In recent years, you have certainly heard about GLP-1: from newspaper headlines to Hollywood celebrities praising its results, to widespread discussions on social media. In many cases, the focus is on weight loss as an aesthetic phenomenon. However, it is important to look beyond the hype to understand whether, and how, these drugs may be useful for women going through perimenopause and menopause.

Menopause represents a complex biological transition, characterized by a progressive decline in ovarian function and the permanent cessation of the menstrual cycle. From an endocrine perspective, the decline in estrogen has a systemic impact, affecting not only the reproductive system but also metabolism, the cardiovascular system, body composition, and bone health. In particular, reduced estrogen levels alter fat distribution, promoting an android phenotype (fat distribution concentrated mainly around the abdomen and waist, typical of an “apple-shaped” body) with visceral fat accumulation, and promote insulin resistance through mechanisms involving low-grade chronic inflammation, altering the function of cells and blood vessels.

This unfavorable metabolic scenario explains the growing interest in therapies capable of intervening early on these pathophysiological pathways.

In this article, we aim to clarify: what GLP-1s are, how they work, what benefits they may offer, what risks they entail, and above all, what we currently know about their role in menopausal women.

GLP-1 Explained Clearly: How They Really Work

GLP-1 (glucagon-like peptide-1) is a hormone produced by the intestine when we eat, particularly in response to carbohydrates and fats. In addition to stimulating insulin secretion in a glucose-dependent manner, GLP-1 inhibits glucagon secretion, slows gastric emptying, reduces appetite through its action on hypothalamic receptors, and acts on the autonomic nervous system by modulating the parasympathetic response.

GLP-1 receptor agonist drugs (such as liraglutide, semaglutide, and tirzepatide) mimic this natural mechanism, but in a more potent and longer-lasting way. This is why they help control blood glucose levels, appetite, and body weight, acting on several key organs such as the pancreas, brain, intestine, and heart.

The metabolic effects include:

• • Improved insulin sensitivity
• • Reduction of non-alcoholic fatty liver disease (NAFLD)
• • Systemic anti-inflammatory and vasoprotective effects

One of the most studied and well-documented effects of GLP-1 receptor agonists is significant weight loss, as they help reduce caloric intake and increase satiety.

The extent of weight loss varies depending on the active ingredient, administered dose, duration of treatment, and the patient’s clinical profile.

• • Liraglutide 3.0 mg/day (approved for obesity): allows a 6–8% reduction in body weight over approximately 56 weeks, according to the SCALE study.
• • Semaglutide 2.4 mg/week (approved for obesity): in the STEP trials, showed an average weight reduction of 14.9% at 68 weeks, with more than 50% of patients losing at least 15% of their initial weight.
• • Tirzepatide (dual GIP/GLP-1 agonist, not yet formally approved for obesity in the EU): in the SURMOUNT-1 study, resulted in an average weight loss of up to 22.5% at 72 weeks with the 15 mg weekly dose, approaching the effectiveness observed with some bariatric procedures.

These results are significantly superior to those achieved with other anti-obesity drugs currently available and far exceed the average outcomes attainable with diet and exercise alone (approximately 3–5%).

This is where the hype originates: the promise of a seemingly simple, rapid, and widely shareable approach to weight management. However, reality is more complex and requires careful clinical evaluation.

Why GLP-1 Attract So Much Interest During Menopause

The menopausal period is associated with an increased risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease (CVD). The prevalence of metabolic syndrome in postmenopausal women can reach 45%, with a direct correlation between time since menopause and the severity of the altered metabolic profile.

The menopausal transition is also accompanied by a decline in muscle mass (sarcopenia) and bone mass, with an increase in intramuscular and visceral fat. These changes increase the likelihood of developing insulin resistance and chronic systemic inflammation (inflammaging), two key elements in the development of atherosclerosis and diabetes.

GLP-1 receptor agonists, beyond their effects on weight and glycemia, modulate inflammatory activity and may promote a redistribution of body fat, with selective reduction of visceral fat and potential benefits on lipid profile and blood pressure. This makes GLP-1RAs interesting drugs also for primary cardiovascular prevention in high-risk women or at a time when traditional approaches (diet and exercise) alone are not always sufficient.

