Mounjaro And Menopause A Comprehensive Guide

Introduction

Menopause brings profound hormonal changes that can make weight management particularly challenging, with approximately 70% of women experiencing weight gain during this transition. However, emerging research suggests that Mounjaro (tirzepatide) may be especially beneficial for women navigating menopause and perimenopause. This comprehensive guide explores how Mounjaro works during menopause, the evidence for its effectiveness, interactions with hormone replacement therapy (HRT), and practical considerations for women in midlife.

Understanding Menopause and Weight Gain

What Happens During Menopause

Menopause is defined as occurring when a woman hasn't had a menstrual period for 12 consecutive months, typically between ages 45-55. However, the transition - called perimenopause - often begins several years earlier and brings hormonal fluctuations that significantly affect metabolism and body composition.

Hormonal Changes

During perimenopause and menopause, the ovaries gradually produce less oestrogen and progesterone. These aren't just reproductive hormones - they influence metabolism, fat distribution, appetite regulation, and insulin sensitivity.

Declining oestrogen leads to:

• Reduced resting energy expenditure (you burn 250-300 fewer calories daily)
• Decreased insulin sensitivity (increased risk of type 2 diabetes)
• Changes in fat distribution (more abdominal fat accumulation)
• Increased inflammation throughout the body
• Changes in how the body responds to hunger hormones
• Reduced muscle mass and bone density

Weight Gain Statistics

Research shows that women gain an average of 5-10 pounds during the menopausal transition, with some gaining significantly more. Even more concerning than total weight gain is the redistribution of fat to the abdominal area, which carries greater health risks than fat stored elsewhere.

Why Menopausal Weight is Harder to Lose

• Metabolic rate decreases by 5-8% during perimenopause
• Insulin resistance worsens, making it easier to gain weight
• The hunger hormone ghrelin increases
• Sleep disturbances (hot flushes, night sweats) affect metabolism and increase cravings
• Mood changes and stress can trigger emotional eating
• Reduced energy often leads to less physical activity
• Traditional diet and exercise approaches become less effective

How Mounjaro Addresses Menopausal Weight Challenges

Mounjaro's dual-action mechanism targeting both GLP-1 and GIP receptors may be particularly beneficial during menopause because it addresses multiple hormonal pathways affected by declining oestrogen.

Appetite Regulation

Research shows that ghrelin (the hunger hormone) increases during menopause, driving increased appetite and food-seeking behaviour. Mounjaro counteracts this by:

• Mimicking GLP-1, which suppresses ghrelin release
• Activating GIP receptors, which also reduce ghrelin levels
• Signalling the hypothalamus (appetite control centre) to reduce hunger
• Creating sustained feelings of fullness

This dual mechanism may be more effective than single-action GLP-1 medications for managing the increased hunger signals characteristic of menopause.

Metabolic Improvements

• Improves insulin sensitivity, combating menopausal insulin resistance
• Helps regulate blood sugar levels more effectively
• Reduces inflammation throughout the body
• May help restore more favourable fat distribution patterns
• Supports improved lipid profiles (cholesterol and triglycerides)

Body Composition Changes

Whilst Mounjaro primarily promotes weight loss, it also influences where fat is stored and lost. Reducing abdominal fat is particularly important during menopause because visceral fat (fat around organs) contributes to:

• Increased cardiovascular disease risk
• Higher likelihood of developing type 2 diabetes
• Greater inflammation throughout the body
• Worsened hormonal imbalances

Clinical Evidence: Does Mounjaro Work During Menopause?

Whilst no large-scale trials have exclusively focused on menopausal women, several studies provide compelling evidence.

SURMOUNT Trials Analysis

A post-hoc analysis of the SURMOUNT trials, published in 2025, examined weight loss by reproductive stage (premenopausal, perimenopausal, and postmenopausal). The findings were striking:

Women in all reproductive stages achieved substantial weight loss with Mounjaro 15mg:

• Premenopausal women: 26% average weight loss
• Perimenopausal women: 23% average weight loss
• Postmenopausal women: 23% average weight loss

All groups showed significantly greater weight loss compared to placebo (which showed only 2-3% loss across groups). Importantly, menopausal women achieved weight loss comparable to younger women, demonstrating that the medication remains highly effective despite age-related metabolic changes.

Waist circumference reductions were also substantial across groups:

• Premenopausal: 22cm reduction
• Perimenopausal: 20cm reduction
• Postmenopausal: 20cm reduction

Mayo Clinic Study on HRT Plus Tirzepatide

In a groundbreaking study presented at ENDO 2025, researchers examined 120 postmenopausal women using tirzepatide for weight loss. The study compared outcomes in 40 women using both tirzepatide and menopause hormone therapy (HRT) to 80 women using tirzepatide alone.

The Results:

• Women using tirzepatide plus HRT: 17% average weight loss
• Women using tirzepatide alone: 14% average weight loss
• 45% of HRT users achieved ≥20% weight loss
• Only 18% of non-HRT users achieved ≥20% weight loss

This suggests a synergistic effect between HRT and tirzepatide, with the combination producing superior outcomes to either treatment alone.

