The Connection Between GLP-1s, Menopause and Metabolism
GLP-1s may combat metabolic changes, like weight gain.
In the last decade, researchers have gained a much better understanding of the complex, multi-faceted transition known as menopause. Before, it was seen as a one-size-fits-all experience that solely signaled a change to a woman’s reproductive system. However, now we understand that menopause impacts several aspects of women’s health, particularly as it relates to weight changes and metabolic health.
Many of these changes can negatively affect one’s overall quality of life and wellness, so solutions are being sought to mitigate them. One such option that’s getting attention is GLP-1s. Below, we’ll uncover how the metabolism changes during menopause and what’s been discussed so far regarding GLP-1s for menopause management.
What exactly is metabolic health?
As one study explained, “Metabolic health is an umbrella term for factors that combine several aspects of cellular, cardiovascular, and cardiorespiratory health and well-being.” To put it more simply, metabolic health refers to how the body utilizes and processes nutrients.
Healthcare professionals can gain insight into someone's metabolic health by looking at specific biomarkers, such as:
Blood pressure
Waist circumference
Body adiposity (the amount of fat in the human body)
Lipid levels: HDLs, LDLs, triglycerides
Blood glucose level
The impact of poor metabolic health
Individuals with poor metabolic health or diagnosed with metabolic syndrome have an increased risk of developing coronary heart disease, diabetes and other complex health problems.
Those with three or more of the following may have metabolic syndrome:
High blood pressure
High blood sugar
Abdominal obesity (e.g., apple shape)
Heightened triglyceride levels
Reduced HDL cholesterol levels
The connection between menopause and metabolism
The hormonal changes brought on by menopause impact several biological systems, as exposed by its signs and symptoms. People are most familiar with symptoms like hot flashes, fatigue and insomnia. However, metabolic changes, such as increased insulin resistance, rising blood pressure and shifts in fat distribution, are also occurring. As mentioned earlier, these symptoms can cause metabolic syndrome, but that’s not all. Women experiencing menopause also have an increased risk of cardiometabolic diseases, such as:
Type 2 diabetes
Obesity
Non-alcoholic liver disease
Cardiovascular diseases
One study pointed out that metabolic, cardiovascular and body weight changes are progressive and chronic in menopause. Because of this, researchers have expressed how managing long-term, non-infectious diseases is crucial because it can prolong life expectancy. By controlling these changes, it’s possible to improve women’s health.
Menopause alters women’s metabolic health
To determine how glucagon-like peptide-1 (GLP-1) antagonists might be used to alleviate menopause symptoms, it helps to understand what happens before, during and after menopause.
Premenopause
Research finds that premenopausal women have greater protection from metabolic diseases due to where they accumulate weight, but why is that? To understand this, we must look at estrogen, a sex steroid that plays a role in metabolism, the health of white adipose tissue, and body fat distribution. Keep in mind that there are two main stores of white fat in the body: subcutaneous fat and visceral fat.
Before women reach menopause, their estrogen levels follow a predictable pattern, rising and falling throughout the menstrual cycle. These estrogen hormones have a protective effect and are responsible for the collection of subcutaneous fat tissue within the gynoid region (surrounding the glutes and thighs). Weight distribution in this area is positively linked with cardiometabolic effects, such as reduced insulin resistance.
Because there is more subcutaneous fat than visceral fat at this stage due to estrogen, premenopausal women have a lower risk of developing metabolic disease compared to menopausal women.
During menopause
Once estrogen levels start to decrease during menopause, women often experience a decrease in lean muscle mass and a boost in fat mass. There’s also a rise in bioavailable androgen hormones, like testosterone and the follicle-stimulating hormone, or FSH, for short.
Androgens encourage the accumulation of subcutaneous fat in the abdominal region, which is associated with a poorer quality of life and metabolic diseases. FSH plays a role in fertility for women of reproductive age, but high levels in menopausal women are linked to lipid metabolism disorders.
Interestingly, while physical activity is correlated with improved body composition and a healthier blood lipid profile in middle-aged women, it doesn’t appear to balance changes in most metabolic health indicators during menopause.
Post-menopause
Compared to men, post-menopausal women are more impacted by obesity and actually have increased rates of severe obesity. This can be explained by plummeting estrogen levels, which causes women to collect visceral fat quickly in their midsections. According to the National Health and Nutritional Examination Survey (NHANES), this boost in visceral adiposity is correlated with the most significant risk of mortality in women.
One study found that when compared to pre-menopausal women, post-menopausal had:
Increased blood measures (Inflammation, glucose, and HbA1c)
Greater sugar intakes
Worse sleep
Are GLP-1s a solution to metabolic changes during menopause?
Menopause affects about one-third of women's lives, and while it’s a natural occurrence, it markedly influences weight and metabolism. Many women of menopausal age complain that it’s difficult to shed the weight once it’s put on due to changes that are out of their control.
As established before, estrogen helps to regulate white adipose tissue, a metabolically dynamic organ that plays an often overlooked but essential role. It manages thermogenesis, lipid metabolism, insulin signaling, glucose, homeostasis, appetite and more.
Therefore, while making lifestyle changes to combat weight—such as exercise, dietary adjustments, and better sleep—are helpful, those strategies alone often don’t remain effective long-term. These hormonal changes can deregulate metabolism and make weight loss seem impossible for this particular group.
As a result, many female patients and even providers are looking at GLP-1s to help.
How GLP-1 medications work
GLP-1 receptor agonists, like semaglutide, mimic the naturally occurring GLP-1 hormone that aids glycemic control, weight loss and insulin secretion. Research has shown that GLP-1 medications have:
Greatly decreased HbA1c concentrations and fasting blood glucose level
Led to reduced BMI, waist circumference, and total body fat by suppressing appetite, boosting insulin secretion, bettering thermogenesis and decreasing glucagon secretion
Decreased fatty acid synthesis in the liver
And more
These antidiabetic drugs even offer renal and cardiovascular benefits. While more research is needed regarding the role of GLP-1s in managing metabolism in menopausal women, optimistic assumptions can be made. Combatting these issues should translate to a lowered risk of high blood pressure, type 2 diabetes and other cardiometabolic diseases often common in menopausal women.
The future of GLP-1s, menopause, and metabolic health
Right now, it’s uncertain if GLP-1 drugs will be added to the menopause management treatment plan, but it’s still worth the discussion. We’ve witnessed the impact that semaglutide can have on weight loss, and we understand that menopausal women are prone to weight gain that can trigger poor metabolic health. Therefore, more practitioners may begin to consider GLP-1s to help their patients.
Menopause is an often taboo and embarrassing topic to address for some women. This makes care pathways like virtual care ideal for treatments like HRT and weight loss. They are discreet and convenient, allowing patients to seek care in the comfort of their own home and on their own schedule. At OpenLoop, we’ve empowered hundreds of clients to expand their patient pathways with our seamless, white-labeled digital health infrastructure.
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