HRT and GLP-1 for Menopause Weight Loss: Why Women Need More Than One Tool

As a nurse practitioner, I sit with women every week who say some version of this:

“I’m eating better, I’m moving more, my labs look ‘fine’—so why does my body feel like it’s working against me?”

If you’re in perimenopause or menopause, that frustration is very real. Hormone shifts can bring hot flashes, disrupted sleep, mood changes, brain fog, and a stubborn layer of midsection weight that seems impossible to lose.

For years, hormone replacement therapy (HRT) has been the primary medical tool we used to help women feel better. It can be incredibly effective for symptoms like hot flashes, sleep, and mood—but many women noticed that weight loss was still an uphill battle.

More recently, GLP-1 medications like semaglutide and tirzepatide have changed the landscape of medical weight loss. These medications can significantly reduce appetite, improve blood sugar, and support meaningful weight loss. But even with GLP-1s, some midlife women hit plateaus or feel like something is still “off.”

We now have growing evidence—including a 2024 study in postmenopausal women—that combining HRT with GLP-1 therapy can lead to better weight-loss results than using GLP-1s alone. In other words, for many women, it’s not about choosing either hormones or weight-loss medication. It’s about using the right combination in a safe, personalized way.

At Atlas Health & Wellness in Mount Vernon, Ohio, this is exactly how we think about care: a whole-person plan that addresses both hormones and metabolism.

What’s Really Happening to Your Body in Midlife?

Before we talk about HRT and GLP-1s, it’s important to understand why midlife weight gain happens in the first place.

During perimenopause and menopause, key hormones like estrogen and progesterone decline, and in some women, testosterone drops as well. These changes:

• Slow your metabolism

• Shift fat storage to the abdomen

• Make it harder to build and maintain muscle

• Disrupt sleep (which further impacts weight and cravings)

• Affect mood and motivation

So when women tell me, “I’m doing what I’ve always done, but it stopped working,” they’re exactly right. Your hormonal environment has changed, and your plan needs to change with it.

What Is HRT (Hormone Replacement Therapy)?

Hormone Replacement Therapy is designed to restore or rebalance hormones that naturally decline in perimenopause and menopause. This can include:

• Estrogen

• Progesterone

• Sometimes testosterone, when appropriate

When carefully prescribed and monitored, HRT can:

• Reduce hot flashes and night sweats

• Improve sleep quality

• Support better mood and mental clarity

• Help preserve bone density and muscle mass

• Improve vaginal and sexual health

• Enhance overall quality of life

From a weight and metabolism standpoint, HRT helps by:

• Reducing insulin resistance

• Supporting lean muscle (which is metabolically active)

• Making it easier to be active, sleep well, and stay consistent with healthy habits

HRT is not a “weight-loss drug,” but it creates a healthier internal foundation that makes weight loss more achievable—especially in midlife.

What Are GLP-1 Medications (Semaglutide, Tirzepatide, etc.)?

GLP-1 receptor agonists—like semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®, Zepbound®)—are medications that mimic a hormone your gut already produces. They work on the brain and digestive system to help regulate appetite and blood sugar.

GLP-1s can:

• Reduce appetite and cravings

• Slow stomach emptying so you feel fuller longer

• Improve blood sugar control and insulin sensitivity

• Lower inflammation and support cardiometabolic health

Because of these effects, GLP-1 medications have become one of the most effective options for medical weight loss, especially in people with insulin resistance, prediabetes, or type 2 diabetes.

However, GLP-1s do not fix underlying hormone changes from perimenopause and menopause. That’s where the combination with HRT becomes powerful.

Why HRT and GLP-1s Together Can Be More Effective for Menopause Weight Loss

A 2024 study in postmenopausal women found that those using both HRT and semaglutide lost more weight than women using semaglutide alone. That finding supports what many of us are already seeing in practice.

Here’s why the combination makes sense:

1. HRT Improves the Hormonal Landscape

When estrogen is low, the body tends to:

• Store more fat around the abdomen

• Lose lean muscle more quickly

• Become more insulin resistant

These changes make weight loss harder and can limit how well any weight-loss medication works.

By restoring hormonal balance, HRT:

• Supports better insulin sensitivity

• Helps protect muscle tissue

• Makes it easier to be active, sleep well, and think clearly

In short, HRT helps fix the foundation.

