How HRT and GLP-1 medications help with menopause weight gain

Menopause can mark a profound change in a woman’s health. Many experience hot flashes, mood changes, and other symptoms as hormones fluctuate during perimenopause and ultimately decline after menopause. But one of the most frustrating, and often persistent, changes is the weight gain that often accompanies it. 

Many women notice an increase in weight, five pounds or more is typical. Even those who don’t see a shift on the scale can notice an increase in waist size because where fat is stored tends to shift to around the abdomen. This hormonally driven weight gain can happen even if habits don’t dramatically change. 

The good news is that there are more ways to deal with menopause weight gain than ever before. Hormone replacement therapy (HRT) and GLP-1 weight loss medications, like Wegovy and Zepbound, are now being considered as complementary treatments that can help manage menopausal weight gain when used together. 

“Both HRT and GLP-1 medications address different challenges of the menopausal transition. Emerging evidence suggests that weight loss outcomes may be improved when these therapies are used together. says Dr. Karen Mann, OB-GYN, and Noom’s Medical Director. “Together, these therapies address both the hormonal changes and the metabolic slowdown.”

Let’s take a look at how HRT and GLP-1s work and outline the benefits of a combined approach for both menopause symptoms and lasting weight loss.

What am I gaining weight during menopause?  

Understanding the changes that make weight gain more likely during and after menopause can help you build a plan that works. While you might be doing everything right, your body has metabolically changed due to hormone levels.

As you enter perimenopause, typically in your 40s, your body’s hormones fluctuate, leading to changes in how and where your body stores fat. Let’s look at what’s happening:

• Estrogen: The fluctuation and ultimate decline in estrogen is often the biggest cause of the accumulation of belly fat during menopause. As your body runs out of eggs, estrogen levels fluctuate and ultimately fall to a new lower level. Lower estrogen levels are associated with a redistribution of fat from the hips to the abdomen. 
• Progesterone: The decline of progesterone can also contribute. It can lead to sleep disruption, which may increase levels of cortisol. Chronically elevated cortisol tells the body to store fat in the abdominal region, compounding the effects of lower estrogen.
• Testosterone: The gradual decline of testosterone (yes, women have it too!) can cause a loss of lean muscle mass. Losing muscle slows your metabolism down, making menopause weight gain easier.

Add these metabolic changes to natural aging and potentially lower activity levels, and weight gain becomes more likely. But these aren’t definite, and there are things you can do to manage weight gain. 

HRT and how it can help with weight loss

Hormone replacement therapy involves adding back estrogen, and often progesterone, to replace the hormones the ovaries no longer produce after menopause.

HRT is FDA-approved to treat moderate to severe hot flashes, night sweats, and genitourinary symptoms of menopause (GSM)—which include vaginal dryness, discomfort, and urinary changes. It’s also used to help prevent bone loss and reduce the risk of osteoporosis in some women.

The specific approval depends on the type of HRT: local (vaginal) treatments are used primarily for GSM, while systemic forms (pills, patches, or gels) are prescribed for whole-body symptoms like hot flashes. Women who still have a uterus need to combine estrogen with progesterone when using systemic therapy to lower the risk of endometrial cancer.

HRT isn’t FDA-approved for weight loss, but many clinicians recognize that restoring estrogen levels can indirectly support weight management during menopause. It may also improve sleep, energy, and overall quality of life, which can make healthy habits easier to maintain. 

Here’s what HRT can do:

• Keep belly fat in check: When estrogen levels drop during menopause, fat often shifts toward the midsection. HRT can help your body hold onto its premenopause shape and may reduce how much deep belly fat—known as visceral fat—builds up.
  
• Help protect your muscles: HRT may also make it easier to maintain lean muscle as you age. More muscle helps keep your metabolism steady, which can make managing menopause weight gain a little easier.
  

How GLP-1s can help reduce menopausal weight gain

While HRT can help steady hormones and slow some of the physical changes that come with menopause, it’s not a magic fix for weight gain. That’s where GLP-1 medications—like Wegovy and Zepbound—may come in.

These medications work differently from HRT. Instead of replacing hormones like estrogen and progesterone, GLP-1s mimic a natural gut hormone (called glucagon-like peptide-1)  that helps control appetite, slow digestion, and balance blood sugar. For women navigating menopause, that can make it easier to manage cravings, support healthy blood sugar, and reduce the stubborn belly fat that often shows up around this time of life.

GLP-1 medications were originally designed for diabetes, but some are now FDA-approved for weight management in people who meet certain criteria.

Who can take GLP-1s?

You may qualify if:

• Your BMI is 30 or higher, or
  
• Your BMI is 27 or higher, or you are overweight with at least one weight-related issue, like high blood pressure or high cholesterol.

These medications aren’t made specifically for menopause, but they can be an important tool for women who find that diet and exercise alone aren’t enough. GLP-1s can help:

• Reduce appetite and slow digestion: GLP-1s mimic a hormone that signals fullness, helping you eat less without feeling deprived.
• Improve blood sugar control: Better insulin response can help offset the blood-sugar changes that often happen with lower estrogen levels.
• Support meaningful weight loss: Studies show that semaglutide (Wegovy®) can lead to an average weight loss of about 15%, while people taking tirzepatide (Zepbound®) lost an average of 21% of body weight.

