Glucagon-like peptide-1 (often referred to as "GLP-1") and Glucagon-like peptide-1 receptor agonists (often referred to as "GLP-1 RA") are increasingly recognized for their role in managing metabolic disorders like obesity and type 2 diabetes.  Beyond weight and glucose control, GLP-1 receptor agonists may improve cardiovascular profiles and reduce atherosclerosis risk, which is particularly relevant for postmenopausal women who can be at increased cardiovascular risk.

GLP-1 receptor agonist therapy appears to offer benefits particularly in the menopausal transition, particularly in terms of weight loss in patients with obesity and cardio-metabolic health (heart disease risk, elevated cholesterol markers, changes in blood sugar, etc).

Obesity is determined by body mass index (BMI), which is a person’s weight in kilograms divided by the square of their height in meters. Optimal BMI is between 18.5 to 24.9, 25–29.9 is considered overweight, and 30 and above is considered obese. However using other metrics such as waist to hip ratio (divide your waist by your hip) has also been shown as a good metabolic marker of health. 

Overweight or obesity increases a woman's risk of cardiometabolic conditions such as type 2 diabetes, hypertension, dyslipidemia, and coronary artery disease. Obesity also increases the risk of cancer in women, including breast and endometrial cancer.

The Role of GLP-1 in the Body

GLP-1 is a hormone in your body that plays an important role in glucose regulation. After you eat, your digestive system releases GLP-1, which signals the pancreas to secrete insulin. This process helps lower blood sugar levels as insulin's role is to remove sugar (glucose) from the blood stream. GLP-1 RA slows stomach emptying, making you feel full longer. It also reduces appetite, aiding in weight control. 

"Glucagon-like peptide-1 (GLP-1) receptor agonists have become available for effective weight loss treatment due to their effects of suppressing appetite, slowing gastric emptying, and promoting fat loss." (Alexiadou, 2025)

GLP-1 RA and Their Mechanism of Action

GLP-1 RA are medications designed to mimic the effects of the natural hormone. By activating GLP-1 receptors, they increase insulin secretion when needed and decrease glucagon release. This dual action helps manage blood sugar levels more effectively. GLP-1 RA also delay gastric emptying and reduce appetite, supporting weight loss. Medications like Ozempic and Wegovy work as GLP-1 agonists. 

"They have been shown to have beneficial effects on cardiovascular outcomes, particularly in reducing major adverse cardiovascular events (MACE), which include cardiovascular death, myocardial infarction, and stroke."

Menopause is associated with a gradual decline in estrogen (particularly estradiol) levels, leading to various metabolic changes such as weight gain (particularly visceral fat weight gain often referred to as "meno-belly") and increased risk of type 2 diabetes.

Individuals who use GLP-1 RA medications need to be particularly careful about bone and muscle loss as the resulting body composition changes are also impacting the naturally aging of our body which includes the natural decline of muscle mass and bone density. 

Muscle mass and bone health tends to peak in the late twenties or early thirties, after which they steadily decline. Menopause accelerates these decline resulting in the loss of muscle mass and bone density associated with menopause can lead to both sarcopenia (muscle loss) and osteoporosis (fragile bones).

"Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have emerged as a leading pharmacologic for managing weight gain across most populations, including peri and postmenopausal women who frequently suffer from weight gain. GLP-1 RAs are consistently the most effective pharmacologic for weight loss and can be a valuable tool for use in peri and postmenopausal women." (Mikdachi, & Dunsmoor-Su, 2025)

Incorporating weight training into your exercise routine can amplify the positive benefits of GLP-1 RA. As these medications aid in weight loss by curbing appetite, maintaining muscle mass with strength training exercises is crucial. 

In the STEP trial, 17,000 patients from 41 countries were enrolled in a randomized controlled trial (RCT) that lasted approximately 3 years. They were included if they had a BMI of 27 or more and had established cardiovascular disease. Cardiovascular disease was defined as:

• a previous myocardial infarction
• previous stroke
• symptomatic peripheral arterial disease.

The STEP trial excluded patients if they had diabetes at trial entry (HBA1C >6.5). The primary endpoint was a "MACE" ("Major Adverse Cardiac Events" which are death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). The study found that the GLP group lost 9% of their body weight, while the placebo group didn’t lose weight. In this short window of time, combined MACE (death from CVD, nonfatal MI, nonfatal stroke) was lowered by 20% in the semaglutide group (6.5% vs 8.0%).

"Regardless of baseline HbA1C status, 3 years of semaglutide reduces MACE by 20% in patients with a BMI >27 and a history of a cardiovascular risk factor." (Lincoff 2023)

Types of GLP-1 RA Medications

There are several types of GLP-1 RA medications available, each with its unique properties.