GLP-1 Study with Semaglutide

A study published in the journal Menopause examined semaglutide (a GLP-1-only medication) use during menopause, finding:

• Women on semaglutide plus HRT: 16% weight loss
• Women on semaglutide without HRT: 12% weight loss
• Both groups achieved clinically meaningful weight loss exceeding 10%

Women vs Men in Weight Loss

Interestingly, analysis of the SURMOUNT trials revealed that women generally lose more weight on Mounjaro than men, with women achieving approximately 24% weight loss compared to 18% in men. The reasons aren't entirely clear but may relate to how the dual GIP/GLP-1 mechanism interacts with female hormones and metabolism.

Combining Mounjaro with Hormone Replacement Therapy (HRT)

The emerging evidence that combining Mounjaro with HRT produces superior weight loss results is exciting, but requires careful consideration of interactions and safety.

How HRT and Mounjaro Work Together

HRT addresses the root cause of menopausal symptoms by replacing declining hormones:

• Reduces hot flushes and night sweats, improving sleep
• May help preserve muscle mass and bone density
• Improves insulin sensitivity
• Can reduce abdominal fat accumulation
• Enhances mood and energy levels
• May reduce cardiovascular disease risk

Mounjaro addresses appetite and metabolism:

• Dramatically reduces hunger and cravings
• Slows gastric emptying, promoting fullness
• Improves insulin sensitivity further
• Promotes significant weight loss
• May improve metabolic health independently

The synergy appears to work through complementary mechanisms:

• HRT partially restores metabolic function affected by oestrogen decline
• This may allow Mounjaro to work more effectively on appetite and metabolism
• The combination addresses both hormonal and metabolic aspects of menopausal weight gain

Important Safety Consideration - Progesterone Absorption

The British Menopause Society has raised concerns about potential interactions between GLP-1 medications (including Mounjaro) and oral progesterone, which many women take as part of HRT.

The Issue:

Because Mounjaro slows gastric emptying (how quickly your stomach contents move into the intestine), there's theoretical concern that oral progesterone tablets might not be absorbed as effectively. This is particularly important because women who take oestrogen as part of HRT must also take progesterone to protect against endometrial cancer (cancer of the uterine lining).

The British Menopause Society Recommendations

If you're taking oral progesterone (such as Utrogestan or Gepretix) and want to start Mounjaro, you should either:

1. Switch to a transdermal (through-the-skin) combined HRT patch that includes both oestrogen and progesterone. These aren't affected by gastric emptying since they're absorbed through skin.
2. Switch to a Mirena, Levosert, or Benilexa coil (IUS - intrauterine system) which releases progesterone locally in the uterus. This provides endometrial protection without requiring oral medication.
3. Discuss alternative options with your healthcare provider, such as:
   • Vaginal progesterone
   • Different HRT formulations
   • Regular monitoring of endometrial thickness

Important Note: This concern applies specifically to oral progesterone tablets. Other forms of HRT (patches, gels, implants, coils) are not affected by Mounjaro's effect on gastric emptying.

What About Oestrogen-Only HRT?

Women who have had a hysterectomy (uterus removed) only need oestrogen replacement, not progesterone. For these women, there's no absorption concern with Mounjaro, regardless of whether they take oestrogen orally, transdermally (patch or gel), or via other routes.

Practical Considerations for Using Mounjaro During Menopause

Before Starting Mounjaro

If you're in perimenopause or menopause and considering Mounjaro:

1. Discuss with your GP or prescriber:
   • Your current HRT regimen (if any)
   • Whether changes to HRT are needed before starting Mounjaro
   • Your symptoms and weight management goals
   • Other health conditions or medications
2. Consider your HRT options:
   • If taking oral progesterone, plan the switch to alternative forms
   • Allow time for new HRT regimen to settle before adding Mounjaro
   • Ensure you're on optimal HRT for your symptoms
3. Assess your eligibility:
   • Mounjaro is approved for people with BMI ≥30 kg/m², or ≥27 kg/m² with weight-related complications
   • Many menopausal women meet these criteria due to menopausal weight gain
4. Set realistic expectations:
   • While results are excellent, weight loss takes time
   • Focus on overall health improvements, not just the scale
   • Understand that both medications work best with lifestyle changes

Starting Treatment

• Begin with 2.5mg weekly dose
• Gradually increase every 4 weeks if tolerating well
• Monitor for side effects (which may overlap with menopause symptoms)
• Continue building healthy eating and exercise habits

Distinguishing Mounjaro Side Effects from Menopause Symptoms

If new symptoms appear after starting Mounjaro, consider timing, nature, and whether they improve as you adjust. Discuss with your healthcare provider if uncertain.