What Science Says: Benefits Beyond the “Miracle Diet” Myth

Clinical studies have shown that the use of GLP-1 receptor agonists can lead to:

• • Total body weight reduction ranging from 5% to 15% on average
• • Significant decrease in visceral fat (assessed by DEXA or MRI)
• • Improvement in HbA1c even in non-diabetic individuals
• • Improvement in lipid profile (reduction in triglycerides, increase in HDL cholesterol)
• • Reduction in both systolic and diastolic blood pressure
• ‍

A study in postmenopausal women with obesity showed that semaglutide 2.4 mg weekly was associated with an average weight reduction of 11.8 kg over 68 weeks, with additional benefits on quality of life and cardiovascular parameters.

Some animal studies suggest that these drugs may have protective effects on blood vessels and the brain, by reducing inflammation and cellular oxidative stress.

GLP-1 receptor agonists can therefore represent an effective pharmacological option for weight loss in women during perimenopause and menopause. In these populations, treatment has shown reductions in body weight, visceral fat, and fat mass, improvement in glycemic profile, and favorable effects on lipid levels.

It is important to emphasize that scientific literature is still evolving and that these benefits must be interpreted within the overall clinical context of each woman. There is no one-size-fits-all solution.

Risks and Critical Aspects to Consider

Like all medications, GLP-1RAs have a risk profile that must be carefully considered. The most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea), generally self-limiting. However, in some individuals, they may cause dehydration or require treatment discontinuation.

More serious adverse effects, such as cholecystitis and pancreatitis, may also occur.

Rapid weight loss, if not accompanied by adequate protein intake and physical activity, may promote loss of lean mass, increasing the risk of sarcopenia. This is particularly relevant during menopause, a phase already characterized by a physiological reduction in muscle mass and strength.

Regarding bone health, data are conflicting. Some studies suggest a neutral or slightly negative effect on bone density, while others indicate a possible indirect benefit related to weight loss and reduction of marrow fat. Long-term studies specifically focused on women with established osteoporotic risk are still needed.

In addition, individual response to GLP-1RAs may vary depending on genetic profile, metabolic status, and gut microbiota composition.

Menopause and GLP-1: So, What Role Can They Play?

GLP-1RAs may represent a useful tool, within an integrated therapeutic strategy, for women with visceral obesity, metabolic syndrome, or documented insulin resistance. The decision to introduce them into clinical practice should be based on a multidimensional assessment: BMI, waist circumference, body composition (lean and fat mass), comorbidities, lifestyle, adherence, and personal preferences.

It is useful to frame each woman according to her “metabolic phenotype” (for example, insulin-resistant, with NAFLD, sarcopenic) to guide therapy more precisely.

Collaboration among endocrinologists, gynecologists, dietitians, and physiatrists can maximize outcomes, especially in the presence of contraindications or multiple comorbidities.

It is important to remember that these drugs are not intended to replace attention to lifestyle or to offer “better and faster” solutions, but rather to support informed decisions as part of a multidisciplinary care plan. Balanced nutrition, tailored physical activity (including strength training), emotional support, and clinical monitoring remain essential pillars.

A Long-Term Approach, Not a Trend

GLP-1s should not be seen as a shortcut or an alternative to primary prevention. Their role must be integrated into a multidisciplinary plan that includes:

• • Balanced, protein-rich nutrition
• • Regular physical activity, with attention to muscle strengthening
• • Ongoing clinical monitoring
• • Psychological support and health education

Only through a personalized approach, based on evidence and guided by specialists, is it possible to turn the therapeutic opportunity offered by GLP-1s into a real clinical benefit for women’s health during menopause.

Clinical experience and emerging evidence tell us that there is no “miracle drug” that solves everything. The benefits of GLP-1s are real for some women and specific clinical conditions, but they do not replace a comprehensive view of menopausal health.

Viewing GLP-1 as a possible tool—carefully evaluated with competence and attention—is very different from seeing it as “the new celebrity secret.” It is a perspective that considers women in their full biological, emotional, and cultural complexity.

You can book a visit with Dr. Silvia Accornero directly on the Pausetiv website

Sources:

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Disclaimer:

This article is for educational purposes only and does not replace medical advice. Treatment decisions should always be made with a qualified healthcare professional.