A New Match for Menopausal Weight Gain: Ozempic

Kymberly Smith had had enough. It was February 2020, and she was grieving the sudden death of her husband when Covid lockdowns began. She was alone, without any access to her support network, and she was “in the throes of menopause.”

Eventually, Ms. Smith, 57, started using antidepressants for her grief. She was also on hormone therapy to ease her constant hot flashes and disruptive night sweats. But when it came to the 20 pounds she had gained, around her belly, she “just couldn’t shake it away.”

That weight gain, she said, is difficult to untangle from her circumstances — it might have been caused by the antidepressants or by the fluctuations in hormone levels during menopause. But it made her feel like she had no control over her life and body. “You lose yourself,” she said. “You feel a little bit helpless.”

This past April, Ms. Smith started using Wegovy, the weight loss drug that, along with the diabetes drug Ozempic and others like it, has soared in popularity. She has since lost about 35 pounds.

Women going through menopause raise concerns about weight and body changes almost as often as they do about hot flashes and night sweats, said Dr. Stephanie Faubion, medical director for the Menopause Society and a director of the Mayo Clinic’s Center for Women’s Health. “They come in, and they’re often in tears about it. They don’t know what’s happening,” she said. Some estimates suggest that roughly 70 percent of women gain up to 1.5 pounds per year during the menopause transition, which can last as long as a decade.

This weight gain can affect women’s self-esteem and quality of life and can also increase the risk of diabetes, cardiovascular disease and other health issues. Excess weight is also correlated with more hot flashes and night sweats; the Menopause Society recommends weight loss as an effective nonhormonal treatment for those symptoms.

Now, some women going through menopause are seeking drugs like Ozempic, despite the steep costs: Without insurance coverage, the drugs can run around $1,000 a month. “We’re getting requests daily,” Dr. Faubion said.

And some doctors are beginning to oblige. Given the prevalence of obesity in the United States, “a majority of midlife women actually meet the criteria to receive these medications,” said Dr. Daniela Hurtado, an assistant professor of medicine, endocrinologist and obesity medicine specialist at the Mayo Clinic.

Experts worry that these medications — which are relatively new, and whose long-term effects are still being studied — may exacerbate the loss of muscle mass and bone density already common among menopausal women, potentially putting them at greater risk for fractures, falls and osteoporosis.

“That is a concern to me, definitely,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity.

‘You just struggle and struggle’

Some menopausal weight gain is most likely caused by the slowdown in metabolism that happens as we age, Dr. Hurtado said. Menopause symptoms like insomnia and night sweats might also lead to weight changes, because women may be “tired and less likely to exercise,” she said. And hormonal changes during menopause shift how and where fat is stored in the body, with women generally gaining excess fat around the midsection while also losing muscle overall.

“The fact of the matter is that for lots of adults, but particularly menopausal women, those hormonal changes make it extremely difficult to lose weight no matter what you’re doing,” said Dr. Elaine Eustis, a gynecologist whose South Carolina practice specializes in menopause care.

Since opening her clinic in March 2022, Dr. Eustis has treated 1,500 patients, 150 of whom are now taking some form of semaglutide, the substance in Ozempic and Wegovy. Semaglutide simulates a hormone that our bodies naturally produce, making people feel full over longer periods of time. The drug also targets the areas of the brain that regulate appetite, leading many patients to report that their “food noise,” or mental chatter around eating, fades away.

Karen Smith, 60 (no relation to Kymberly), knew, as a nurse, that she would likely gain weight during menopause. But she wasn’t prepared for just how hard it would be to lose that weight.

She cut out bread and meat and piled her plate with vegetables. She tried yoga and weight lifting and walked her dog two miles each day. Nothing worked. “You just struggle and struggle,” she said.

Because these drugs are approved only for certain groups (Ozempic and Mounjaro for those with diabetes, Wegovy and Zepbound for people with obesity or who are overweight with certain health conditions), many people end up paying out of pocket for the medication. Ms. Smith sought out a telehealth clinic that could prescribe compounded semaglutide, which is much cheaper than a brand-name drug. The Food and Drug Administration has warned consumers about these unauthorized medications, citing potential safety risks and a lack of oversight.

Still, Ms. Smith wanted the medication. She lost 30 pounds in her first five months on the drug.

“It’s been the only thing that has ever worked,” she said.

A complicated calculus

Any weight loss typically leads to muscle loss, and among menopausal and postmenopausal women, losing a significant amount of muscle mass can raise the risk of becoming frail, Dr. Hagan said.

Estrogen loss during menopause accelerates bone loss, putting women at an increased risk for fractures and osteoporosis, Dr. Hurtado said, so adding semaglutide to the mix could possibly worsen the problem because significant, rapid weight loss can also potentially lead to bone density loss. Studies have found that hormone therapy helps prevent bone loss during menopause, though not all women want to or can use this option. It is essential that menopausal women who are taking medications for weight loss do strength training and eat plenty of protein, she said, to build muscle that can help counteract the effects of bone loss.

“I don’t want them to become so frail that they are going to fall in the winter and break a hip,” said Dr. Hurtado, who monitors her menopausal patients on semaglutide for changes in bone density and muscle mass.

There are also potential side effects — including nausea, vomiting and constipation — for patients of any age who are on Ozempic and similar drugs, especially as people increase their doses. In rare cases, the drugs can put people at risk for an inflamed pancreas, or suppress appetite so much that they consume dangerously few nutrients.

But many menopausal women are willing to take the gamble. And for some, the trickiest part of taking the drugs is the hard questions raised about what they’re willing to do to lose weight, and why they feel so strongly about it.

When Johanna Winter-Harper gained nearly 60 pounds in perimenopause, she tried to embrace the idea of body neutrality.

“I wanted to love myself as I was,” said Ms. Winter-Harper, 51, who is a therapist in Chicago.

But she worried that the added weight harmed her health. She has a family history of heart disease and diabetes and was alarmed when her blood sugar rose to the level of pre-diabetes. When she couldn’t lose the weight after exercising more and adjusting her diet — more protein, fewer carbohydrates, heaps of fruit and vegetables — she decided to try Ozempic.

She has lost 50 pounds in the last year on the medication, and her cholesterol and blood sugar levels have fallen. Still, she said, she felt conflicted.

“I embraced myself up to a certain point, and then yes, there was health,” she said. “But when I’m really honest about it, I wanted to be thinner, too.”