Should women in perimenopause use weight loss drugs like Ozempic?

GLP-1 receptor agonists - the class of drugs that includes semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda) - have become one of the most talked-about developments in weight management in decades. Originally developed to treat type 2 diabetes, they are now being widely prescribed and self-administered for weight loss, including by women navigating the hormonal and metabolic changes of perimenopause.

As a Registered Nutritional Therapist who works with this group of women every day, I am not categorically opposed to these medications. They have a legitimate clinical role in specific contexts. But the conversation around them is missing something important: for most perimenopausal women, weight gain is not a simple problem of too much appetite. And a drug that suppresses appetite is not addressing the actual problem.

How GLP-1 drugs work

GLP-1 (glucagon-like peptide-1) is a hormone naturally produced in the gut in response to eating. It stimulates insulin release, slows gastric emptying, and signals satiety to the brain. GLP-1 receptor agonists mimic this hormone, effectively reducing appetite and slowing the rate at which food moves through the digestive system.

The weight loss results in clinical trials have been significant - more so than any previous pharmaceutical intervention. But trials are conducted over defined periods, with monitoring and support. The real-world picture for women using these drugs long-term, particularly during a complex hormonal transition, is considerably more nuanced.

Why perimenopause weight gain is different

Weight gain during perimenopause is not primarily driven by overeating. It is driven by hormonal change. Declining oestrogen reduces insulin sensitivity, alters fat distribution towards the abdomen, affects thyroid function, disrupts sleep, and raises cortisol. These are metabolic and endocrine changes, and they require a metabolic and endocrine response.

Suppressing appetite does not address insulin resistance. It does not restore oestrogen. It does not lower cortisol or improve sleep. It reduces caloric intake, which may produce weight loss in the short term, but it does not change the underlying hormonal environment that is driving the weight gain in the first place.

This is why many women find that if they stop the medication, the weight returns - often rapidly. The root cause has not been addressed.

The specific risks for perimenopausal women

Muscle mass loss

This is the concern I raise most frequently with clients considering or already using GLP-1 drugs. Rapid weight loss, particularly when protein intake is inadequate, results in significant loss of lean muscle mass alongside fat. In clinical trials, a meaningful proportion of total weight lost on semaglutide was lean mass rather than fat.

For perimenopausal women, this is a serious problem. Oestrogen already reduces muscle protein synthesis during this transition. Accelerating muscle loss through inadequate nutrition compounds a process that is already working against you. Muscle mass is directly linked to insulin sensitivity, metabolic rate, bone density, and long-term independence. Losing it while pursuing a lower number on the scale is trading a short-term result for a long-term cost.

Nutritional deficiency

GLP-1 drugs suppress appetite significantly. Many women on these medications report eating very small amounts - sometimes insufficiently small amounts - and feeling no hunger signal to prompt them to eat more. Combined with slowed gastric motility, this creates real risk of inadequate protein, micronutrient, and caloric intake.

In perimenopause, when the body's demands for protein, magnesium, B vitamins, vitamin D, zinc, and omega-3 fatty acids are already higher than most women are meeting through diet alone, further reducing food intake without careful monitoring is a genuine clinical concern.

Gut health disruption

GLP-1 drugs slow gastric motility - the rate at which food moves through the digestive system. Side effects including nausea, constipation, bloating, and gastric discomfort are among the most commonly reported by users. These are not merely inconvenient. The gut is central to hormone metabolism, nutrient absorption, and immune function. Chronic constipation impairs oestrogen clearance. Disrupted gut motility affects the microbiome. For women where gut health is already a factor in their hormonal symptoms, adding a drug that further compromises digestive function requires careful consideration.

Psychological relationship with food and hunger

Hunger is not the enemy. It is a signal from the body that has meaning, and learning to eat in response to genuine physiological need - rather than stress, boredom, or habit - is a meaningful and sustainable goal. Drugs that eliminate hunger signals entirely bypass this process entirely. For some women this is experienced as liberating. For others it creates a disconnect from their body's signals that can be difficult to re-establish when the medication is stopped.

When GLP-1 drugs may be appropriate

None of the above means these medications are never appropriate for perimenopausal women. For women with clinically significant obesity, established insulin resistance or type 2 diabetes, or where the metabolic risks of excess weight are significant and other interventions have not been sufficient, GLP-1 drugs can play a legitimate role as part of a broader clinical plan.

The key words are "part of a broader clinical plan." Used in isolation, without concurrent nutritional support, resistance training, and attention to the hormonal drivers of weight gain, they are unlikely to produce lasting results and carry the risks outlined above.

What a root-cause approach looks like instead

For most perimenopausal women presenting with weight gain, the most effective approach addresses the actual drivers: improving insulin sensitivity through dietary composition and resistance training, supporting cortisol regulation through stress management and sleep, optimising nutrient status, addressing gut health, and considering HRT where appropriate in discussion with a GP.

This is not a quick fix. But it produces lasting change because it addresses the underlying physiology rather than overriding a symptom of it.

If you are currently using a GLP-1 medication, the most important thing you can do alongside it is ensure your protein intake is adequate (a minimum of 30g per meal), engage in regular resistance training to protect muscle mass, and work with a practitioner who can monitor your nutritional status and support the hormonal picture concurrently.

I offer a dedicated GLP-1 Support Package for women using these medications who want to protect their muscle mass, optimise their nutrition, and address the underlying hormonal drivers of weight gain at the same time. I also work with women who want to explore the root-cause approach before or instead of medication.

Book a free 20-minute consultation to find out which approach is right for you.