Things to keep in mind about GLP-1s

GLP-1s can cause side effects like nausea, diarrhea, or constipation, and some people may experience fatigue or headaches. They’re also not recommended for everyone, including those with certain thyroid conditions or a history of pancreatitis. And because they can cause muscle loss along with fat loss, pairing medication with strength training and adequate protein is key.

Read more about the safety of Wegovy and Zepbound.

GLP-1s can quiet “food noise”

One of the most profound effects reported by people taking GLP-1s is the reduction of “food noise.”  By quieting this noise, it can become easier to focus on mindful eating and behavioral changes.

GLP-1s and HRT: The weight loss benefits of a combined approach

Combining hormone replacement therapy (HRT) with GLP-1 medications is emerging as one of the most promising new strategies for managing weight and overall well-being during menopause. By addressing both hormonal balance and metabolism, this dual-action approach offers benefits that go beyond either treatment alone.

Recent research found that women using tirzepatide (Zeobound) and HRT together lost more weight and maintained it more effectively than those using a GLP-1 medication by itself. The results highlight how restoring estrogen may enhance how the body responds to GLP-1s.

Another study reached similar conclusions, noting that when taken together, HRT helps preserve muscle and reduce belly fat, while semaglutide (Wegovy) lowers appetite and insulin sensitivity. Together, they create a more stable, sustainable environment for healthy weight management.

How GLP-1s and HRT work together

When used together, HRT and GLP-1 medications target two of the biggest challenges of menopause—hormonal imbalance and metabolic slowdown. Each treatment works in a different but complementary way, helping create a steadier foundation for long-term weight management and overall well-being.

• Stronger metabolic support: Estrogen helps maintain lean muscle and prevent the metabolic slowdown that comes with menopause, while GLP-1s regulate blood sugar and support fat loss—especially around the belly.
• Improved sleep and lower stress: HRT often relieves hot flashes and night sweats, helping women sleep more soundly. Better sleep lowers cortisol, a stress hormone closely linked to abdominal fat and cravings.
• Dual-action control: HRT helps prevent the physical buildup of visceral fat, while GLP-1s quiet the mental “food noise,” making it easier to stay consistent with healthy habits.

HRT and GLP-1: Safety and professional guidance

While the potential benefits of combining these two therapies are significant, they can both have side effects and safety issues that need to be considered.

• HRT safety: While modern, low-dose HRT is generally safe for many people, it isn’t right for everyone. There can be a slightly increased risk of blood clots, stroke, and certain types of cancer. Your clinician will review your full health history—including age, family history, and time since menopause—to determine the safest approach and type of therapy for you.
• GLP-1 safety: GLP-1 medications are best known for short-term side effects like nausea, vomiting, and constipation, which tend to appear when you first start or increase the dose. These symptoms are usually temporary and improve as your body adjusts. More serious—but rare—risks include pancreatitis, gallbladder issues, kidney problems, and thyroid tumors (seen mainly in animal studies). That’s why ongoing medical supervision and gradual dose adjustments are key to staying safe and minimizing discomfort.

Frequently asked questions (FAQs) about HRT and GLP-1s

Can I take GLP-1s if I’m already on HRT?

Yes, many clinicians are safely prescribing GLP-1s (like Wegovy and Zepbound) to people who are already receiving HRT. However, this must be coordinated and closely monitored by your healthcare provider to watch for any potential side effects.

Does HRT cause weight gain or weight loss?

HRT does not typically cause weight gain and isn’t a weight loss drug. Its main effect is preventing the hormonal redistribution of fat to the abdomen. Studies show women on HRT often have less belly fat compared to those not on HRT.

Is it safe to take both HRT and a GLP-1 at the same time?

The combination is considered safe and effective under medical guidance. 

How long do I need to take a GLP-1 or HRT to see weight loss results?

How long a person takes HRT is based on menopause symptoms and certain health risks, such as blood clots. People tend to take GLP-1s for six months or longer. Stopping them can lead to weight regain if the right habits aren’t in place. Your clinician will work with you to determine the right plan for you.

Can I get a personalized plan that includes both?

Yes. Noom Med and Noom + HRT^Rx are designed to connect you with clinicians who specialize in personalized, comprehensive care, allowing you to access a coordinated plan that integrates both.

The bottom line: GLP-1s and HRT can improve weight loss results when combined

Menopause may change how your body stores fat, builds muscle, and responds to hunger—but it doesn’t have to dictate your future health or weight. The combination of HRT and GLP-1 medications represents a new era in women’s health—one that treats both the hormonal and metabolic sides of midlife weight gain.

By replenishing estrogen, HRT helps the body maintain lean muscle and a more balanced fat distribution. GLP-1s, meanwhile, work on the appetite and blood-sugar regulation systems, helping reduce “food noise” and curb cravings. Together, they can make weight loss during menopause not just possible—but sustainable.

“We’re moving toward a more holistic and personalized approach to menopause care,” says Dr. Mann.“Combining therapies like HRT and GLP-1s allows women to address the root causes of weight gain—not just the symptoms—and reclaim a sense of balance and energy in midlife.”

With the right clinical guidance and lifestyle support, this combined approach offers more than symptom relief—it provides a pathway toward feeling stronger, more balanced, and more in control in the years ahead.

If you’re ready to explore your options, see if you qualify for Noom Med and Noom + HRT^Rx. You’ll be connected with licensed clinicians who specialize in weight loss and personalized menopause care, helping you find the plan that’s right for your unique body and goals.