By Leanna Coy, FNP-BC
Menopause often leads to significant weight changes for women and individuals assigned female at birth. This is primarily due to the hormonal fluctuations that are triggered by the menopause transition. It is a common problem for perimenopausal and menopausal women to struggle with becoming overweight or obese. When weight gain occurs, it often leads to additional health problems, such as high blood pressure or diabetes. A study led by the Mayo Clinic found meaningful results in treating women for weight issues during this phase of life by combining a popular glucagon-like peptide medication (GLP-1) with hormone replacement therapy (HRT).
Weight Gain and Menopause
Hormonal changes that occur during the menopause transition, including declining estrogen, trigger a cascade of biological changes. These changes often appear as hot flashes, night sweats, disrupted sleep, and mood changes. Up to 75% of women experience some physical effects of the hormone shifts. But these are not the only changes. Weight gain is common. Nearly two-thirds of women between the ages of 40 and 59 years are overweight. After age 60, three-fourths of women are overweight.
Weight gain in menopause increases health risks. In menopause, women are already at an increased risk for cardiovascular issues with the declining estrogen levels and shifting body fat distribution. With additional weight gain, blood pressure can rise, cholesterol levels may go up, hardening of the arteries and insulin resistance may begin. Obesity is also associated with an increased risk for endometrial cancer and breast cancer.
HRT is the most effective treatment for the management of menopausal symptoms. The primary form of HRT is estrogen replacement, which is used to rebalance and minimize the symptoms of low estrogen.
Tirzepatide is a GLP-1 medication approved by the Food and Drug Administration for the treatment of overweight and obesity. GLP-1 medications quickly became the most popular weight loss medications during the COVID-19 pandemic and have proven to be the most effective weight loss drugs. Tirzepatide is the most beneficial GLP-1 for weight loss, with users losing an average of 22.5% of their body weight.
GLP-1 medications aid in weight loss by:
- Decreasing appetite
- Improving the feeling of fullness when eating
- More efficiently converting food into energy
Key Study Findings
A Mayo Clinic study reported by The Lancet Obestrics, Gynaecology, & Women’s Health, found that post-menopausal women who used a combination of tirzepatide and HRT lost 35% more weight than women using tirzepatide alone. That is significant.
With weight loss, improvements to health are expected. The researchers found improvements in blood pressure, blood sugar, and liver enzymes in the participants who used tirzepatide. But those who also used HRT had additional health benefits, including even lower blood pressure and lower triglycerides (a measure of bad cholesterol).
The results of this study echo similar research findings on combining HRT with other GLP-1 medications, such as semaglutide, for weight loss. Prior studies have found that the addition of HRT to a GLP-1 medication helps boost the appetite-suppressing effect of GLP-1 use.
What Happens Next
As this is an observational study involving a review of patient records over two years, further research is needed to confirm and clarify the findings. Studies are needed to show that the medication combination was the primary cause of the increased weight loss, and that no other factors, such as improved sleep, increased physical activity, better dietary choices, or improved quality of life from the HRT use, led to increased weight loss. If further studies confirm the benefits of combined HRT and GLP-1 therapy, new treatment options could become available in the future.
Given the large difference in weight loss between participants who used HRT and those who didn’t, the results are noteworthy. With most women spending one-third of their lives in the menopause phase, research like this can make a huge difference in creating new, more effective treatment options that are not only geared at women and people who were identified as female at birth, but that will also potentially improve their health as they age.
Women spend one-third of their lives in menopause. Having treatment options that can potentially improve their health as they age is impactful. Combining HRT with tirzepatide was found to have significantly greater weight loss for post-menopausal women than the use of tirzepatide alone. This finding could inform future treatment options.