. Enough protein and strength training at least twice a week are the main ways to protect it.
Sources
- Tchang BG, et al. Body weight reduction in women treated with tirzepatide by reproductive stage: a post hoc analysis from the SURMOUNT program. Obesity, 2025;33:851–860. doi.org/10.1002/oby.24254
- Greendale GA, et al. Changes in body composition and weight during the menopause transition. JCI Insight, 2019;4(5):e124865. doi.org/10.1172/jci.insight.124865
- Hurtado MD, et al. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause, 2024;31(4):266–274. doi.org/10.1097/GME.0000000000002310
- Castaneda R, et al. The role of menopause hormone therapy in modulating tirzepatide-associated weight loss in postmenopausal women with overweight or obesity: a retrospective cohort study. The Lancet Obstetrics, Gynaecology & Women's Health, 2026;2(2):e118–e128. doi.org/10.1016/S3050-5038(25)00145-100145-1)
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022;29(7):767–794. menopause.org
- Mozaffarian D, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory. American Journal of Clinical Nutrition, 2025;122:344–367. doi.org/10.1016/j.ajcnut.2025.04.023
- Zepbound (tirzepatide) prescribing information, Eli Lilly and Company. DailyMed
- Wegovy (semaglutide) prescribing information, Novo Nordisk. DailyMed
- US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. odphp.health.gov
- US Departments of Agriculture and Health and Human Services. Dietary Guidelines for Americans, 2025–2030. cdn.realfood.gov/DGA.pdf
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Educational information, not medical advice. Talk to your clinician about your treatment.