(Peri)Menopause, Metabolism, and GLP-1s: Fighting the Weight Gain Battle

If you found your way to this article, you're likely wondering "Am I in perimenopause?" or you know you are, but are having a hard time wrapping your head around it all. That includes weight gain, fatigue, moodiness of a savage teenager, and a seemingly betrayal of body fat holding a convention around your midsection.

The challenges of perimenopause and menopause aren't talked about enough; we certainly don't get a lot of warning about what is happening or going to happen to us. Even among women going through it, there's this weird silence.

And forget getting real understanding from younger people or men; to them, it's like this invisible thing we're supposed to just quietly "deal with."

It's no wonder that women are driving the GLP-1 revolution, taking drugs like semaglutide and tirzepatide to shed pounds and try to capture the vitality we never appreciated in our youth.

I started GLP-1 Newsroom because I needed answers and have a particular set of skills in investigative journalism. Let's get into this topic.

what women in midlife need to know about weight gain

Understanding Perimenopause, Menopause, and Post Menopause

Starting (on average) in our mid-40s, women embark on a journey nobody prepares you for. I remember at age 46 talking to my OBGYN who asked "What age did your mother go through menopause? That's when you will." I had no idea. Of all the great conversations I had with my mom, that wasn't one them.

All I could say was "I remember as a teenager there were a few years it was like a demon invaded her body. And she was always sweaty."

So for those of you lucky enough to still have your birth mother around, ask her. It will tell you a lot about these phases coming your way.

Perimenopause

Perimenopause is the transitional phase leading up to menopause, often starting in a woman's 40s but sometimes as early as the late 30s.

Hormone levels — especially estrogen and progesterone — start fluctuating wildly, causing symptoms like irregular periods, hot flashes, sleep disturbances, mood swings, and the infamous stubborn weight gain. This stage can last anywhere from a few years to over a decade.

Unfortunately, there isn't a medical test for perimenopause. As I found out, if you're still on birth control, they can't test you for menopause either. Because hormonal birth control can mask the natural fluctuations in your hormones, making menopause tests like FSH (follicle-stimulating hormone) unreliable.

Most of the common, dreaded side effects (hot flashes, mood shifts, fatigue) happen during perimenopause.

Menopause

Menopause is technically one day: the 12-month anniversary of your last period. It marks the official end of reproductive years. However, the lead-up (perimenopause) and the follow-up (postmenopause) are where most of the physical and emotional changes happen.

At menopause, estrogen levels hit rock bottom, which can intensify symptoms like night sweats, vaginal dryness, bone density loss, and metabolic shifts that make weight management harder.

Side effects are most intense during perimenopause and a year or two after menopause.

Post Menopause

Once you’ve crossed that 12-month mark without a period, you’re considered postmenopausal. Symptoms can persist — sometimes for years — but for many women, they eventually stabilize.

However, postmenopause comes with long-term health risks like osteoporosis, heart disease, and increased abdominal fat, all linked to the sustained low estrogen environment.

Lifestyle choices and medical options like hormone therapy or GLP-1 medications can play big roles in managing this phase.

Perimenopause Side Effects & Weight Gain: Why It Happens

The average weight gain during perimenopause is about five pounds, but around 20% of women gain ten pounds or more. And here’s the kicker: it's not just because you're eating differently or exercising less. Hormonal shifts — particularly the slow, chaotic decline of estrogen — drive this change.

Redistribution of Fat

"Does menopause cause belly fat?" — the short answer is yes. It's not a moral failure or a willpower issue; it's literally your biology. Even if you always carried extra weight in your hips, thighs, or butt, menopause shifts your fat storage patterns.

As estrogen drops, your body starts favoring the belly area — even if it never did before. Here's why. When estrogen levels are normal, your body tends to store fat in "safer" places like your hips, thighs, and butt. That fat is subcutaneous (under the skin), and while it’s still fat, it’s less dangerous for your health.

When estrogen drops, your body loses that protective pattern. Without estrogen steering the ship, your body starts to prioritize visceral fat — the deep belly fat that wraps around your organs.

This kind of fat isn’t just storage; it’s biologically active. It pumps out inflammatory signals and messes with insulin sensitivity, making you more prone to weight gain, blood sugar issues, and heart disease.

Perimenopause Fatigue and Muscle Loss

Fatigue during perimenopause is real and exhausting. It’s not just feeling "tired" — it's like your energy is leaking out of a hole you can't find. Part of that comes from disrupted sleep (thanks, night sweats and anxiety), but hormonal swings also directly sap energy.

Meanwhile, muscle mass quietly declines. On average, women lose about 0.06 kg (0.2%) of total lean body mass per year during the menopausal transition. Over time, this loss accelerates.

Postmenopausal women have about 4% less appendicular lean mass (think arms and legs) compared to premenopausal women.

Translation: less muscle mass means a slower metabolism, and a slower metabolism means even more uninvited weight gain. Menopausal women are burning about 300 fewer calories a day, even without changing a thing about their eating or fitness routine.

