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If you were old enough to see NSYNC perform "Bye Bye Bye" live on tour or witness Britney Spears slither on stage with a snake at the MTV Video Music Awards, you might be going through perimenopause. (Hot flashes? Missed periods? Trouble sleeping? Sound familiar?)
Your algorithm probably knows it too: In addition to all those cute Lance Bass videos you get served up, you may also be getting ads touting the benefits of weight-loss drugs for women of a certain age. But can Ozempic and its fellow weight-loss drugs help you manage weight changes that often occur with perimenopause and menopause?
Kristi Tough DeSapri, MD, founding physician at Bone and Body Women's Health, in Winnetka, Illinois, has noticed a marked uptick in her peri/menopausal patients asking about weight-loss drugs -- specifically, glucagon-like peptide 1 (GLP-1) receptor antagonists, like Wegovy and Ozempic (a diabetes medicine linked with weight loss), among others.
"I've had people ask, 'Am I a candidate? Would my insurance pay for this?' " Dr. DeSapri says, adding that even if her patients don't meet the criteria, it's a conversation she's always happy to have. "It opens up and normalizes the discussion [around menopausal weight gain]," she says.
If you too have been curious about weight-loss medication for perimenopause and menopause weight gain, it might be time to book an appointment with your own doc -- because these drugs aren't right for everyone. But having that all-important conversation is the first step to finding the right option for you.
Meet the experts: Kristi Tough DeSapri, MD, is the founding physician at Bone and Body Women's Health, in Winnetka, Illinois. Daniel H. Bessesen, MD, is an endocrinologist in Denver, Colorado who is affiliated with multiple area hospitals including UCHealth University of Colorado Hospital and Denver Health.
If you're in perimenopause (the eight- to 10-year timeframe preceding menopause) or menopause (you haven't had a menstrual cycle for at least a year) you may have noticed the number on the scale starting to creep up: Around 70 percent of women experience weight gain during this time, according to the Journal of Health Psychology.
"The average woman gains about six to seven pounds during this menopausal transitional period," says Daniel H. Bessesen, MD, an endocrinologist in Denver, Colorado. Of course, that's just an average, with some women gaining less and some women gaining more.
The reasons for this weight gain vary, and can often be attributed to a confluence of factors. A shift in hormones is a big one: During menopause, when the ovaries stop releasing eggs, estrogen and progesterone levels decrease. Dropping estrogen levels are not only linked to weight gain, but also to a change in body composition, which can have negative health effects, says Dr. Bessessen.
"Women tend to gain fat mass and lose a little bit of lean body mass [during menopause]," he adds. "Fat tends to redistribute from hips and thighs to the abdomen ... That's where the adverse health consequences come -- not just from the accumulation of fat tissue, but where it is."
This abdominal fat surrounding the organs is known as visceral fat. Whereas subcutaneous fat -- the fat visible right below the surface of the skin, which women tend to store in their hips and thighs -- is thought to offer some protection from conditions like diabetes and heart disease, says Dr. Bessessen, visceral fat may actually contribute to these diseases.
Another potential cause of menopausal weight gain: Energy expenditure goes down (meaning: our bodies burn fewer calories). This may be partially attributable to a reduction in lean muscle mass, but a study in the International Journal of Obesity also found a 30 percent decrease in "spontaneous physical activity energy expenditure," meaning that menopausal women are simply moving less.
Disturbances in sleep, which can begin in perimenopause and carry on through menopause, may also be a contributing factor, Dr. DeSapri says.
"When our sleep gets hijacked, so too does our metabolism," she explains. "When we sleep poorly, we have increases in our hunger hormones, like ghrelin. We also experience a decrease in leptin, which is our satiety hormone."
While it may be tempting to head off menopause weight gain by seeking out a weight-loss drug Rx from your doc, medications like semaglutide (the drug in Wegovy and Ozempic) are not meant to be used prophylactically, Dr. Bessessen says -- meaning to prevent or protect from an issue.
"There are clear indications that the FDA has for prescribing a weight-loss medication, and prevention of weight gain during menopause is nowhere on the radar," he says. "The guidelines say BMI over 30 or BMI greater than 27 with a weight-related comorbidity." What constitutes a "weight-related comorbidity" isn't well-defined, but most physicians consider those to be conditions such as cardiovascular disease, hypertension, diabetes, and hyperlipidemia.
