Author: Bob Brensel | President, Pharmacist | ScriptWorks
Bob Brensel, RPh, earned his Pharmacy Degree at University of the Pacific in Stockton, California in 1980. Former California Pharmacists Association’s Award Winner for Recognition of Outstanding Achievement in Compounding Pharmacy. Read More →
Menopause typically begins when a woman has gone 12 consecutive months without a menstrual period. It marks a significant shift in a woman’s life — physically, emotionally, and metabolically. With declining levels of estrogen, women experience challenges related to weight loss, abdominal fat, insulin resistance, and other cardiometabolic risks.
For years, hormone replacement therapy (HRT) has been a foundational tool in helping manage menopause-related symptoms. More recently, GLP-1 receptor agonists have become a compelling option for addressing weight and metabolic changes. Now, emerging insights suggest that the combination of these two approaches may offer greater potential than either therapy alone.
At ScriptWorks Pharmacy in Walnut Creek, California, we are dedicated to assisting individuals throughout California in navigating menopause’s complexities.
What Contributes to Menopausal Weight Gain?
Weight changes during menopause are often attributed to hormonal shifts. A gradual decline in estrogen levels can be associated with changes in body composition, including increased abdominal fat and decreased lean muscle mass.
In addition, age-related metabolic slowdown, decreased physical activity, and lifestyle habits may also contribute to menopausal weight gain. These shifts can affect how the body stores fat and how efficiently it burns calories.
According to BMC Women’s Health, researchers examining weight trends during menopause have noted associations between weight gain and health markers like blood pressure and glucose metabolism.
Source: BMC Women’s Health
Estrogen’s Role in Appetite and Energy Balance
One of the most common — and often frustrating — challenges women face during menopause includes unwanted weight gain. Hormonal changes, particularly declining estrogen levels, can contribute to shifts in metabolism, increased visceral fat, and a reduced ability to maintain lean muscle mass. These changes may occur even with consistent diet and exercise habits, leaving many women searching for additional support.
Estrogen is one of the key hormones involved in reproductive and metabolic processes. Research has explored its potential impact on appetite regulation and energy expenditure. A publication from the Yale School of Medicine has examined estrogen’s influence on appetite pathways in the brain, including those that overlap with the hormone leptin, which is involved in signaling satiety and hunger.
According to Yale researchers,
“Estrogen interacts with many systems in the brain and body that help control eating behavior and metabolism,”
Source: Yale Medicine
Hormone Replacement Therapy: BHRT for Menopausal Weight Gain
Bioidentical hormone replacement therapy (BHRT) is a form of hormone therapy that uses compounds chemically identical to the hormones naturally produced by the body, including estradiol, progesterone, and testosterone. Providers typically prescribe BHRT in customized doses, compounded into delivery forms such as capsules, creams, or sublingual drops. This personalization allows providers to tailor therapy to address specific symptoms and health goals — including weight-related concerns.
Why BHRT May Be Considered for Menopausal Weight Support
For women experiencing weight gain related to menopause, BHRT may be prescribed as part of a comprehensive approach aimed at rebalancing hormonal influences on metabolism. Providers may consider BHRT for several reasons:
- Estrogen and Fat Distribution: Estrogen plays a role in how the body stores and distributes fat. Declining levels during menopause are linked with increased abdominal fat. BHRT may help support a more favorable fat distribution pattern in some women.
- Insulin Sensitivity: Estrogen may influence how the body responds to insulin. BHRT may be used to support improved glucose handling, which is an important factor in managing weight and preventing metabolic slowdown.
- Preservation of Lean Muscle Mass: Some forms of BHRT include testosterone, which may support lean muscle maintenance — helpful for sustaining a healthy metabolism.
- Individualized Adjustments: Because BHRT is compounded for each patient, dosing can be fine-tuned over time based on symptoms, labs, and response, creating a more dynamic and supportive framework for managing weight gain.
While BHRT is not a weight loss medication, it may be part of a broader care plan designed to address the hormonal drivers of midlife metabolic changes. When used thoughtfully and under the supervision of a licensed provider, BHRT may offer a supportive option for women aiming to manage body composition during the menopausal transition.
GLP-1 Agonists and Their Mechanism of Action
GLP-1 (glucagon-like peptide-1) is a naturally occurring hormone involved in digestion and blood sugar regulation. It is released in the body after eating and plays a role in slowing gastric emptying and signaling fullness to the brain.
GLP-1 receptor agonists are a class of medications that mimic the activity of this hormone. Providers commonly prescribe them to manage type 2 diabetes and chronic weight management in certain cases, as approved by the FDA. These medications may influence food intake and appetite signaling by acting on specific brain regions involved in hunger regulation.
“In postmenopausal women with overweight or obesity treated with semaglutide (GLP-1), [Hormone therapy] use was associated with an improved weight loss response.”