Perimenopause Hair Loss: Another Surprise

It’s not just your waistline — hormonal shifts can also trigger perimenopause hair loss. Lower estrogen and progesterone mean hair grows slower and becomes thinner. Some women even notice a change in texture or increased shedding. Plus, those gray hairs seem to start multiplying nightly.

It’s not about vanity; it’s a sign of underlying changes in your body's ecosystem.

Nutrient-dense eating, stress management, and targeted hair supplements (talk to your doctor first) can help slow the process.

body fat and weight gain during menopause is different for each of these four women

GLP-1 Agonists: Why Midlife Women Are Paying Attention

Now that we seen the biggest impacts of the menopause phases, such as weight gain, muscle loss, inflammation, insulin issues, heart risks, etc., it starts to make sense why so many midlife women are reaching for GLP-1s.

These medications (Ozempic, Wegovy, Mounjaro, and Zepbound) help regulate blood sugar, tame appetite, improve insulin sensitivity, and promote weight loss — addressing exactly the issues that get harder to manage during perimenopause and menopause.

In 2023, about 75% of GLP-1 prescriptions were written for women. While younger women saw a surge, midlife women are increasingly using these meds to tackle stubborn weight gain and shifting metabolic health. Especially when lifestyle changes alone aren't cutting it.

Can You Take Estrogen With GLP-1?

Yes. In fact, they tend to play off of each other for the betterment of your body.

Estrogen therapy (whether oral, patch, or cream) is often prescribed to manage severe menopausal symptoms, and it doesn’t conflict with GLP-1 meds like semaglutide. Addressing hormonal imbalances while also improving metabolic function can be a powerful 1-2 punch.

That said, it’s important to work with a knowledgeable provider who understands how to balance both. Estrogen therapy isn't right for everyone, especially if you have certain cancer risks or clotting disorders.

woman having a hot flash during menopause

What Are the Risks of a Menopausal Woman on GLP-1s?

GLP-1 medications can be incredibly helpful during the menopause transition, but they’re not a magic bullet or a quick fix — and they come with specific challenges that menopausal women need to be aware of.

Muscle Loss: Menopause already speeds up muscle loss. GLP-1 medications can compound this if you're losing weight quickly without focusing on strength training and adequate protein. You must follow the program of proper protein intake, hydration, and fitness.
Skin Elasticity: Estrogen decline naturally reduces skin elasticity. Rapid weight loss can make sagging skin more noticeable, leading to frustration. This is where collagen supplements come in handy.
Fatigue and Weakness: Some fatigue attributed to GLP-1 side effects could actually be menopausal fatigue, making it hard to tease apart what's causing what.
Hair Thinning: Both menopause and some GLP-1 users report hair thinning, causing confusion and fear it's "just the drug" when it's often a mix of factors.
Frustration with Progress: The scale might move, but body recomposition (building muscle, maintaining firmness) requires lifting weights, eating enough protein, and being patient — something that’s already harder after 40. Instead of measuring by the scale number, get a smart scale (like this RENPHO version) that shows you how much visceral fat, subcutaneous fat, and other important health markers.

Moods of Menopause & GLP-1s

Mood swings during perimenopause and menopause are notorious — and brutal. Estrogen and progesterone fluctuations can trigger anxiety, irritability, low moods, and even feelings that border on depression.

Sleep disruptions, physical symptoms, and life transitions at this stage (like aging parents, career changes, or empty nests) just add fuel to the fire.

Meanwhile, GLP-1 medications like semaglutide and tirzepatide have their own complex relationship with mood.

Some studies have shown positive mental health benefits. For example, improved blood sugar regulation and weight loss can boost self-esteem and reduce depression symptoms for many users.
Other research and post-marketing reports highlight concerns about mood changes in a small subset of people — including rare cases of increased depression or even suicidal thoughts.
While not a direct hormone therapy, GLP-1s may support hormonal balance by reducing systemic inflammation and improving insulin sensitivity. These effects can help moderate some of the mood disturbances linked to hormonal fluctuations
By modulating the hypothalamus and improving temperature regulation, GLP-1s may reduce the frequency and severity of hot flashes, which are known to disrupt sleep and worsen mood

If you’re on a GLP-1 and notice major mood changes, it’s worth checking in with a provider — not because the medication is automatically "bad," but because adjusting dosage, layering in therapy, or tweaking your plan can make a big difference.

I found that taking GLP-1s, eating healthier, and moving a bit more actually helps my mood. It has nothing to do with body weight. However, as someone suffering from chronic depression, it feels weird to be so damn optimistic all the time now.

Wrapping It Up: You're Not Crazy, and You're Not Alone

Midlife body changes are messy, frustrating, and often feel invisible to everyone else. But they’re very real.

Understanding what's happening — from hormonal chaos to changes in fat distribution to muscle mass loss — can help you respond smartly instead of just feeling defeated.

Maybe that means adjusting your diet, adding strength training, getting serious about sleep, or exploring medication options like GLP-1s. Maybe it means giving yourself some damn grace for once.

Because if there's one thing this stage of life has taught me, it's that surviving these changes isn't about "getting your old body back." It's about building a new relationship with yourself — one that’s based on strength, knowledge, and a lot more self-compassion than the world ever taught us to have.

You're not broken. You're adapting. And you're definitely not alone.