HRT vs Ozempic for Menopausal Weight Management

This article has been recently updated since its original publication.

Key Highlights

• Perimenopause and menopause can lead to a significant increase in visceral fat and loss of muscle.

• Body composition is more indicative of overall health than weight itself.

• GLP-1 agonists like Ozempic may accelerate muscle loss, potentially increasing menopausal frailty risk.

• HRT presents an alternative weight management tool that improves bodily composition including fat redistribution.

• HRT also helps preserve muscle and bone health, unlike GLP-1 agonists, which may exacerbate frailty.

  
  

Introduction

No part of the body goes untouched by estrogen deficiency. Estrogen influences our gut microbiome, bones, muscle, brain, and metabolism. [1]

Perimenopause, marked by the onset of menopausal symptoms (eg. irregular periods, brain fog, loss of sex drive), is often accompanied by an increase in visceral fat. You may be eating the same, exercising the same, but feeling and looking different.

Ozempic and HRT are often considered solutions for this transition; let's explore which one is the best option for your overall health.

How Does Menopause Influence Body Composition

The hallmark of menopause is when you experience your final menstrual period. However, perimenopause can start up to 10 years before menopause; many women start hormone therapy during perimenopause.

Although weight gain is one of the more noticeable effects of the menopausal transition, your whole body is changing. Here are some key changes to bodily composition to be aware of:

The Connection Between Menopause And Weight Gain

Estrogen helps modulate the body's fat distribution, supports muscle maintenance, and influences energy expenditure.

As estrogen decreases, the body experiences a phenotypic change in fat, typically transitioning to the abdomen. Research finds that post-menopausal women had 49% greater intra-abdominal fat, increasing metabolic and cardiac health risks. [2]

Moreover, the metabolic slowdown accompanying menopause makes it harder to burn calories efficiently. As a result, activities and eating habits that once helped maintain your weight may not be enough.

The Connection Between Menopause And Frailty

Around 1/2 of women experience at least one bone fracture post menopause. [3]

Frailty is a complex condition characterized by decreased strength, endurance, and physiological function, making individuals more vulnerable to stressors such as illness or injury.

"Muscle is the organ of longevity." Dr. Gabrielle Lyon

During menopause, many women experience a significant increase in frailty due to interconnected physiological changes. This includes:

1. Loss of muscle mass. Reduced estrogen levels accelerate muscle loss. Research finds that women in late perimenopause had 10% less muscle mass than women in early perimenopause. [4]

2. Loss of bone density. The decline in estrogen adversely affects bone density; women lose up to 20% of bone mass during menopause. [5]

Frailty is not just a physical condition; it is closely linked to overall health. Research indicates that frailty is a strong predictor of lifespan and healthspan. [6]

What is Ozempic or Semaglutide?

Ozempic, known generically as semaglutide, is a medication initially classified as a diabetes medication, prescribed to help individuals with type 2 diabetes manage their blood sugar levels. It belongs to a class of drugs known as GLP-1 receptor agonists.

GLP-1 is crucial in regulating blood sugar levels by stimulating insulin release from the pancreas when blood sugar levels rise. Additionally, GLP-1 slows gastric emptying, making individuals feel fuller for longer and reducing appetite.

Can Ozempic Be Used For Menopausal Weight Gain?

Semaglutide, or Ozempic, has been observed to successfully promote weight loss in menopausal and post-menopausal women, though its FDA approval for this specific purpose is still under review.

Study Demonstrating Ozempic Weight Loss Efficacy

One notable study published in the New England Journal of Medicine investigated the effects of the active ingredient semaglutide in Ozempic on a group of nearly 2,000 adults with obesity. [7]

The study participants, a majority of whom were postmenopausal women, were either given semaglutide or a placebo. The results demonstrated significant weight loss in postmenopausal women in the semaglutide group.

Group	Average Weight Loss
Semaglutide	15%
Placebo	2.4%

However, ozempic can also result in muscle loss. A recent study showed that those taking Ozempic, or any form of semaglutide, lost a ratio of 60% fat and 39% muscle mass. [7]

Does Ozempic Increase Frailty Risk In Menopausal Women?

While there is no conclusive research to establish that Ozempic can lead to frailty or musculoskeletal syndrome, individuals can lose muscle mass on this drug.

To avoid increasing risks of sarcopenia and musculoskeletal syndrome, it's critical to actively monitor nutrition, specifically protein intake.