Semaglutide, is a weekly injection available as Ozempic and Wegovy, are popular for its effectiveness in type 2 diabetes blood sugar control and weight management. Wegovy has had additional approval for treating patients with BMI greater or equal to 27 and a previous heart history to decrease cardiac risk or MACE (as we discussed earlier).

Liraglutide (Saxenda) another well-known option has a daily use pen for chronic weight management and type 2 diabetes management.

Tirzepatide (available as Mounjaro) is a new class of medication that mimics two gut hormones: GLP-1 RA and glucose-dependent insulinotropic polypeptide (GIP). It is a weekly injection, and Mounjaro is used mainly for type 2 diabetes. Another option, Zepbound, targets multiple metabolic pathways is used for weight management.

The Tirzepatide medications are the newest forms and seem to have a lot of new benefits not seen in the other group Semaglutide medications.

"In a head-to-head clinical trial, people taking Mounjaro lost an average of 16 lbs to 25 lbs. People taking Ozempic lost an average of 12 lbs. However, the highest Ozempic dose (2 mg) wasn’t included in this study."

You should discuss with your primary care doctor to determine the best option for your specific needs. Understanding these types helps you make informed health choices.

For those dealing with obesity or any of the cardio-metabolic conditions mentioned including diabetes, these medications offer a valuable tool in their weight management journey. They are often prescribed in combination with lifestyle changes, such as diet and exercise, for maximum effectiveness.

Impact on Body Weight and Muscle Mass

While GLP-1 RA medications are effective at promoting weight loss, they can also negatively also impact muscle mass. Maintaining muscle mass is essential as you lose weight, ensuring that your body stays strong and functional.

When combined with regular resistance exercise and a diet with proper protein consumption, GLP-1 RA medications can help many maintain a healthy body weight. The benefit of control hunger and increase feelings of fullness, aiding in long-term weight management.

Integrating Nutrition and Protein Intake

Balanced nutrition and adequate protein intake are essential when managing weight and muscle mass, especially while on GLP-1 RA medications. One needs to focus on including lean protein sources and fiber rich foods the diet to maintain health and nutrition.

Consuming adequate protein can help stabilize blood sugar levels and reduce hunger, supporting better weight management outcomes and most importantly prevent excess muscle loss (also known as sarcopenia). Protein is needed for muscle repair and growth among many other biochemical pathways in the body.

I typically recommend my patients get adequate protein by using this calculation:

weight (lbs) x 0.7 g protein/lb body weight = total grams of protein per day

This is an average, as some women need more depending on their activity level. When looking at macros I suggest aiming for around 30% macros from protein at a minimum.

You can download my free protein e-book to learn more about protein and this important macronutrient.

 GLP-1 RA can decrease appetite, which makes it even more crucial to strategically include protein as top of mind and as a daily protein goal.

Including diverse, high-quality protein sources in your diet is key. Consider lean options like:

• chicken
• red meat
• fish/seafood
• tofu
• lentils and beans
• eggs/egg whites
• cottage cheese
• greek yogurt
• protein powders (whey isolate, pea protein, beef protein, etc)

Fiber rich foods can enhance digestive function, adding another layer of benefit and reducing risk of developing constipation or gas or bloating. E.g. chia seeds, ground flax seeds, psyllium husk powder, vegetables, fruits, whole grains, beans, lentils, etc. Drinking adequate water 8 cups on average is critical if one is increasing their fibre intake.

The most studied diet for it's antiinflammatory and overall health benefit is the Mediterranean diet (MED Diet). You can download my free 7 day MED diet check list here.

Consuming adequate protein and fiber in one's diet, ensures a optimal nutrition to support your overall health goals for the long term.

Incorporating Exercise with GLP-1 RA Medication

Incorporating exercise while taking GLP-1 RA medications is a critical component of optimal health and fitness. Regular physical activity supports our physical and mental well-being by reducing stress levels on top of all the other health benefits.

Physical activity can improve insulin sensitivity and enhance cardiovascular health, while resistance training supports muscle preservation and weight management.

Aerobic activities, like walking, hiking, swimming or cycling help improve heart health and boost endurance. They also aid in better blood sugar control. With these activities, you can burn calories and keep your weight in check, which is essential for managing conditions like diabetes.

Optimal exercise consists of doing movement daily of any form for a minimum of 20 minutes daily (150 minutes a week). But for weight loss recommendations are up to 60 minutes a day (300 minutes a week). Of these exercise times, 3 sessions should be resistance focused and weights need to be heavier to challenge your muscles.

