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Menopause typically occurs between the ages of 45 and 55.
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Researchers estimate that 60%–70% of women gain weight during menopause.
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Current treatment options for menopausal weight gain include menopausal hormone therapy (MHT), lifestyle changes, and GLP-1 medications.
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A new study found that adding MHT may help improve weight loss in menopausal women taking certain types of GLP-1 medications.
Menopause — a life stage that marks the end of female reproductive years — tends to occur between ages 45 and 55.
Although menopause symptoms can be different for each person, some commonly shared symptoms include hot flashes, night sweats, mood swings, fatigue, vaginal dryness, and weight gain.
“Weight gain is a common concern among midlife women,” Regina Castaneda, MD, postdoctoral research fellow in the Division of General Internal Medicine, Women’s Health, at Mayo Clinic Florida, told Medical News Today.
“Although aging is the primary driver, the menopause transition also plays a role. As estrogen levels decline, women tend to lose lean muscle while gaining fat mass, fat shifts toward visceral deposits, and resting energy expenditure falls. Menopausal symptoms, such as hot flashes and night sweats, may further reduce physical activity and impair metabolic health.”
Researchers estimate that between 60%-70% of women gain weight during menopause. Current treatment options for menopausal weight gain include menopausal hormone therapy (MHT), lifestyle changes like following a healthy diet and getting enough exercise, and prescription weight-loss medications including glucagon-like peptide-1 (GLP-1) receptor agonists.
Castaneda is the lead author of a study recently presented at The Menopause Society’s 2026 Annual Conference, which found adding MHT may help improve weight loss in menopausal women taking certain types of GLP-1 medications.
The study is yet to undergo peer review.
Semaglutide vs tirzepatide with or without MHT
For this study, researchers analyzed health data for about 2,400 over the age of 45 who were taking either semaglutide (the active ingredient in Ozempic and Wegovy) or tirzepatide (the active ingredient in Zepbound and Mounjaro).
Some study participants were taking MHT, while others were not.
“Increasingly, midlife women are turning to GLP-1–based therapies such as semaglutide and tirzepatide to manage overweight or obesity,” Castaneda said. “At the same time, many encounter claims in the news and on social media that menopause hormone therapy can ‘boost’ the effectiveness of these medications, despite limited supporting evidence.”
“To our knowledge, this is the largest study comparing weight-loss outcomes with semaglutide and tirzepatide among midlife women with and without menopause hormone (therapy), drawing on real-world clinical data,” she added.
MHT with semaglutide linked to greater, sustained weight loss
At the study’s conclusion, researchers discovered that MHT was linked to a significantly greater and sustained weight loss in participants taking semaglutide.
“While encouraging, these results should be viewed as hypothesis-generating,” Castaneda said. “They do not mean that hormone therapy should be prescribed solely to improve weight-loss outcomes. Menopause hormone therapy has specific clinical indications, such as bothersome menopausal symptoms, and weight management is not one of them.”
“That said, when hormone therapy is clinically indicated, relieving menopausal symptoms can meaningfully improve a woman’s quality of life,” she continued. “This, in turn, may help her stay engaged with diet and physical activity, which remain a vital part of any weight-loss journey.”
No ‘statistically significant’ weight loss from tirzepatide and MHT
When looking at tirzepatide, while researchers report study participants taking this particular GLP-1 medication initially showed greater weight loss when using MHT, the end results did not reach statistical significance.
Castaneda said there are two possible explanations for these findings.
“The first is the ceiling effect,” she explained. “Tirzepatide produces substantially greater weight loss on its own, and that effect may be strong enough to overcome many of the metabolic disadvantages associated with menopause, leaving less room for hormone therapy to add a measurable benefit.”
“The second relates to how these medications work,” Castaneda continued. “Preclinical studies suggest that the potential synergy between estrogen and GLP-1-based therapies centers on GLP-1 receptor signaling specifically: estrogen appears to amplify the GLP-1’s appetite-suppressing effects.“
“Semaglutide acts solely on the GLP-1 receptor, whereas tirzepatide is a dual agonist that also targets the GIP (gastric inhibitory peptide) receptor. This broader mechanism may make estrogen’s added contribution less pronounced,” she detailed.
“Importantly, this finding does not mean hormone therapy has no effect in women taking tirzepatide,” added Castaneda. “It means the question remains open, and larger studies with longer follow-up, and better controls for possible confounders are needed to answer it.”
Controlling menopause weight gain important for healthy aging
MNT spoke with Sheryl Ross, MD, a board-certified ob-gyn, and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, who said that weight gain is often the most common complaint women in menopause talk about daily.
“Many women are typically motivated to lose weight when the scale tips above a certain number and find success in the beginning of their weight loss journey, but quickly gain it back as their motivation fades and hormonal changes work against them,” said Ross, who was not involved in this study. “Weight gain, especially in the ‘meno’ belly increases the risk of diabetes and heart disease.”
“Finding ways to control weight gain for women in menopause is not only important emotionally, but also matters physically and for healthy aging,” Ross continued.
“There has been an obvious uptick in the use of GLP-1’s in menopause for good reasons. More research is needed to give menopausal women the best recommendations on how to lose weight and keep it off long term,” she cautioned.
How does MHT help support weight loss?
MNT also spoke with Prudence Hall, MD, an ob-gyn in private practice in Santa Monica, CA, who likewise was not involved in this study, to find out more about how MHT might aid GLP-1s in increasing and sustaining weight loss in menopausal women.
Hall explained that hormone replacement therapy addresses the systemic root causes of midlife weight gain that GLP-1 medications simply cannot treat on their own, such as:
“Estrogen loss triggers systemic inflammation and chronic fatigue, which often halts physical activity and accelerates weight gain,” she said.
Menopause also places significant stress on the body, elevating cortisol levels. “Over time, adrenal burnout compounds metabolic dysfunction,” Hall explained. “Restoring hormonal balance stabilizes the stress response and facilitates fat loss.”
Lower testosterone levels at this stage of life further reduce lean muscle mass and lowers basal metabolic rate, she noted.
Finally, “even subclinical drops in thyroid hormone function can easily drive 20 to 25 pounds of weight gain,” Hall explained.
“When hormone deficiencies are comprehensively balanced, weight loss becomes sustainable. A GLP-1 can certainly accelerate results, but hormone therapy restores the underlying metabolic engine that keeps weight off long term,” Hall concluded.
View the original article on Medical News Today