The use of semaglutide to prevent weight gain during menopause would be categorized as an "off-label" use -- and Dr. DeSapri says this particular use case has not been established in the scientific literature at this point. "I don't know of any research or anyone recommending this," she says.
Now, this doesn't mean that weight-loss centers and some physicians are not prescribing it for this off-label reason, but be aware that this is not an FDA-approved use.
The best advice both Dr. Bessessen and Dr. DeSapri can offer is to have a conversation with your physician -- and keep an open mind.
"I see people who come in the door and say, 'I heard about Ozempic. I want to take it,' " Dr. Bessessen says. "If they can't get the Ozempic, then they're unhappy -- and that's not a very productive conversation for anyone."
When it comes to prescribing a weight-loss drug, your doctor will consider numerous factors. If your weight gain is only moderate, they'll likely try to address lifestyle factors -- diet, exercise, and sleep -- with you first, says Dr. DeSapri.
The next step from there might be one of the older, less potent weight-loss drugs, such as phentermine. "It is a stimulant, and it is only FDA approved for three months of use, but it's been used long-term in many patients," explains Dr. Bessessen. "There are people who respond very well to phentermine and lose a lot of weight and don't have a lot of side effects," he says. Compared to a GLP-1, which can cost around $1,000 a month, phentermine costs about $20, so it's a much more economical option, especially if you don't need to lose a significant amount of weight.
If you fall in that BMI of 30 or more range, or have a BMI of 27 with a weight-related comorbidity, that's when your doctor might consider a GLP-1. And there's promising emerging research pointing to hormone therapy (more on this next) and semaglutide medication being a powerful combo: Women on both medications experienced a higher total body weight loss percentage at just three months, compared to women who were on semaglutide alone, according to a small study in Menopause.
The best treatment for you will depend on your unique circumstances.
Research is still ongoing regarding the effects of GLP-1s on bone density, which is a common concern for women during menopause. (Up to 20 percent of bone loss can occur during this time.)
A recent study published in the Lancet found that patients losing weight on a GLP-1 experienced an "increase in bone resorption" (that is, the breaking down of bone tissue). The study's authors were not able to pinpoint, however, whether that bone resorption was caused by the medication specifically or weight loss generally. (Studies have shown that weight loss, in and of itself, can cause bone loss.)
What does that mean for the menopausal woman considering semaglutide or another med? Know that losing weight may increase your risk of bone loss and act accordingly. Make sure you are consuming the recommended amount of protein, calcium, and vitamin D -- all of which support bone health. Weight-bearing exercises, such as walking and jogging, in addition to strength-training, will help keep bones strong too.
First, know this: "Hormone therapy is not indicated for weight loss," Dr. DeSapri notes. "That being said, when we give back estrogen, we know that helps promote muscle mass. And we know that when we increase our muscle mass, we have better metabolism, and more calories burned."
Dr. Bessessen adds that the earlier a woman goes on hormone therapy, the more likely she may be to prevent some of those body composition shifts too.
"Women who start estrogen replacement therapy early in the menopause transition will tend to keep the fat tissue they have on their hips and thighs and not so much in their abdomen, and they won't gain as much fat tissue," he says.
Because the research points to a 30 percent decrease in spontaneous physical activity energy expenditure during menopause, both Dr. DeSapri and Dr. Bessessen recommend exercise as a good place to start -- not only to address weight gain, but also to prioritize your well-being overall.
"Maintaining activity -- doing some strengthening, flexibility, and balance activities are all important as we get older," Dr. Bessessen says. "Exercise is great and takes the focus a bit away from weight entirely to health."
In addition to the 150- to 200-minutes-a-week of recommended cardio for the heart, Dr. DeSapri suggests aiming for two to three resistance training sessions a week to maintain lean muscle mass. (Not sure where to start with strength-training? Check out WH beginner's guide!)
Diet will also play a role in weight maintenance. Dr. DeSapri recommends limiting alcohol intake and aiming for eating habits more in line with the Mediterranean diet -- prioritizing plant-based foods and increasing fiber and protein intake while decreasing sugar intake.
For many women, small concerted changes like these will go a long way -- no weight-loss drugs required. "If somebody has just modest weight gain and no health problems, lifestyle [adjustments] alone will probably be good enough," Dr. Bessessen says.