GLP-1s and Hormone Therapy: A Game-Changing Duo for Menopause Belly Fat

What You Need to Know About GLP-1s and Hormone Therapy for Menopause Belly Fat

If you're in perimenopause or menopause, you've likely noticed your body shifting in ways that feel out of your control. Despite your best efforts, weight gain can feel inevitable, especially around the midsection. You may be eating the same, moving your body, doing everything "right," and still watching your body change.

It’s not your fault.

The hormonal changes of midlife, especially the decline in estrogen, play a powerful role in where your body stores fat and how your metabolism functions. Add in a modern environment that promotes sedentary habits and ultra-processed foods, and you’ve got a recipe for frustration and shame.

But here’s the good news: we now have tools that can help. The combination of GLP-1 medications and hormone therapy (HT) is one of the most promising and effective strategies we’ve seen for managing menopause belly fat and improving metabolic health.

Let’s break down how these therapies work together to combat visceral fat, why that matters, and how you can protect your muscle and metabolism in the process.

What Are GLP-1 Medications?

GLP-1 stands for glucagon-like peptide-1, a hormone released in your gut after you eat. It tells your brain that you're full, slows how quickly food leaves your stomach, and improves insulin sensitivity. This means you feel fuller longer and eat less, and it helps your body use blood sugar more effectively.

If you want to go deeper on how these medications work and hear from one of my favorite experts in the field, I highly recommend watching my conversations with Dr. Rocio Salas-Whalen, a board-certified endocrinologist and obesity medicine specialist. We cover myths, mechanisms, muscles, and more.

• Answering Your Questions and Dispelling Myths About GLP-1 agonists
• Beyond BMI: The Truth About Obesity and GLP-1 Medications with Dr. Rocio Salas Whalen

It may surprise you to learn that these medications aren’t new. The first GLP-1 drug, exenatide (the brand name is Byetta), was approved in 2005. It was inspired by a fascinating discovery: the Gila monster, a venomous lizard from the American Southwest, produces a compound in its saliva called exendin-4.⁽¹⁾⁽²⁾ This peptide mimics GLP-1 but lasts much longer in the body, making it a valuable blueprint for modern medications.

Since then, newer versions like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have emerged with even more powerful effects.

What sets these medications apart is that they do more than reduce appetite. They provide an anti-inflammatory benefit, largely because they help reduce visceral (intra-abdominal) fat, which is itself, highly inflammatory tissue. By shrinking visceral fat stores, GLP-1s help decrease the release of inflammatory cytokines, which contributes to improved blood sugar control, lower blood pressure, and a healthier lipid profile.

Here's a quick reference table that outlines the FDA-approved GLP-1 receptor agonists, including their brand names and approval dates. Huge thanks to my teammate, Jean Cunningham, PharmD, who put this together—and whose enthusiasm for GLP-1s is unmatched!

How Menopause Affects Your Weight and Fat Distribution

During the menopause transition, up to 70% of women gain weight. But this isn’t just about the number on the scale, it’s about where the weight goes. Falling estrogen levels lead to more fat being stored in the abdominal area. This type of fat, known as visceral fat, wraps around organs and increases the risk of type 2 diabetes, fatty liver, and cardiovascular disease.

But that’s not the whole story.

Menopause also accelerates the natural loss of muscle mass, a condition known as sarcopenia, and reduces your total daily energy expenditure, making it even harder to maintain a healthy weight or lose excess fat. These changes in body composition can feel frustrating and out of your control, but understanding them is the first step toward regaining that control.

I break this down in more detail in this blog post on changes in body composition during menopause.

Hormone therapy (HT) can help. Studies show that estrogen therapy during menopause can attenuate visceral fat gain by as much as 60%, improve insulin sensitivity, and even help increase lean muscle mass.

Why GLP-1s and Hormone Therapy Work Better Together

Here’s where it gets exciting: a 2024 study published in Menopause found that postmenopausal women who were on both semaglutide (the brand name for this is Ozempic) and hormone therapy (HT) lost significantly more weight than those on semaglutide alone.⁽³⁾

At every checkpoint (which was at 3, 6, 9, and 12 months), women on HT had a higher percentage of total body weight loss. They were also more likely to achieve clinically meaningful milestones like losing 5% or 10% of their starting weight. Importantly, both groups improved their metabolic health, but the HT + GLP-1 group did better.