Why Resistance Training Matters

Resistance training, such as weight lifting, holds particular value for those on GLP-1 RA medications. It is essential for maintaining and building muscle mass, which tends to decrease with weight loss. By incorporating exercises that focus on muscle strength, you can prevent muscle loss and increase your metabolic rate.

This type of training helps in reshaping your body and supports long-term weight management. It also benefits bone density, reducing the risk of bone loss and osteoporosis. By performing exercises like squats, lunges, and push-ups, you build strength, improve balance, and increase bone strength. Consider working with a trainer if you have never done any form of weight workout before. There are also great tools online and an app I regularly recommend to my patients by Nike Training Club which has many great workouts you can download on to your phone.

To maximize benefits, include resistance exercises in your routine 2 - 3 times a week. This balanced approach can help you achieve optimal results while using GLP-1 RA medications, supporting your journey to better health and fitness.

Side Effects and Other Health Considerations

There are many life saving benefits to this group of medication as we have discussed. However, it is important to consider possible side effects and health considerations as well. 

When you start using GLP-1 RA medications, one might experience some common side effects. These medications often cause digestive symptoms such as:

• nausea/vomiting
• diarrhea/constipation
• feeling full sooner
• slowed emptying of the stomach

The severity and duration of these side effects vary among individuals. Monitoring your symptoms and talking with your primary healthcare provider can help in managing these side effects efficiently.

Managing Side Effects

Managing the side effects of GLP-1 RA medications often involves simple adjustments. If you find yourself feeling nauseous, eating smaller meals more frequently can help. Staying hydrated is also crucial, especially if you experience diarrhea or vomiting. 

Your primary healthcare provider often will suggest starting with a lower dose and gradually increasing it to minimize side effects. Also, keeping track of any side effects and discussing them with your doctor will help create a tailored plan to manage them effectively.

Contraindications and Cautions

These medications may not be suitable if you have certain health conditions, such as:

• chronic kidney disease
• history of pancreatitis
• sleep apnea
• some forms of heart disease may require careful monitoring while using these medications (depending on the condition)

Consult with your healthcare provider about your complete medical history before starting GLP-1 medications. They will help assess risks related to cardiovascular disease or other ongoing health conditions. Your doctor can also determine if these medications are safe for you, considering all potential interactions and risks. Always follow medical advice closely to ensure the best health outcomes.

The Cost and Accessibility of GLP-1 RA Medications

GLP-1 RA medications are effective but can be expensive. The cost can vary widely based on the specific medication and your Province/jurisdiction that you live in.

Brand names like Ozempic and Wegovy can cost several hundred dollars per month out of pocket if not covered by insurance. Such pricing can make it difficult for those without ample resources to afford these treatments consistently.

For people managing chronic conditions like diabetes or obesity, the financial cost of these medications may become substantial. Speaking with your pharmacy or primary healthcare provider about generic alternatives and assistance programs can provide options for reducing costs and ensuring continued access to treatment.

Some insurance plans cover these medications for type 2 diabetes treatment but may not extend the same coverage for obesity or weight management. It is important to check with your insurance provider about specific coverage rules.

End game: Adopting a Healthy Lifestyle

GLP-1 RA drugs are changing the way chronic health conditions such as type 2 diabetes and obesity are treated. Upcoming innovations and research promise to make these therapies even more effective for managing issues such as reducing risks of heart attacks and strokes.

Making healthy lifestyle changes is essential to support weight loss and overall well-being. Focus on balanced nutrition, emphasizing whole foods like fruits, vegetables, and lean proteins. Adequate protein intake helps control hunger by promoting satiety. Regular physical activity is also vital. Aim for at least 150 minutes of moderate exercise weekly, such as brisk walking or cycling and at least 2-3 sessions a week of resistance training.

Monitoring progress is key. Keep a journal of your food and activity levels to help stay on track. Speak to your primary care provider if you have questions and have a team of health providers who can support you on your health journey.

If you need support in your menopause journey and would like to talk more about your health, please book a free discovery call with me here.

To your best health,

Dr. Amy Tung, ND, MSCP
Naturopathic Doctor

Menopause Society Certified Practitioner

References:

https://www.goodrx.com/classes/glp-1-agonists/glp-1-drugs-comparison

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Mikdachi, H., & Dunsmoor-Su, R. (2025). GLP-1 receptor agonists for weight loss for perimenopausal and postmenopausal women: current evidence.. Current opinion in obstetrics & gynecology. https://doi.org/10.1097/GCO.0000000000001015.

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Disclaimer:

The information in this blog is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health professional with any questions regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking treatment because of something you have read in this blog.

Individual results may vary, and the strategies discussed here are not guaranteed to work for everyone. This content does not create a patient-client relationship and should not be used as a replacement for personalized medical care.