GLP-1 Medications for Weight Management During Perimenopause

Anja Lee Hall
Nov 21, 2025
8 min read

Perimenopause brings significant hormonal changes that often lead to weight gain, particularly around the midsection. As estrogen levels fluctuate and eventually decline, many women find that their usual diet and exercise routines no longer work the same way. This has led to growing interest in GLP-1 receptor agonists—medications originally developed for type 2 diabetes that have shown remarkable effectiveness for weight management.

If you're navigating perimenopause and considering GLP-1 medications, understanding how these drugs work, their benefits, and potential risks can help you make an informed decision with your healthcare provider.

What Are GLP-1 Medications?

GLP-1 receptor agonists are a class of medications that mimic glucagon-like peptide-1, a naturally occurring hormone in your body. GLP-1 is released by the intestines after eating and performs several important functions:

Stimulates insulin secretion when blood sugar is elevated
Reduces glucagon release, which helps lower blood sugar
Slows gastric emptying, keeping you fuller longer
Reduces appetite by affecting hunger signals in the brain
May improve insulin sensitivity

These medications were initially developed and FDA-approved for managing type 2 diabetes. However, their significant weight loss effects led to specific formulations being approved for weight management.

FDA-Approved GLP-1 Medications for Weight Management

Semaglutide (Wegovy)

How it works: Semaglutide is a once-weekly injectable medication that mimics GLP-1 with 94% similarity to the natural hormone.
Dosing: Treatment begins with 0.25 mg weekly for four weeks, gradually increasing over 16-20 weeks to the maintenance dose of 2.4 mg weekly. This gradual escalation helps minimize side effects.
Clinical results: In clinical trials, participants lost an average of 15-20% of their body weight over 68 weeks when combined with lifestyle modifications. Some studies showed even greater results, with nearly one-third of participants losing 20% or more of their starting weight.
FDA approval: Approved for weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition.

Tirzepatide (Zepbound)

How it works: Tirzepatide is unique because it activates both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptors, offering dual action for weight loss and metabolic improvement.
Dosing: Starting dose is 2.5 mg weekly, increasing every four weeks to a maximum maintenance dose of 15 mg weekly.
Clinical results: Clinical trials showed average weight loss of 20-22% over 72 weeks, making it one of the most effective weight loss medications currently available. In the SURMOUNT-1 trial, participants lost up to 22.5% of body weight at the highest dose.
FDA approval: Approved for weight management in adults with obesity or overweight with weight-related comorbidities.

Liraglutide (Saxenda)

How it works: Liraglutide is a daily injectable GLP-1 receptor agonist that was the first in this class approved specifically for weight management.
Dosing: Starts at 0.6 mg daily and increases weekly by 0.6 mg increments to the maintenance dose of 3.0 mg daily.
Clinical results: Participants typically lose 5-10% of body weight over one year. While less dramatic than newer options, liraglutide remains effective for many patients.
FDA approval: Approved for weight management since 2014.

Other GLP-1 Medications (Diabetes Treatment)

Several other GLP-1 receptor agonists are FDA-approved for type 2 diabetes management and may be prescribed off-label for weight loss:

Semaglutide (Ozempic): Lower-dose version (0.5 mg or 1 mg weekly) approved for diabetes but often prescribed off-label for weight management when Wegovy is unavailable.
Dulaglutide (Trulicity): Once-weekly injection for diabetes that can produce modest weight loss of 2-6 pounds.
Exenatide (Byetta, Bydureon): Available as twice-daily or once-weekly formulations for diabetes management.

How GLP-1s May Help During Perimenopause

GLP-1 medications address several specific challenges that perimenopausal women face:

Visceral fat reduction: Studies show GLP-1s are particularly effective at reducing abdominal fat, which tends to accumulate during perimenopause and poses cardiovascular risks.
Improved insulin sensitivity: By enhancing how cells respond to insulin, these medications counteract the insulin resistance that often develops during the menopausal transition.
Appetite control: The appetite-suppressing effects help manage increased hunger that many women experience due to hormonal fluctuations.
Metabolic support: GLP-1s can help offset the metabolic slowdown that occurs with declining estrogen and aging.
Cardiovascular benefits: Some GLP-1 medications have shown cardiovascular benefits in clinical trials, which is particularly relevant since heart disease risk increases after menopause.
Blood sugar regulation: Even without diabetes, maintaining stable blood sugar becomes more challenging during perimenopause. GLP-1s help smooth out these fluctuations.