Managing Both Conditions Simultaneously

Some tips for women managing menopause and weight loss together:

1. Prioritise Sleep:

• Hot flushes and night sweats disrupt sleep, affecting weight loss
• HRT often improves sleep quality
• Practice good sleep hygiene
• Consider bedroom cooling devices if night sweats persist

2. Support Bone Health:

• Menopause accelerates bone loss
• Ensure adequate calcium (1000-1200mg daily) and vitamin D
• Include weight-bearing exercise
• Rapid weight loss can affect bones, so monitor bone density

3. Maintain Muscle Mass:

• Menopause and weight loss both risk muscle loss
• Prioritise protein intake (1.2-1.6g per kg body weight)
• Include strength training 2-3 times weekly
• Consider working with a physiotherapist or personal trainer

4. Monitor Cardiovascular Health:

• Menopausal women face increased heart disease risk
• Weight loss and Mounjaro both improve cardiovascular markers
• Regular blood pressure and cholesterol checks
• Don't smoke; maintain physical activity

5. Address Mood Changes:

• Both menopause and weight loss efforts can affect mood
• HRT often improves mood symptoms
• Consider therapy or counselling if needed
• Build strong social support networks

Special Populations and Considerations

Perimenopause vs Menopause

Whilst the terms are often used interchangeably, they represent different stages:

• Perimenopause: The transition period (typically 4-8 years before final period) with fluctuating hormones
• Menopause: The point of final menstrual period
• Postmenopause: All time after menopause

Mounjaro appears effective at all stages, though some women find that stabilising on HRT during perimenopause before adding Mounjaro works well.

Surgical Menopause

• Symptoms may be more severe
• Weight gain can be more rapid
• Oestrogen-only HRT is sufficient (no progesterone needed)
• Mounjaro can be particularly helpful for managing the acute weight gain

Early Menopause (Before Age 45)

• HRT is strongly recommended until natural menopause age
• Weight management is crucial for long-term health
• Mounjaro can help, but HRT should be first-line treatment

Women with Type 2 Diabetes

• Mounjaro is approved for type 2 diabetes treatment (original indication)
• Dual benefits: blood sugar control and weight loss
• May allow reduction of other diabetes medications
• Regular monitoring is essential

Real-World Experiences

Positive Experiences

• Dramatic reduction in food cravings and constant hunger
• Improved ability to stick to healthy eating patterns
• Better energy levels as weight decreases
• Improved sleep quality (partly due to reduced weight)
• Better mobility and reduced joint pain
• Enhanced confidence and mental health
• Clothes fitting better or fitting into smaller sizes

Challenges

• Distinguishing menopause symptoms from side effects
• Managing both HRT adjustments and Mounjaro simultaneously
• Cost of medications (particularly if paying privately for both)
• Navigating healthcare system to access both treatments
• Balancing multiple medications and appointments

Celebrity Endorsement

Comedian Amy Schumer publicly discussed using Mounjaro during perimenopause, reporting that it improved her perimenopause symptoms, enhanced her libido, worked better for her than Wegovy (which caused intolerable side effects), and combined well with HRT from telehealth provider Midi Health. Her openness helped normalise discussion of both menopause and weight loss medication.

Accessing Mounjaro During Menopause in the UK

NHS Access

• BMI ≥35 kg/m², or
• BMI ≥30 kg/m² with weight-related conditions (like type 2 diabetes, high blood pressure)
• Usually requires participation in NHS weight management programme
• Availability varies by region; waiting lists can be long

Private Prescribers

• Online consultations available
• Faster access than NHS
• Monthly costs typically £150-250 depending on dose
• Some clinics specialise in menopause care and can manage both HRT and Mounjaro

Combining Services

• NHS for HRT prescriptions (free or prescription charge)
• Private provider for Mounjaro
• Regular GP monitoring for overall health

Looking Ahead: Future Research

• No large trials exclusively in menopausal women
• Limited long-term data on Mounjaro specifically (newer than semaglutide)
• Unknown optimal timing (should women stabilise on HRT first?)
• Effects on bone density during rapid weight loss in menopause
• Whether benefits extend to other menopausal symptoms beyond weight

Conclusion

For women navigating the challenges of menopausal weight gain, Mounjaro represents a powerful tool that addresses multiple aspects of the metabolic changes occurring during this transition. The medication's dual-action mechanism appears particularly well-suited to counteracting the hormonal shifts that make weight management so difficult during menopause.

Key Takeaways

1. Mounjaro is highly effective for weight loss during menopause and perimenopause
2. Women may achieve even better results than men on this medication
3. Combining Mounjaro with HRT appears to produce superior outcomes
4. Oral progesterone may need to be switched to alternative forms
5. The medication addresses increased hunger, metabolic slowdown, and insulin resistance
6. Lifestyle factors (diet, exercise, sleep, stress management) remain crucial
7. Long-term health benefits extend beyond weight loss

Final Thoughts

Menopause is a natural transition, but the weight gain and metabolic changes that often accompany it are not inevitable. With appropriate treatment - whether Mounjaro alone, HRT alone, or the combination - menopausal women can achieve significant weight loss and improved metabolic health.

The key is working closely with healthcare providers who understand both menopause management and weight loss treatment, ensuring that your approach addresses your unique circumstances, symptoms, and goals. Whether through the NHS or private care, these treatments are increasingly accessible to women who need them.

Remember that managing your weight during menopause isn't vanity - it's an investment in your long-term health, reducing risks of cardiovascular disease, type 2 diabetes, certain cancers, and other obesity-related conditions. You deserve to feel energetic, healthy, and confident during this life stage, and medications like Mounjaro can help make that possible.