"Women in perimenopause should eat more, not less." Dr. Mary Claire Haver, Certified Menopause Specialist

Even though Ozempic may reduce our appetite and caloric intake, menopausal women should prioritize nutrition and musculoskeletal health for long-term well-being.

HRT for Menopausal Weight Management

Hormone replacement therapy (HRT) is currently not indicated for menopausal weight loss. However, HRT has been seen to improve body composition.

HRT Improves Body Composition in Menopausal Women

Oftentimes, weight is just a number. Body composition tells us a lot more about our health.

Unlike Ozempic, HRT focuses less on weight loss and more on body composition:

1. Weight Gain Prevention. HRT helps prevent weight gain from estrogen deficiency in the body. [8]

2. Fat Redistribution. HRT specifically targets visceral fat, the main culprit in menopausal weight gain. This can reduce several health effects associated with this symptom. [9]

3. Supports Musculoskeletal Health: Estrogen plays a key role in maintaining muscle and bone health. By restoring estrogen levels, HRT helps preserve muscle mass and bone density, reducing the risk of frailty. [10]

   
   

Vaginal estrogen, in particular, can be used to address many menopausal symptoms and has been shown to significantly reduce all-cause mortality. Research finds that vaginal estrogen may even safe for breast cancer patients. [11, 12]

HRT vs Ozempic for Menopausal Weight Management

Navigating weight management during menopause involves evaluating different treatment options.

While both can assist with weight management, their impacts on health—particularly regarding frailty—vary significantly.

Feature	HRT	Ozempic
Weight Loss	Modest, combats weight gain	Average loss of 15% body weight
Muscle Health	Preserves muscle mass	May reduce muscle mass.
Bone Density	Protects against osteoporosis	No protective effect on bone density
Frailty Risk	Reduces risk by maintaining strength	May increase frailty risk
Body Composition	Targets abdominal fat	Targets all body weight, not just fat
Primary Use	Alleviates menopausal symptoms and health risks	Primarily for weight management

HRT not only alleviates menopausal symptoms but also protects muscle and bone health, reducing the risk of frailty. [10]

Women should consult their physician and/or a menopause specialist to determine the most suitable approach, balancing weight management goals with overall health and wellness during menopause.

Unsure What To Do?

If you are experiencing menopausal symptoms, you may be in perimenopause and should schedule a consultation with your physician. Try to see a certified menopause practitioner.

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Frequently Asked Questions

Can Ozempic be used as a primary treatment for menopause symptoms?

Ozempic is not specifically approved for treating menopause symptoms. While it may alleviate certain symptoms, it's crucial to consult with your healthcare provider to determine the most effective treatment plan, which may include hormone therapy or other approaches to address estrogen decline.

How quickly can improvements be noticed after starting Ozempic?

Improvements in blood sugar levels may be noticeable sooner, while significant weight loss may take several weeks. Incorporating healthy lifestyle changes like regular physical activity and a balanced diet can enhance Ozempic's effectiveness. Discuss your progress with your healthcare provider.

Are there any lifestyle changes recommended when taking Ozempic?

Yes, adopting healthy lifestyle changes can optimize Ozempic's benefits. Focus on balanced nutrition, including absorbable protein, fiber and regular strength and endurance exercises

This article is for informational purposes only and not a substitute for professional medical advice. Always consult a qualified healthcare provider with any questions regarding medical conditions.

References

1. https://www.sciencedirect.com/science/article/pii/S075333220100155X?via%3Dihub

2. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2000.tb06506.x

3. https://www.nature.com/articles/s41574-020-0339-7

4. https://journals.physiology.org/doi/full/10.1152/japplphysiol.00315.2019

5. https://www.nejm.org/doi/full/10.1056/NEJMoa022464

6. https://doi.org/10.1016/j.mad.2019.03.005

7. https://pubmed.ncbi.nlm.nih.gov/33567185/

8. https://academic.oup.com/jbmr/article/18/2/333/7592572#google_vignette

9. https://journals.lww.com/menopausejournal/fulltext/1999/06040/impact_of_hormone_replacement_therapy_on_the_body.7.aspx

10. https://www.tandfonline.com/doi/abs/10.1517/14656566.1.6.1163

11. https://jamanetwork.com/journals/jamaoncology/fullarticle/2811413

12. https://academic.oup.com/oncolo/article/25/12/e1846/6443875