A new match for menopausal weight gain: Ozempic
Kymberly Smith had had enough. It was February 2020 and she was mourning 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, began taking antidepressants for her grief. She also received hormone therapy to ease her constant hot flashes and night sweats. But when it came to the 20 pounds she had gained around her midsection, “she just couldn’t shake it.”
That weight gain, she said, is difficult to disentangle from her circumstances; it may be 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 helpless.”
Last April, Ms. Smith started taking Wegovy, the weight-loss drug that, along with the diabetes drug Ozempic and similar drugs, has soared in popularity. Since then, she has lost about 35 pounds.
Women going through menopause worry about weight and body changes almost as often as they worry about hot flashes and night sweats, said Dr. Stephanie Faubion, medical director of the Menopause Society and director of the Mayo Clinic’s Center for Women’s Health. “They come in and are often in tears about it. They don’t know what’s happening,” she said. Some estimates suggest that approx 70 percent of women gain up to 1.5 pounds per year during the transition to menopause, which can last up to ten years.
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 problems. So is being overweight correlated of more hot flashes and night sweats; the Menopause Association advises weight loss as an effective non-hormonal treatment for those symptoms.
Now, some women going through menopause are looking to medications like Ozempic, despite the high cost: Without insurance coverage, the drugs can cost about $1,000 a month. “We get requests every day,” said Dr. Faubion.
And some doctors are starting to respond. Given the prevalence of obesity in the United States, “a majority of midlife women actually meet the criteria to receive these medications,” says Dr. Daniela Hurtado, assistant professor of medicine, endocrinologist and obesity medicine specialist at the Mayo Clinic.
Experts worry that these drugs – which are relatively new and whose long-term effects are still being studied – could already be worsening the loss of muscle mass and bone density. common in menopausal womenpotentially putting them at greater risk for fractures, falls and osteoporosis.
“That definitely worries me,” says Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity.
‘You struggle and struggle’
Some weight gain in menopause is most likely caused by the slowdown in metabolism that occurs as we age, said Dr. Hurtado. Symptoms of menopause, such as insomnia and night sweats, can also lead to weight changes, because women “may be tired and less likely to exercise,” she said. And hormonal changes during menopause change how and where fat is stored in the bodywhereby women generally also gain excess fat around the abdomen lose muscle mass general.
“The fact is that these hormonal changes make it extremely difficult for many adults, but especially menopausal women, to lose weight no matter what you do,” says Dr. Elaine Eustis, a gynecologist whose practice specializes in South Carolina. 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 treatment. semaglutide, the substance in Ozempic and Wegovy. Semaglutide simulates a hormone that our bodies naturally produce, which makes people feel full for longer periods of time. The drug also targets the areas of the brain that regulate appetite, causing many patients to report the disappearance of their “food noise,” or mental chatter around food.
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 how difficult 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 every day. Nothing worked. “You just struggle and struggle,” she said.
Because these medications are only approved for certain groups (Ozempic and Mounjaro for people with diabetes, Wegovy and Zepbound for obese or overweight people 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 this illicit drugs, citing potential safety risks and a lack of oversight.
Still, Mrs. Smith wanted the medication. She lost 30 pounds in the first five months of taking the drug.
“It’s the only thing that’s ever worked,” she said.
A complicated calculation
Any weight loss typically leads to muscle loss, and in menopausal and postmenopausal women, losing a significant amount of muscle mass can increase the risk of becoming frail, said Dr. Hagan.
Estrogen loss During menopause, bone loss accelerates, putting women at increased risk for fractures and osteoporosis, said Dr. Hurtado, so adding semaglutide to the mix could potentially worsen the problem, as significant, rapid weight loss could also potentially lead to loss of bone density. Studies have shown that hormone therapy helps prevent bone loss during menopause, although not all women want or can use this option. It’s essential that menopausal women taking medications to lose weight 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 get so weak that they fall in the winter and break a hip,” says Dr. Hurtado, who monitors her menopausal patients taking semaglutide for changes in bone density and muscle mass.
There are also possible side effects – including nausea, vomiting and constipation – for patients of any age who take Ozempic and similar medications, especially as people increase their doses. In rare cases, the drugs can put people at risk for an inflamed pancreas, or suppress their appetite so much that they consume dangerously few nutrients.
But many menopausal women are willing to take the gamble. And for some, the hardest part of taking the drugs is the tough questions asked about what they’re willing to do to lose weight, and why they feel so strongly about it.
When Johanna Winter-Harper gained nearly 50 pounds during perimenopause, she tried to embrace the idea of body neutrality.
“I wanted to love myself the way I was,” said Ms. Winter-Harper, 51, a therapist in Chicago.
But she worried the extra weight was harming her health. She has a family history of heart disease and diabetes and was alarmed when her blood sugar rose to pre-diabetes levels. When she couldn’t lose weight after exercising more and changing her diet – more protein, fewer carbs, lots of fruits and vegetables – she decided to try Ozempic.
She has lost 50 pounds in the past year thanks to the medication, and her cholesterol and blood sugar levels have dropped. Still, she said, she felt conflicted.
“I embraced myself to a certain point, and then, yes, there was health,” she said. “But if I’m completely honest about it, I also wanted to be thinner.”