Most women gain weight during the menopausal transition — but even hormone therapy does not prevent weight gain or cause weight loss. These hormonal changes during mid-life can exacerbate weight gain for those already struggling with their weight.
Health benefits
Losing even 5–10% of body weight (and keeping it off) for someone with a BMI over 30 can have lasting health benefits, including:
- Decreased joint pain
- Lower risk of breast and other cancers
- Improved cholesterol
- Lower chance of diabetes (or better glucose control)
- Decreased blood pressure
- Improved sleep apnea
- Improved PCOS symptoms
- Reversed insulin resistance
- Improved sleep
- Improved mood
- Reduced inflammatory markers
Medications
Most anti-obesity medications work by altering the hormones responsible for hunger, satiety, and energy expenditure. Our bodies usually have a weight "set-point" — the amount of stored energy (fat) the brain thinks we need to carry around "just in case." It takes a lot of work to move that set-point, and as soon as the effort stops, we tend to return to it. These medications work in the brain to change the set-point, so the body can let go of excess fat and keep it off more easily. This also means the medications usually need to be continued after weight loss in order to maintain it.
GLP-1 Agonists
Semaglutide (Ozempic / Wegovy) and Tirzepatide (Mounjaro / Zepbound) are once-weekly injectable medications. They can result in up to 20% body weight loss over a year. Side effects can include nausea, vomiting, and constipation. They are unsafe in people who have had medullary thyroid cancer or pancreatitis, or who have a family history of MEN2 syndrome.
Contrave
A combination of bupropion and naltrexone, this can help you lose up to four times as much weight as you would with diet and exercise alone. You cannot take it if you have had a seizure disorder or have severe high blood pressure. Bupropion is also sometimes used off-label alone for weight loss.
Qsymia
A combination of topiramate and phentermine. You can lose 10% or more of your body weight in a year on this medication. Topiramate can cause birth defects, so appropriate contraception should be used; phentermine is a stimulant that may increase blood pressure. Topiramate can also be used off-label for weight loss.
Metformin
FDA approved to treat diabetes, but can be used off-label for insulin resistance and weight loss. It can be effective in women with PCOS and in those on certain medications that cause weight gain, including some anti-psychotics. Weight loss is usually modest (5–10 pounds); side effects can include abdominal pain, bloating, and diarrhea.
Treat it like the chronic disease it is.
Dr. Stone is board certified in Obesity Medicine and treats women. Let's build a plan that actually lasts.
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This information is for educational purposes and is not a substitute for individualized medical advice. Please consult Dr. Stone about your specific situation.