Source: Menopause
Potential Benefits of GLP-1 Receptor Agonists
- Blood Sugar Control: GLP-1 plays a role in regulating blood sugar levels after meals by stimulating insulin secretion in response to food consumption.
- Support for Weight Management: Patients often use GLP-1 receptor agonists alongside other therapies for type 2 diabetes, metabolic syndrome, and elevated blood sugar. They may also help lower HbA1c levels and support cardiovascular and nervous system health by reducing inflammation and cell damage.
- Cardiovascular Considerations: Research has explored the potential cardiovascular benefits of GLP-1 receptor agonists, which is particularly relevant for individuals managing diabetes and obesity-related health issues.
Source: Frontiers in Immunology
A Look at Combination Approaches: Estrogen and GLP-1
Interest in the potential interactions between estrogen and GLP-1 pathways continues to grow. Preliminary research suggests that estrogen receptors in the brain may modulate the way GLP-1 agonists influence appetite and reward behaviors, though clinical applications are still being evaluated.
A recent retrospective review examined postmenopausal women who were using GLP-1 medications, comparing outcomes between those who were also on hormone replacement therapy and those who were not.
Over the course of 3, 6, 9, and 12 months, both groups experienced positive changes in weight and metabolic indicators:
- Decreased fasting blood glucose
- Lower blood pressure
- Reductions in LDL and total cholesterol
- Lower triglyceride levels
“[…] one key finding stood out: women who combined GLP-1 therapy with hormone therapy experienced approximately 30% more total body weight loss than those using GLP-1 therapy alone.”
Source: Menopause
The results suggest a possible synergistic benefit when patients use these therapies together. The dual approach may work through complementary mechanisms — GLP-1 agonists helping reduce appetite and regulate glucose, while HRT may modulate fat distribution and insulin sensitivity.
RELATED ARTICLE
Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use
Hurtado, M. D., Tama, E., Fansa, S., Ghusn, W., Anazco, D., Acosta, A., Faubion, S., & Shufelt, C. L. (2024). Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause, 31(4), 345–352. Link
Other Studies on Estrogen and GLP-1
Another study in Nature Medicine noted that estrogen and GLP-1 may work together to influence areas of the brain that control eating behavior and energy use. These findings are currently under investigation to better understand their implications.
Though they emphasize the need for further clinical evaluation, one research team noted that
“Estrogen may play a role in the brain’s response to appetite-regulating hormones like GLP-1.”
Source: Nature Medicine
Personalized Options Through BHRT/GLP-1 Compounding Pharmacy
In navigating the challenges of menopause — specifically menopausal weight gain — a combination of BHRT and GLP-1 receptor agonists has emerged as a compelling option that may support metabolic health and appetite regulation.
At ScriptWorks, we are deeply experienced in BHRT and the use of GLP-1 medications for menopausal patients. We offer personalized pharmacy support to help patients and providers integrate compounded medications thoughtfully.
Our commitment is to serve as a trusted partner for both prescribers and patients seeking tailored solutions during menopause — whether that includes hormone therapy, GLP-1 support, or a combination of approaches based on individual needs.
Compounded medications are prepared based on specific prescriptions from healthcare providers. These may include customized strengths, delivery methods, or combinations of active ingredients. These preparations are not one-size-fits-all and are intended for patients whose needs are not met by commercially available products.
Stay Informed: Contact the East Bay’s Most Trusted Compounding Pharmacy
Menopause marks a major life transition, and it often comes with changes that may impact physical health and quality of life. By staying informed and seeking professional guidance, individuals can explore strategies that align with their unique needs and preferences.
To learn more about how ScriptWorks Pharmacy supports patients dealing with menopausal weight gain, please contact us or speak with your healthcare provider to determine if a personalized approach to medication is appropriate for you.
References:
- Saei Ghare Naz, M., Mousavi, M., Noroozzadeh, M., Farahmand, M., Azizi, F., & Ramezani Tehrani, F. (2024). To what extent the weight changes impact the risk of hypertension among menopausal women: Insights from Tehran lipid and glucose study. BMC Women’s Health, 24(1), Article 128. Link
- Hurtado, M. D., Tama, E., Fansa, S., Ghusn, W., Anazco, D., Acosta, A., Faubion, S., & Shufelt, C. L. (2024). Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause, 31(4), 345–352. Link
- Mehdi, S. F., Pusapati, S., Anwar, M. S., Lohana, D., Kumar, P., Nandula, S. A., Nawaz, F. K., Tracey, K., Yang, H., LeRoith, D., Brownstein, M. J., & Roth, J. (2023). Glucagon-like peptide-1: A multi-faceted anti-inflammatory agent. Frontiers in Immunology, 14, Article 1148209. Link
- Zheng, Z., Zong, Y., Ma, Y., Tian, Y., Pang, Y., Zhang, C., & Gao, J. (2024). Glucagon-like peptide-1 receptor: Mechanisms and advances in therapy. Signal Transduction and Targeted Therapy, 9, Article 19. Link