Menopause, the time when a woman's periods stop permanently, is often accompanied by a range of physical and emotional changes. One of the most common concerns for women during this stage of life is weight gain. Hormonal shifts, particularly the decline in estrogen levels, can make weight control a challenge. This article explores the connection between menopause and weight gain, and examines the role of weight loss medications in managing this issue.
Why Weight Gain is Common During Menopause
Several factors contribute to weight gain during menopause:
- Hormonal Changes: The decline in estrogen levels affects lipid metabolism and can lead to a redistribution of fat mass from the hips to the abdomen. Estrogen also helps regulate appetite, and its decline can lead to increased cravings and food intake.
- Aging Metabolism: As women age, they tend to lose muscle mass, which slows down metabolism. Muscle is metabolically active, meaning it requires more energy to sustain. The loss of muscle mass and increase in fat mass can lead to weight gain, particularly around the abdomen.
- Lack of Sleep: Insomnia and night sweats, common symptoms of menopause, can disrupt sleep patterns. Poor sleep is linked to weight gain as it can lead to fatigue, reduced physical activity, and increased cravings for carbohydrates.
- Stress: The demands of midlife, including job pressures, financial strain, and caring for family members, can increase stress levels. Cortisol, the stress hormone, can trigger emotional eating and interfere with blood sugar regulation, leading to insulin resistance and weight gain.
- Genetics: Genetics, lack of sleep, and a sedentary lifestyle also play a role in weight gain during menopause.
Weight Loss Medications: A Potential Solution
With the growing popularity of medications like Ozempic, Mounjaro, Wegovy, and Zepbound, more and more doctors are prescribing these medications to women in menopause. These medications, typically taken once weekly as injections, work by helping the pancreas increase the production of insulin to move sugar from the blood into body tissues. They also slow down the movement of food through the stomach and curb appetite, thereby causing weight loss.
Types of Weight Loss Medications
- Ozempic (semaglutide): Originally approved by the Food and Drug Administration (FDA) to treat Type 2 diabetes, Ozempic is sometimes prescribed "off-label" for weight loss. It contains semaglutide, which helps lower blood sugar levels and slows the digestive process, promoting a feeling of fullness.
- Wegovy (semaglutide): Wegovy is FDA-approved for weight loss and contains the same main ingredient as Ozempic.
- Mounjaro (tirzepatide): Mounjaro is another medication used for weight loss that contains tirzepatide as its main ingredient.
- Zepbound (tirzepatide): Zepbound is FDA-approved for weight loss and contains the same main ingredient as Mounjaro.
How Weight Loss Medications Work
These medications belong to a class called glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 is a naturally occurring hormone that helps lower blood sugar levels and slows the digestive process, so you feel fuller, longer. GLP-1 also works in the brain to silence food noise, further promoting a feeling of satiety.
Effectiveness of Weight Loss Medications
Past clinical studies have shown that users of these medications can lose between 5% and 20% of their body weight over time. A post-hoc analysis led by endocrinologists at NewYork-Presbyterian and Weill Cornell Medicine showed that GLP-1 agonist tirzepatide is equally effective throughout all reproductive stages of a woman's life. In SURMOUNT-1, for example, significantly greater body weight reductions from baseline were observed with tirzepatide versus placebo in women in the premenopausal (26% vs. 2%), perimenopausal (23% vs. 3%), and postmenopausal (23% vs. 3%) stages.
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Potential Side Effects
The most commonly reported side effects of medications used for weight loss are nausea and constipation, but gallbladder and pancreatic disease are also reported. Makers of these drugs recommend having a conversation about the side effect profile and personalized risks with a health care professional before starting.
Combining Weight Loss Medications with Hormone Therapy
Combining hormone replacement therapy (HRT) with semaglutide may improve weight reduction while also helping manage menopause symptoms. HRT is linked with decreases in total fat mass and abdominal fat and improvements in insulin resistance and cholesterol levels. It may also help perimenopausal and menopausal women lose weight by easing vasomotor symptoms that affect sleep. A recent Mayo Clinic study found that postmenopausal women who were overweight or had obesity and combined semaglutide and HRT experienced about 30% more significant weight loss than those using semaglutide alone.
Lifestyle Changes: A Crucial Component
While weight loss medications can be effective, they are not a magic bullet. Lifestyle changes, including diet and exercise, are crucial for long-term weight management.
Diet
The Mediterranean diet, a plant-forward diet filled with anti-inflammatory foods, limits sugar, sodium, processed carbohydrates, trans and saturated fats, and processed foods. It includes whole foods rich in nutrients, fiber, and antioxidants that work together to optimize health and maintenance of a healthy weight.
Exercise
Experts recommend 150 minutes of moderate-intensity physical activity and two days of muscle strengthening per week. Weight-bearing exercises, like Pilates, are particularly effective for targeting core strength, which is where menopausal weight often deposits.
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Other Prescription Weight-Loss Drugs
Bupropion-naltrexone
Bupropion-naltrexone is a combination drug. Naltrexone is used to treat alcohol and opioid addiction. Bupropion is a drug to treat depression, called an antidepressant, and a drug to help people stop smoking, called a quit-smoking aid. Like all antidepressants, bupropion carries a warning about suicide risk. Bupropion-naltrexone can raise blood pressure. So your provider will need to check your blood pressure regularly at the start of treatment.
Liraglutide
Liraglutide also is used to manage diabetes. It's given as a daily shot. Nausea is a common complaint.
Orlistat
You also can get orlistat in a reduced-strength form without a prescription (Alli). Orlistat can cause side effects such as passing gas and having loose stools. You need to follow a low-fat diet when taking this medicine. In rare cases, people have had serious liver injury with orlistat.
Phentermine-topiramate
Phentermine-topiramate is a combination of a weight-loss drug called phentermine and an anticonvulsant called topiramate. Phentermine has the potential to be misused because it acts like a stimulant drug called an amphetamine. Other possible side effects include an increase in heart rate and blood pressure, insomnia, constipation, and nervousness. Phentermine by itself (Adipex-P, Lomaira) also is used for weight loss. It's one of four similar weight-loss drugs approved for use for less than 12 weeks, called short-term use.
Semaglutide
Semaglutide also is used to help control type 2 diabetes. To take the drug, you'll need to have test results that show you have one of these conditions.
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Setmelanotide
Setmelanotide doesn't treat any of the gene problems that cause these conditions. But it can help you lose weight. It can lessen your appetite and make you feel fuller. You take setmelanotide as a daily shot. Never give setmelanotide to a child under 6 years old.