Where Lifestyle Support Fits In

While medications like GLP-1s can be powerful tools, long-term success still depends on supporting your body’s natural metabolism.

That’s why many women combine medical treatment with programs like The Blood Sugar Method—a comprehensive, science-based system that helps stabilize blood sugar, curb cravings, and rebuild metabolic resilience during perimenopause.

Inside The Blood Sugar Method, you’ll find practical tools for meal planning, protein balance, stress and sleep regulation, and hormone-supportive nutrition—all key factors that enhance GLP-1 results and sustain progress when medication isn’t an option or is later discontinued.

Clinical Evidence for Perimenopausal Women

While most GLP-1 clinical trials haven't specifically targeted perimenopausal women, the available evidence is encouraging:

Research shows that women in the perimenopausal and postmenopausal age groups respond similarly to younger adults in terms of weight loss percentage. Some studies suggest that older women may actually experience greater absolute weight loss, though this may reflect higher starting weights.

A 2023 analysis of semaglutide trials found no significant difference in efficacy between pre- and postmenopausal women, suggesting hormonal status doesn't diminish the medication's effectiveness.

The metabolic improvements seen with GLP-1s—including better insulin sensitivity, reduced inflammation markers, and improved lipid profiles—are particularly valuable during perimenopause when metabolic health often declines.

Potential Side Effects

Understanding potential side effects helps you prepare and make informed decisions:

Gastrointestinal effects (most common):

Nausea (affects 20-40% of users, typically worst during dose increases)
Vomiting
Diarrhea
Constipation
Abdominal pain
Bloating and gas

Most gastrointestinal symptoms improve over time as your body adjusts. Eating smaller, more frequent meals and avoiding high-fat foods can help minimize these effects.

Other common side effects:

Fatigue or low energy
Headaches
Dizziness
Injection site reactions

Serious but rare side effects:

Pancreatitis (inflammation of the pancreas)
Gallbladder problems
Kidney problems
Hypoglycemia (low blood sugar, especially if taking with other diabetes medications)
Changes in vision
Increased heart rate
Thyroid tumors (seen in animal studies; human risk unclear)

Contraindications: GLP-1 medications should not be used by people with:

Personal or family history of medullary thyroid carcinoma
Multiple endocrine neoplasia syndrome type 2
History of pancreatitis
Severe gastrointestinal disease
Pregnancy or planning pregnancy

Important Considerations for Perimenopausal Women

Bone health: Some research suggests rapid weight loss may affect bone density. Since perimenopausal women already face increased osteoporosis risk, discuss bone health monitoring with your healthcare provider. Adequate calcium, protein, vitamin D, and weight-bearing exercise are essential.

Muscle preservation: Significant weight loss can include muscle loss. Prioritizing protein intake (aim for 0.8-1.0 grams per pound of ideal body weight) and resistance training helps maintain muscle mass during treatment.

Nutrient absorption: Slower gastric emptying may affect nutrient absorption. Consider discussing vitamin supplementation with your healthcare provider, especially for nutrients crucial during perimenopause like calcium, vitamin D, B vitamins, and magnesium.

Interaction with hormone therapy: If you're taking hormone replacement therapy (HRT), GLP-1 medications can generally be used safely alongside it. However, always inform your healthcare provider about all medications you're taking.

Mental health: Perimenopause can bring mood changes, anxiety, and depression. While GLP-1s don't directly affect mood, the lifestyle changes and physical improvements may have positive psychological effects. However, report any mood changes to your healthcare provider.

