GLP-1 medications and menopause: What women need to know

GLP-1 receptor agonist medications, the class of drugs that includes semaglutide and tirzepatide, have surged in popularity among women seeking to manage weight during perimenopause and menopause.

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But as prescriptions climb, functional nutrition practitioners and certified menopause specialists are raising urgent questions about whether women in midlife are being adequately supported while on these medications.

Cindi Stickle, a functional nutrition practitioner, certified menopause specialist, and creator of the It’s Not Just Hormones System, says the risks go well beyond what most patients are being told.

The muscle loss problem

GLP-1 medications and menopause: From significant lean muscle loss to inadvertent under-fuelling, the picture is more complex than the scale suggests. Picture: iStock

One of the most significant concerns surrounding GLP-1 medications in midlife women is the loss of lean muscle mass. Research suggests that up to 40% of the weight lost on GLP-1 medications may come from lean mass rather than fat, a finding Stickle describes as particularly alarming for women already navigating perimenopause.

“In perimenopause and menopause, that risk is amplified. Oestrogen is already declining, which accelerates muscle loss and makes it harder to rebuild. What I’m seeing is women getting smaller on the scale but feeling weaker, more fatigued and less stable overall.”

The implications extend far beyond aesthetics.

Muscle tissue plays a central role in metabolic rate, blood sugar regulation and long-term health. When lean mass declines, metabolism slows, and Stickle warns that many women are inadvertently making long-term weight maintenance harder, not easier.

“When muscle is lost in midlife, metabolism slows, which makes long-term weight maintenance more difficult. In many cases, women are unintentionally setting themselves up for future plateaus or regain because muscle wasn’t prioritised during the weight loss phase,” she explains.

The invisible risk of under-eating

GLP-1 medications work in part by suppressing appetite. But, Stickle cautions that reduced hunger does not mean reduced nutritional need.

“GLP-1 medications reduce appetite, but they don’t reduce the body’s need for nutrients. Many women are unintentionally under-eating, skipping meals, struggling to get enough protein and eating portions that are too small to support metabolic function.”

In practice, this often manifests as a deceptively manageable pattern: coffee in the morning, a light snack or a very small meal later in the day, and little else. Over time, Stickle says, this chronic under-fuelling creates a mismatch between what the body needs and what it is receiving.

“The body is still expected to maintain muscle, regulate hormones and manage stress, but it doesn’t have the resources to do it effectively. That’s when fatigue, weakness, poor recovery and stalled progress start to show up – even if weight loss initially looked successful.”

What GLP-1s cannot fix

GLP-1 weight-loss medications can help midlife women shed pounds but carry significant risks of accelerated muscle loss (up to 40% of weight lost), under-eating, slowed metabolism and fatigue – especially amid perimenopause and menopause hormone changes – unless women actively prioritise muscle preservation, consistent nutrient-dense fueling, blood sugar stability and stress management. Picture: iStock

Beyond nutrition, Stickle emphasises that weight loss medication does not address the broader physiological changes occurring during perimenopause, and that conflating the two can leave women frustrated and poorly supported.

Fluctuating oestrogen, declining progesterone, and heightened sensitivity to stress all affect how the body stores fat, uses energy and recovers. Even when the scale moves, many women continue to experience brain fog, disrupted sleep, anxiety and unexplained plateaus.

“Losing weight doesn’t automatically translate to feeling better. If the hormonal and stress-related drivers aren’t addressed, women can see physical changes without the internal improvements they expected,” Stickle says.

Supporting metabolism the right way in midlife

Stickle is clear that the solution is eating strategically and supporting the whole system.

“In midlife, metabolism isn’t improved through restriction. It’s supported through the right inputs,” she says, pointing to four key pillars: preserving and building muscle mass, fuelling the body consistently, stabilising blood sugar and regulating the nervous system.

Chronic stress, she notes, keeps the body in a heightened state of arousal that compromises energy, recovery and metabolic efficiency. GLP-1 medications can reduce intake, but they cannot build or protect metabolism independently.

“When these foundational pieces are missing, the body adapts by slowing down and conserving energy. This is why some women experience initial success followed by fatigue, plateaus or difficulty maintaining results. The goal isn’t just weight loss – it’s maintaining a metabolism that supports energy, strength and long-term health.”

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