Why? Menopause hormone therapy may not only reduce visceral fat but it may also improve sleep, boost mood, and increase the likelihood of staying active, all key factors in sustainable weight loss.

Common Side Effects of GLP-1s and How to Stay Comfortable

Like any medication, GLP-1s come with a few side effects—most commonly nausea, constipation, and reduced appetite. These are generally mild and tend to lessen over time, especially when the dose is adjusted gradually.

A few tips to support your body during treatment:

Stay well hydrated. These medications can reduce your thirst signals, so you may not feel thirsty even when your body needs fluids. Aim to drink regularly throughout the day, even if you're not craving water.

Ease into fiber. Fiber is your best ally for preventing constipation—a common side effect of GLP-1s—but it must be increased slowly. Because digestion slows on these medications, a sudden spike in fiber can lead to bloating, burping, or gas. Add fiber-rich foods or supplements gradually, and drink plenty of water to support digestion.

Skip the carbonated drinks. They can increase bloating and discomfort when digestion is already slowed.

Watch your rate of weight loss. Losing more than 1–2 pounds per week can increase the risk of gallstones, hair loss and muscle loss.

Talk with your healthcare professional if side effects persist or disrupt your day-to-day life. They can help adjust your dose or offer strategies to support digestion and hydration.

How to Prevent Muscle Loss While Using GLP-1s

This is one of the biggest concerns I hear from women: "Will I lose muscle on a GLP-1?"

The short answer: you might, unless you're intentional. Because these medications reduce appetite, it’s easy to under-consume protein, the very thing your body needs to preserve muscle.

Here’s what I recommend:

Aim for 1.5 to 1.8 grams of protein for every kilogram of ideal body weight per day, especially if you’re over 40. You can use our protein calculator to find your protein range, but for many, this will be between 80 to 120 grams of protein per day, depending on your muscle mass. Be sure you eat adequate amounts of protein throughout the day, not just at one meal.

Use a high-quality whey protein supplement, I like to make my menopause power shake, which I load up with fiber, protein, antioxidants, and anti-inflammatory ingredients.

Do resistance training 2-3 times per week. Building and preserving muscle is your insurance policy for long-term weight maintenance. You can start with these free workouts that Holly Rilinger, my trainer and founder of The LIFTED Method, created for my ‘Pause Strong Challenge.

Consider getting a DEXA scan or a home body composition scale such as the InBody Dial H30 to track your body composition and guide your goals.

Remember: muscle is the most metabolically active tissue in your body. The more you have, the better your metabolism. Building muscle increases your chances of maintaining weight loss if you decide to stop GLP-1 therapy.

It’s Not Your Fault: The Truth About the Obesogenic Environment

We are not living in the same world our grandmothers did.⁽⁴⁾ Obesity rates were under 10% in the 1950s.⁽⁵⁾ Today, more than 40% of U.S. adults have obesity.⁽⁶⁾

Why? Processed food, sedentary jobs, endocrine disruptors, and a 24/7 convenience culture have made healthy living harder. It’s not a matter of willpower. It’s biology fighting a toxic environment.⁽⁷⁾⁽⁸⁾

That’s why I believe in giving women the best tools available. Right now, that means considering GLP-1 medications and hormone therapy as part of a comprehensive, medically sound strategy.

Final Thoughts on Treating Menopause Belly Fat with GLP-1s and HRT

I hope this has led you to the beginning of a new perspective.

If you’re struggling with weight gain during midlife, please know this: it’s not your fault, and it’s not just about willpower or working out more. You’re not alone, and your body isn’t broken. GLP-1 medications and hormone therapy offer a science-backed, compassionate approach to restoring your health, managing your weight, and reclaiming your confidence.

Your next step?

Talk to your prescriber about checking your body composition, optimizing your hormone health, and considering GLP-1 therapy. If you don’t have a clinician you feel is knowledgeable about GLP-1s and HT, consider Alloy, Midi or Evernow as options for one or both.

No matter what, protect your muscles. Prioritize protein. Move your body.

You are worth this level of care.

Let’s rewrite the narrative of midlife together.

Ready to dive deeper into how to protect your muscles, prevent weight regain, and understand long-term use of GLP-1s? Read Part 2 here.

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