Menopause

GLP-1s in perimenopause and menopause: what the new research shows

By Juvenate Editorial Published October 29, 2026 Last updated October 29, 2026

If you are in your 40s or 50s, you may have noticed that your body seems to be playing by new rules. The waistband feels different, and the habits that used to work do not seem to work quite the same way. This month brought some of the first trial data to look at GLP-1-based weight loss across menopause stages, plus a major new study on what menopause does to the body. Here is what it means in plain language, and what to bring to your next appointment.

This is not medical advice. Whether a GLP-1 medicine, or any other treatment, is right for you is a decision for you and your doctor or prescriber. No affiliate links. Disclosure.

Why midlife feels different

It is not just in your head. The long-running Study of Women’s Health Across the Nation (SWAN) followed women through the menopause transition and measured body composition with DXA scans. Starting about two years before the final menstrual period, the rate of fat gain roughly doubled and lean mass (which includes muscle) began to decline. Those changes continued until about two years after the final period, then levelled off.

Here is the twist: the number on the scale did not suddenly speed up, because the extra fat and the lost lean mass roughly balanced each other out. As the SWAN team put it, simply measuring body weight “does not illustrate what’s happening ‘under the skin’.” That is one reason so many women feel their shape changing even when their weight barely moves.

A large study published in Nature Medicine this October adds to the picture. Researchers reconstructed menopause from about 300 million routine lab tests, using US national survey data and an Israeli health system covering more than a million women. They found step-like shifts in many markers around the final menstrual period, across systems including bone, liver, kidney and blood fats, with no matching jump in men of the same age. Sex-hormone changes began more than a decade before the final period. The authors also saw that women using hormone therapy appeared to have smaller jumps, but they stressed that this was observational and needs randomized trials to confirm.

The takeaway is not that something is wrong with you. Menopause is a real physiological shift, and it is reasonable to plan for it the way you would plan for any other big life change.

The new GLP-1 data, stage by stage

On October 20, Novo Nordisk presented two exploratory analyses at The Menopause Society’s 2026 Annual Meeting. They used data from REDEFINE 1, a phase 3 trial of CagriSema, an investigational once-weekly injection that combines semaglutide (the GLP-1 medicine in Wegovy and Ozempic) with cagrilintide, an amylin analog. CagriSema is not approved in the US, and the company says an FDA decision is expected in the fourth quarter of 2026.

Here is what the analyses reported at week 68:

All 2,309 women in the trial: 25.0% average weight loss with CagriSema versus 3.0% with placebo.
Premenopausal women: 26.7% versus 2.1% with placebo.
Perimenopausal women: 24.8% versus 1.7%.
Postmenopausal women: 23.1% versus 2.6%.
Waist size, a rough marker of abdominal fat, also fell across the groups.

These are encouraging numbers, but they come with real caveats:

They assume everyone stayed on treatment. The figures use what is called the efficacy estimand, an idealized scenario in which participants kept taking the medicine and used no other weight-loss treatment. Real life is messier.
Menopause stage was assigned after the fact. Researchers grouped women using age, medical history and recorded symptoms, not hormone tests or prospective staging. Novo itself describes the analyses as “hypothesis generating.”
Side effects were common. Across the whole trial, gastrointestinal side effects were reported by 79.6% of people on CagriSema versus 39.9% on placebo, mostly nausea, constipation and vomiting, and mostly mild to moderate and temporary.
It is company data. The analyses were announced by the manufacturer and presented as posters at a medical meeting, which is an earlier, less detailed stage than a full peer-reviewed paper.

The lead author, Dr. Maria Hurtado Andrade of the Mayo Clinic, said the numerical differences between groups “highlight the need for further research to better understand how reproductive aging may influence weight loss outcomes in women.”

What about hormone therapy?

You may see headlines suggesting that hormone therapy makes GLP-1 medicines “work better.” That idea comes partly from a 2024 Mayo Clinic study in the journal Menopause. Researchers looked back at the records of 106 postmenopausal women taking semaglutide. The 16 women who were also on menopause hormone therapy lost more weight at 12 months, 16% compared with 12%.

That is interesting, but it is a small, retrospective study, so it cannot show cause and effect, and the authors called for larger studies. Hormone therapy is a separate decision with its own benefits and risks, and it should be based on your symptoms and health history, not on weight loss. If you have questions about it, your doctor is the right person to ask.

If you are still having periods: the pregnancy question

This part surprises a lot of people. The Menopause Society notes that even when cycles are irregular, women in perimenopause can still get pregnant, and advises using birth control until menopause is confirmed, one year after the final period.

That matters for GLP-1 medicines. On October 23, the American College of Obstetricians and Gynecologists (ACOG) released new guidance on GLP-1s in pregnancy and breastfeeding. Among its points:

It recommends against using GLP-1 medicines during pregnancy, and suggests considering stopping one to two months before a planned pregnancy.
Weight loss on a GLP-1 may increase fertility, so clinicians should talk about reliable contraception with patients who do not want to become pregnant.

There is also a pill-specific detail. The US label for Zepbound (tirzepatide) notes that it can make oral hormonal contraceptives less effective for a while because it slows stomach emptying, and advises switching to a non-oral method or adding a barrier method for a period after starting and after each dose increase. If you use the pill, ask your prescriber how this applies to your medicine.

Practical ways to support your body through the transition

Whatever you and your doctor decide about medicines, these basics help protect what SWAN shows is most at risk in midlife, which is lean mass:

Prioritize protein. It is one of the simplest ways to support muscle while eating less. Our protein on a GLP-1 guide walks through the research.
Lift something. Regular strength training, at whatever level suits you, helps you hold on to muscle. A doctor or physical therapist can help you start safely.
Measure more than weight. Since the scale can hide changes in fat and muscle, notice how your clothes fit, how strong you feel and what your waist measures.
Be kind to your skin and hair. Rapid weight loss and falling estrogen can both show up in the mirror. See our posts on GLP-1 hair loss, Ozempic face and skin changes and healthy aging on a GLP-1.
Do not ignore other symptoms. Hot flashes, sleep problems, mood changes and vaginal dryness are common and treatable. Our guide to vaginal dryness in perimenopause and menopause is a good place to start.

For a handy one-stop summary of protein, skin, hair and sun protection, download our free GLP-1 Glow-Up Guide.

Questions to bring to your doctor

Am I in perimenopause, menopause or postmenopause, and how might that affect my weight and treatment plan?
Is a GLP-1 medicine appropriate for me, and what side effects should I watch for?
If I could still get pregnant, which contraception works best with the medicine you are suggesting?
How should I protect my muscle and bone while losing weight?
Are my other menopause symptoms worth treating separately?

And if you are already on a GLP-1, the same rule applies as always: please get your medicine from a licensed prescriber and pharmacy, and if you ever decide to stop, plan it with your prescriber first. Our post on what happens when you stop a GLP-1 explains why.

The bottom line

Menopause changes body composition, often before the scale shows it. New exploratory data suggest that a next-generation GLP-1 combination produced large average weight loss in women at every menopause stage, though with caveats and a lot of side effects, and it is not yet approved. If you are in midlife and thinking about a GLP-1, the best next step is an honest conversation with your doctor about your stage of life, contraception, muscle and the bigger picture of how you want to feel.

For more, visit our GLP-1 page and our Intimacy & Hormones page.