Glucagon-like-peptide-1 receptor agonists (GLP-1s), including medications like Ozempic® and Zepbound®, have transformed weight management and treatment of chronic disease.
But while GLP-1s are commonly used by perimenopausal women, this population has been largely ignored in studies of the drugs' risks and benefits.
Originally developed for Type 2 diabetes, these medications have gained FDA approval for obesity, reducing risk for heart disease and kidney disease, and treatment of obstructive sleep apnea within the last three years. Their remarkable efficacy for weight management—with users losing an average of 10–21 percent of body weight and up to 90 percent achieving clinically meaningful weight loss of 5 percent or more—has made them among the most sought-after medications in recent years.
While GLP-1s are commonly used by perimenopausal women, this population has been largely ignored in studies of the drugs' risks and benefits.
Recent data suggests that use of GLP-1s is highest for perimenopausal women in the United States. In 2025, the RAND American Life Panel showed that women aged 30–49 were more than twice as likely as men of a similar age to report current or past use of GLP-1s. Women aged 50–64 had the highest use overall, with 20 percent reporting current or past GLP-1 use. These statistics highlight a striking disconnect that echoes decades of women being overlooked in medical research. Despite widespread use of these drugs by perimenopausal women, research has largely ignored the unique risks and potential opportunities for optimizing health that GLP-1s may pose in this population.
This represents more than a research oversight; it means that women and their health care providers are having to make decisions with incomplete information, potentially exposing women to serious risks or missed opportunities to promote health during one of the most physiologically and psychosocially challenging transitions in their lives.
The Perimenopause Context
Perimenopause represents a complex biological and psychological transition currently affecting 1.55 billion women globally. Typically occurring between ages 45 and 55, perimenopause transition is characterized by fluctuating estrogen levels and declining ovarian function that initiate a cascade of physiological and psychological changes that extend far beyond reproductive health. These changes include increased cardiovascular risk and risk of obstructive sleep apnea, declines in bone density and muscle mass, weight gain, poor sleep quality, changes in mood, and “menofog,” the difficulties with thinking and memory that are common during perimenopause.
For perimenopausal women, weight management becomes particularly challenging due to hormonal fluctuations that affect metabolism, appetite regulation, and body composition. The promise of GLP-1s to address these concerns is understandably appealing, but we lack adequate research to guide evidence-based prescribing and patient decisionmaking for this population.
The Research Gaps: What We Don't Know
Studies show GLP-1s are equally effective for weight loss in post-menopausal and pre-menopausal women, with some limited evidence of enhanced benefits when combined with hormone therapy. GLP-1s may additionally impact other physiological changes observed in the perimenopausal period, including vasomotor symptoms like hot flashes and night sweats, declines in bone health, and unhealthy changes in body composition (gains in fat mass and declines in muscle mass), but whether these impacts are beneficial or harmful for women's health remains unknown.
GLP-1s are known to reduce both fat and muscle mass and discontinuation typically results in weight regain—primarily as fat mass—resulting in a less healthy body composition compared to treatment initiation. This is especially relevant for perimenopausal women who already face natural declines in muscle mass and bone density that place them at greater risk for poor aging outcomes if left unaddressed. It remains to be determined how GLP-1s and their discontinuation impact body composition, including bone density, among women during perimenopause and beyond.
There is also great potential for GLP-1s in managing risk of obstructive sleep apnea during the perimenopausal period. Although sleep apnea is more common in men overall, women begin to exhibit sleep apnea at similar rates as men during perimenopause, a striking increase in risk. GLP-1s are the first drug to be FDA-approved for the treatment of sleep apnea. This represents another promising area of clinical advancement for women, but the impact of GLP-1s on perimenopause-related increases in sleep apnea risk has yet to be studied.
The Psychosocial Dimension
The psychosocial implications of GLP-1 use during perimenopause are perhaps the most significantly overlooked area of study.
Unlike other chronic diseases, meaningful changes in body weight are visible to the naked eye. Weight loss is broadly viewed as positive, with leaner and smaller body sizes generally being more aligned with westernized body norms. Perimenopausal women using GLP-1s and experiencing dramatic weight loss may become keenly aware of the potency and widespread nature of weight-related stigma as they notice others, including family, friends, peers, and romantic partners treating them differently because of their weight loss. For some women, this may be a positive change; for others, it may be distressing to feel like they are only valued and treated kindly now that their body size more closely adheres to the “ideal.”
The psychosocial implications of GLP-1 use during perimenopause are perhaps the most significantly overlooked area of study.
Weight regain after significant weight loss may be particularly harmful to physiological and psychosocial health. More than half (54 percent) of patients using GLP-1s discontinue use within one year and 72 percent discontinue within two years. Most people who stop using GLP-1s regain the weight they lost, even with sustained lifestyle changes. Weight regain is linked with feelings of shame, hopelessness, and emotional distress, self-blame, and new or worsening mental health issues, like anxiety, depression, disordered eating behaviors. The psychosocial risk factors associated with large reductions in weight and weight regain overlap significantly with those linked to perimenopause. This convergence may exacerbate existing vulnerabilities and therefore demands clinical attention and research focus.
On the other hand, GLP-1s may support the psychosocial health of perimenopausal women via improved weight status and cardiovascular health. Women during this period experience worsening mood, anxiety, and sleep disruption, as well as declines in body satisfaction, self-esteem, and quality of life. Behavioral and dietary interventions for weight loss are known to improve psychological well-being, including self-esteem, body image, health-related quality of life, and mental health, suggesting weight loss with GLP-1s may have similar beneficial impacts.
Although GLP-1s are a promising intervention for reducing multiple chronic conditions, it is important that future research focuses, too, on psychosocial health, especially in perimenopausal women who have greater utilization of GLP-1s and greater risk for adverse changes in physiological and psychosocial health relative to men and to younger and older women. Understanding the unique risks and opportunities of GLP-1 use during perimenopause could unlock tremendous improvements in treatment success, reduce costly discontinuation and weight cycling, and prevent serious psychological and physical harm.
