Ozempic and Menopause: Everything You Need to Know If You're Managing Both at Once, According to a Prescribing Physician

Menopause is a time of big changes in your body and mind, and a new group of weight loss medications known popularly as Ozempic, for an early form of the drug, are trending. But are these drugs safe and effective for the particular needs of a woman undergoing the hormone fluctuations of midlife? We spoke with a doctor with years of clinical experience for guidance, and came away with a general belief that taking Ozempic is a boon—but it’s not a one-and-done magic shot. Want to investigate using this medication to lower your weight as well as reduce cardiac risk?  Here are the details you need to know before you make a decision for yourself.

Rocio Salas-Whalen, M.D. is a triple board-certified physician with certifications in Internal Medicine; Endocrinology, Diabetes and Metabolism and Obesity Medicine. Her broad professional experience engages with all facets of endocrinology, with an emphasis on women’s health and obesity; follow her at @drsalaswhalen. She is the principal at New York Endocrinology on Manhattan’s Upper East Side.

Dr. Salas-Whalen is bullish on the Ozempic family of weight loss drugs, collectively known as GLP-1s (short for glucagon-like peptide-1 agonists). As both an endocrinologist— a doctor who specializes in issues includingdiabetes, bone loss and a range of hormonal issues—and a gynecologist—specializing in conditions of the female reproductive system—Dr. Salas-Whalen is especially knowledgeable in the workings of hormones and blood sugar, which are the key drivers of menopausal weight gain.

“Ozempic is the poster child, the name we all know, but we now prescribe Wegovy, Monjouro and Zepbound for weight loss more because they are more effective for both weight loss and tolerance,” she says. As an endocrinologist, she’s been prescribing these types of drugs since 2005, when she began prescribing injectable Byetta to her diabetic patients and observing their weight loss. “In 2010, the first off-label use for glucose control and weight loss came with Victoza—it used to be a twice-a-day injection,” she says. Dr. Salas-Whelan says the new a generation of drugs are not only less frequently injected, but also better tolerated, with less of the nausea or vomiting that was a side effect of earlier iterations of this drug class.

TLDR: She says clients who have come to her with menopausal weight gain have lost 10 to 20 percent of their body weight, as long as they follow a plan that includes weight training and mindful nutrition.

A study has shown that breast cancer patients who take aromatase inhibitors, a common breast cancer medication, will find semagludtides don’t work for them—which is unfortunate, since those meds cause weight gain. Otherwise, the same restrictions apply for menopausal women as for everyone else regarding who shouldn’t take semaglutide, including people on certain antibiotics and anticoagulants. Also, people with personal or family history of thyroid cancer are more often than not unable to take semaglutides, since the medication has been linked to an increased risk of thyroid tumors.

“Both Ozempic and HRT [hormone replacement therapy] are great tools to help patients in midlife,  together or separately, to have good metabolic health to reduce risk of disease and mortality and add quality years to life,” says Dr. Salas-Whalen.

While it’s still early days for a large-scale population study of how HRT and Ozempic interact, there is evidence that in tandem, the two are in effect a turbo-powered weight-loss solution: A scientific study published this year found that postmenopausal women using hormone replacement therapy and semaglutide had a higher total body weight loss at three, six, nine and 12-month markers than women using semaglutide alone.

The risks for menopausal women are the same as for someone not in menopause, Dr. Salas-Whalen says. These include muscle mass reduction from rapid weight loss, nausea and diarrhea (especially with fried or fatty food). “I have never seen malnutrition, since I carefully monitor my patients’ diets—that’s why who you go to for this drug makes such a difference. I tell my patients to increase their protein intake—a minimum of 100 grams of protein to maintain muscle as well as eating the most important macro nutrients.”

Weight loss during menopause, with or without semaglutide, is highly individualized, according to the doctor, as is weight maintenance. In Dr. Sala-Whalen’s practice, she focuses on slow weight loss over a longer period of time to build a foundation of healthy habits, like weight-bearing, muscle-building workouts and nutritious eating. That might look like one pound a week over 30 weeks. And when patients stop the drug, they don’t typically do it cold turkey, which could result in a ravenous appetite. Instead, she might titrate the dosage down to really prepare a patient for weight loss maintenance off the drug.