Using GLP-1s During Menopause? How to Support Bone Density, Muscle Mass, and Nutrition
As more people in midlife turn to GLP-1 medications for metabolic support, questions are emerging about how these drugs interact with hormone replacement therapy (HRT), what the long-term effects may be for postmenopausal bodies, and what nutritional strategies are most important to protect health.
This article takes a closer look at what current research tells us—and what it doesn’t yet—about using GLP-1 receptor agonists (like semaglutide or tirzepatide) during and after menopause, especially for those also using HRT. The goal isn’t weight loss at all costs, but rather preserving muscle, bone, metabolic function, and quality of life through evidence-informed, compassionate care.
What Are GLP-1 Medications?
GLP-1 receptor agonists mimic a naturally occurring hormone called glucagon-like peptide-1, which slows stomach emptying, reduces appetite, and enhances insulin secretion in response to food. Originally used to manage type 2 diabetes, medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are now used more broadly to support metabolic health.
They’re often prescribed to help manage insulin resistance, prediabetes, blood sugar variability, and PCOS—all of which can be affected by the hormonal changes of menopause.
Why Menopause and GLP-1s Intersect
During perimenopause and menopause, lower estrogen levels can increase insulin resistance, abdominal fat distribution, appetite changes, sleep disruption, and loss of lean muscle mass. GLP-1 medications may help with some of these symptoms by reducing insulin needs, lowering post-meal blood sugar spikes, and delaying gastric emptying.
A 2024 study in Menopause: The Journal of the North American Menopause Society found that semaglutide had similar effects in postmenopausal women as it did in younger adults (Menopause Journal, 2024).
Limitation: This study used a small sample (n=106), was retrospective, and conducted in a specialized weight-management clinic—not representative of typical use. It also focused on weight outcomes rather than holistic health.
Weight Regain and the Cycle of Weight Loss
While GLP-1s are effective at suppressing appetite and reducing food intake in the short term, emerging research raises concerns about weight cycling—the repeated loss and regain of weight—which is both common and biologically driven after discontinuation.
A 2022 review in Diabetes, Obesity and Metabolism found that individuals who discontinued semaglutide regained approximately two-thirds of their lost weight within a year (Wilding et al., 2022).
Similarly, a 2019 meta-analysis published in Obesity Reviews concluded that weight cycling increases the risk of cardiometabolic disease, systemic inflammation, insulin resistance, and psychological distress—especially among women (Eun-Jung Rhee, 2017).
As registered dietitian and author Christy Harrison explains, weight cycling is not a matter of willpower or poor habits. It reflects the body’s complex homeostatic mechanisms—including hormonal changes in leptin, ghrelin, and thyroid function—that drive people to regain weight after restriction (Harrison, 2023).
Why this matters: People using GLP-1s may experience a rebound in appetite, body weight, and mental health symptoms if the medication is stopped or not paired with long-term support. This underscores the importance of sustainable habits, adequate nutrition, and psychological safety over weight-focused outcomes.
What Should You Watch for? Nutrition, Muscle, and Bone Health
GLP-1 medications can reduce hunger—sometimes dramatically. While this effect may help regulate blood sugar or manage insulin resistance, it also poses risks for underfueling, especially in menopausal bodies that are already vulnerable to muscle and bone loss.
A 2024 review in Diabetes, Obesity and Metabolism warns that lean body mass loss—meaning muscle, not fat—can be a significant portion of the changes seen with GLP-1s (DOM Journal, 2024).
A 2024 animal study published in Biochemical and Biophysical Research Communications found that semaglutide suppressed bone formation markers and increased bone resorption in female mice (ScienceDirect, 2024).
Limitations: The human data is limited in scope and sample size. The animal studies provide mechanistic insight but aren’t definitive. Few trials examine these effects in menopausal or older adults.
Nutrition Priorities While on a GLP-1
If you're taking a GLP-1 medication, nutrition becomes even more important—not less. Appetite suppression can lead to unintended nutrient gaps, low energy availability, and diminished intake of protein, fiber, and key micronutrients. Here’s what to prioritize:
🥩 Protein
Essential to preserve muscle and support immune function.
Aim for 1.2–1.6g/kg body weight per day
Space protein evenly throughout the day to improve absorption
🥦 Calcium + Vitamin D
Critical for bone strength—especially as estrogen declines.
Calcium: 1,000–1,200 mg/day (food + supplements)
Vitamin D: ~800–1,000 IU/day (based on labs and sun exposure)
🫐 Fiber + Antioxidants
Support digestion, gut health, and hormone metabolism.
Include whole grains, legumes, nuts, seeds, fruits, and vegetables
Watch for fiber tolerance, especially if appetite or gastric emptying is reduced
🧂 Electrolytes & Hydration
Slower gastric emptying can increase nausea and dehydration risk.
Prioritize fluid intake, especially with nausea
Include sodium, potassium, and magnesium-rich foods
💪 Strength Training
Supports lean mass retention and metabolic health.
Pair with adequate protein intake and potentially creatine to help preserve lean body mass.
What About Bone Health?
Bone mineral density naturally declines after menopause, and this loss can be accelerated by under-nutrition or rapid weight loss. A 2015 meta-analysis highlights that bone loss is a frequently overlooked consequence of aggressive weight interventions—particularly when they aren’t paired with adequate calcium, vitamin D, and resistance training. (Hunter G, et al. 2015).
This matters whether or not your goal is weight-focused. The takeaway is simple: maintaining bone and muscle should be a central goal of any intervention in midlife and beyond.
When to Consult Your Medical Team
It’s important to talk to your healthcare providers—including your OB-GYN, primary care physician, and a registered dietitian—before starting or combining GLP-1s and HRT.
Discuss with your provider if:
You’re on HRT and are considering a GLP-1 medication
You have a history of osteopenia or osteoporosis
You’re experiencing low appetite or struggling to meet protein needs
You’re unsure how to support your nutrition and body composition on these medications
No medication replaces the need for personalized, whole-person care. The right approach includes support for your hormonal health, muscle and bone preservation, mental well-being, and relationship with food.
Final Thoughts
GLP-1 medications and hormone therapy are powerful tools—but they don’t work in isolation. For people in midlife, the priority isn’t just changing body size but protecting long-term health, mobility, and quality of life.
Whether or not you take these medications, your body still needs nourishment, structure, and support.
References
Hurtado M, et al. (2024). Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause. https://journals.lww.com/menopausejournal/fulltext/2024/04000/weight_loss_response_to_semaglutide_in.4.aspx
Model J, et al. (2024). Interactions between glucagon like peptide 1 (GLP-1) and estrogens regulates lipid metabolism. Biochemical Pharmacology. https://www.sciencedirect.com/science/article/abs/pii/S0006295224006233
Hunter G, et al. (2015). Weight Loss and Bone Mineral Density. Endocrinol Diabetes Obes. https://pmc.ncbi.nlm.nih.gov/articles/PMC4217506/
Neeland I, et al. (2024). Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab. https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15728
Rhee E, (2017). Weight Cycling and Its Cardiometabolic Impact. J Obes Metab Syndr. https://pmc.ncbi.nlm.nih.gov/articles/PMC6489475/
Wilding JPH, et al. (2022). Weight regain after withdrawal of semaglutide: STEP 1 extension. Diabetes Obes Metab. https://pubmed.ncbi.nlm.nih.gov/35441470/
Harrison C. (2023). What is weight cycling? https://christyharrison.com/what-is-weight-cycling