Many women notice weight gain and metabolic changes during perimenopause and menopause. Falling oestrogen, changes to fat distribution and reduced insulin sensitivity can make weight harder to manage. GLP-1 receptor agonists such as semaglutide (Wegovy, Ozempic), and dual GIP/GLP-1 agonists such as tirzepatide (Mounjaro, Zepbound), can help some people lose weight when used alongside nutrition, movement and sleep support, guided by a clinician [1][2][3].
How GLP-1 and GIP/GLP-1 Medicines Work
These medicines mimic the gut hormones that signal fullness, slow gastric emptying and support glucose control. The result can be reduced appetite and improved metabolic control [6]. In large randomised trials, once-weekly semaglutide produced clinically meaningful weight loss versus placebo, on top of lifestyle advice [4]. NICE now recommends semaglutide and tirzepatide for weight management in specific NHS-defined groups, alongside a reduced-calorie diet and increased physical activity [1][2].
Who may be eligible in the UK
Access depends on criteria set out by NICE and NHS England. Wegovy (semaglutide) may be offered within specialist weight management services to adults who meet BMI and comorbidity thresholds after lifestyle support, and tirzepatide is being implemented via phased NHS commissioning for eligible cohorts [1][2][3]. Many people also access treatment privately. Your clinician can confirm if you meet criteria.
Safety, side effects and cautions
Common side effects include nausea, fullness, reflux and constipation. Rare risks include gallbladder problems, pancreatitis, thyroid disease and vision loss. Because these medicines delay gastric emptying, the MHRA advises that patients tell surgical teams before general anaesthesia or deep sedation so aspiration risk can be assessed and managed [5]. These medicines are not suitable for everyone, including some with certain endocrine tumours or during pregnancy. Always tell your clinical team if you are using these medications.
GLP-1 with HRT or MHT
Menopausal hormone therapy (HRT, also called MHT) aims to reduce systemic and genitourinary symptoms and to support long-term bone and cardiometabolic health where appropriate. GLP-1 therapy targets appetite and glucose regulation. Your clinician can advise on using them together safely within a comprehensive plan. There is no single “best” sequence. Personal medical history, goals and monitoring will guide decisions.
Practical plan that works in midlife
- Nutrition: adequate protein, plenty of fibre and plants, smaller & more frequent meals and consistent hydration.
- Resistance training: two or more days per week to protect muscle and bone.
- Lower Intensity Steady State Cardio: for heart health and energy.
- Sleep and stress management: to support healthy metabolism, energy availability, muscle growth, blood sugar control and cravings.
- Medication: consider GLP-1 or GIP/GLP-1 if criteria are met and lifestyle changes alone are not enough.
Specialist support in Hertfordshire
The Menopause Medic provides individualised weight and metabolic health care in Berkhamsted and St Albans, and via remote consultations for women across Watford, Hemel Hempstead, Harpenden, Tring, Welwyn Garden City and surrounding areas.
References
[1] NICE TA875, Semaglutide for managing overweight and obesity. NICE
[2] NICE TA1026, Tirzepatide for managing overweight and obesity, and NHS England interim commissioning guidance. NICENHS England
[3] DHSC overview on access to Wegovy in England. Health Media
[4] NEJM STEP-1 trial, once-weekly semaglutide for weight management. New England Journal of Medicine
[5] MHRA Drug Safety Update, delayed gastric emptying and aspiration risk. GOV.UK
[6] British Heart Foundation explainer on how semaglutide works and side effects. British Heart Foundation