Cost and Insurance Coverage

GLP-1 medications for weight management are expensive, typically ranging from $900 to $1,500 per month without insurance. Insurance coverage varies significantly:

Many insurance plans cover GLP-1s when prescribed for type 2 diabetes
Coverage for weight management is less consistent and often requires meeting specific criteria (BMI thresholds, documented weight-related health conditions, prior weight loss attempts)
Medicare Part D does not cover medications solely for weight loss
Some manufacturers offer savings programs or patient assistance programs for eligible patients

Check with your insurance provider about coverage criteria and explore manufacturer savings programs if paying out of pocket is a concern.

Is a GLP-1 Medication Right for You?

Consider discussing GLP-1 medications with your healthcare provider if you:

Have a BMI of 30 or higher, or BMI of 27 or higher with weight-related health conditions
Have struggled to lose weight through diet and exercise alone
Are experiencing significant weight gain during perimenopause that's affecting your health
Have metabolic concerns like prediabetes, insulin resistance, or metabolic syndrome
Want to reduce visceral abdominal fat that's accumulated during perimenopause
Are committed to making lifestyle changes alongside medication

GLP-1 medications work best when combined with healthy eating patterns, regular physical activity, adequate sleep, and stress management—not as standalone solutions.

What to Expect During Treatment

Initial consultation: Your healthcare provider will review your medical history, current medications, weight loss history, and health goals. They'll assess whether you're a good candidate and discuss realistic expectations.

Starting treatment: Most providers use a gradual dose escalation schedule to minimize side effects. You'll start with the lowest dose and increase every few weeks.

First few weeks: Expect some gastrointestinal adjustment as your body adapts. Many people notice reduced appetite and earlier satiety within days of starting treatment.

Ongoing monitoring: Regular follow-ups allow your provider to monitor your progress, adjust dosing, manage side effects, and check for potential complications.

Long-term use: These medications are intended for long-term use. Weight regain is common if treatment is discontinued, so discuss maintenance plans with your provider.

Lifestyle Modifications to Support Results

GLP-1 medications are most effective when combined with healthy habits:

Nutrition strategies:

Focus on protein at each meal to preserve muscle mass
Choose nutrient-dense foods since appetite will be reduced
Eat slowly and stop when comfortably satisfied
Stay hydrated throughout the day
Limit or avoid processed foods and added sugars

Physical activity:

Include both cardio and strength training
Aim for at least 150 minutes of moderate-intensity exercise weekly
Prioritize resistance training to maintain muscle during weight loss
Consider working with a fitness professional to design an appropriate program

Sleep and stress management:

Aim for 7-9 hours of quality sleep nightly
Practice stress-reduction techniques like meditation or yoga
Address sleep disruptions common during perimenopause

Questions to Ask Your Healthcare Provider

Before starting a GLP-1 medication, consider asking:

Which GLP-1 medication do you recommend for my situation and why?
What results can I realistically expect?
How will we monitor my progress and adjust treatment?
What should I do if I experience side effects?
How long do you anticipate I'll need to stay on this medication?
What happens if I need to stop taking it?
Are there any interactions with my current medications or supplements?
How should I adjust my lifestyle to maximize results?
What additional monitoring do I need (labs, bone density scans, etc.)?
What will this cost, and what options exist if insurance doesn't cover it?

The Bottom Line

GLP-1 medications represent a breakthrough in weight management, especially for women navigating the metabolic shifts of perimenopause. Still, medication is only one part of a comprehensive approach. The habits you build around food, sleep, stress, and muscle maintenance are what determine long-term metabolic health.

If you’re looking for structured guidance, The Blood Sugar Method can help you:

Understand and balance your blood sugar naturally
Build satisfying, low-glycemic meals that support hormones and metabolism
Learn practical strategies for cravings, energy crashes, and sleep disruption
Get expert coaching and community accountability
Access recipes, live Q&As, and step-by-step metabolic lessons

👉 Explore The Blood Sugar Method

Visit thebloodsugarmethod.com for course details

Email team@thebloodsugarmethod.com with questions or to schedule a brief consultation.

Whether or not you choose GLP-1 therapy, pairing evidence-based lifestyle support with medical care gives you the best foundation for lasting results through perimenopause and beyond.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting any new medication or treatment. Individual results may vary, and not all patients will be candidates for GLP-1 therapy.