2. GLP-1 targets appetite and metabolism.

While HRT is working in the background, GLP-1s directly help with:

• Appetite control: You feel full sooner and stay full longer

• Cravings: Especially for high-sugar, high-carb foods

• Blood sugar stability: Fewer spikes and crashes

• Inflammation: Often improved when blood sugar is better controlled

GLP-1s help remodel the system—how you respond to food, how hungry you feel, and how your body handles blood sugar.

3. Together, They Create a Full-Spectrum Strategy

Think of your health like a house:

• HRT strengthens the structure—your hormones, bones, muscles, sleep, and mood.

• GLP-1s help redesign the interior—your appetite, cravings, and metabolic response.

When we use both tools together, midlife women often see:

• Better weight-loss results

• Fewer plateaus

• Improved energy and mood

• More sustainable long-term success

Real-World Benefits I See in Practice

Every woman’s plan is different, but there are common patterns when we combine HRT and GLP-1 therapy in a thoughtful way.

Women often report:

• More predictable progress on the scale
  Instead of losing a few pounds and stalling, many see steadier trends over time.

• Better body composition, not just weight loss
  We aim to protect or build lean muscle while reducing fat, especially abdominal fat.

• Improved sleep and daytime energy
  When hot flashes and night sweats are controlled, it’s much easier to be active and make healthy choices.

• Less “food noise”
  GLP-1s often quiet the constant mental chatter about food and snacking, which reduces frustration and guilt.

• A sense that the “why” is being addressed
  Women feel more confident knowing we’re treating both hormonal changes and metabolic challenges, not just chasing a number on the scale.

Is the Combination of HRT and GLP-1s Right for You?

This is the most important question—and the answer is highly individual.

Not every woman is a candidate for HRT, GLP-1s, or both. Before starting either therapy, we look carefully at:

• Personal and family history of breast cancer or other hormone-sensitive cancers

• History of blood clots, stroke, or cardiovascular disease

• Risks for osteoporosis, diabetes, or heart disease

• Gallbladder or pancreatic issues

• Current medications and medical diagnoses

• Your specific symptoms, goals, and lifestyle

At Atlas Health & Wellness, we approach menopause medical weight loss as a partnership. That means:

• Reviewing your history in detail

• Ordering appropriate lab work

• Discussing the benefits, risks, and alternatives

• Designing a plan that may include HRT, GLP-1s, lifestyle support, or a combination

Sometimes the best next step is starting with hormones, especially if your primary symptoms are hot flashes, poor sleep, or mood changes. In other cases, especially when weight and blood sugar are major concerns, we may consider GLP-1 therapy along with a conversation about hormone support.

What a Personalized Plan Can Look Like

A typical midlife health optimization plan for a woman in perimenopause or menopause may include:

• Hormone Replacement Therapy
  Tailored dosing of estrogen, progesterone, and sometimes testosterone to support symptom relief and long-term health.

• GLP-1 Medical Weight-Loss Support
  Appropriate GLP-1 medication (when medically indicated), paired with nutrition guidance and regular follow-up.

• Nutrition and Movement Coaching
  Realistic strategies that fit your life—not strict, unsustainable rules. We focus on protein intake, blood sugar balance, and joint-friendly movement.

• Sleep, Stress, and Mental Health Support
  Because chronic stress, poor sleep, and burnout all work against your metabolism and hormone balance.

• Ongoing Monitoring
  Regular check-ins, lab work when needed, and adjustments over time as your body changes and your goals evolve.

The goal is not to chase short-term, dramatic weight loss. It’s to build a sustainable midlife health plan that supports your weight, your hormones, your energy, and your long-term longevity.

You Deserve More Than One Tool

Midlife health doesn’t have to be about “toughing it out” or choosing between suffering and vanity. You deserve:

• Evidence-based options

• A provider who listens and explains your choices

• A plan that honors both your symptoms and your goals

The future of women’s health is not “hormones or weight-loss medications.” It’s about integrating the right tools safely and thoughtfully for you.

• HRT helps restore hormonal balance.

• GLP-1s create metabolic momentum.

• Together, they can transform how we approach menopause weight loss, midlife energy, and long-term health.

Ready to Talk About Your Options?

If you’re in perimenopause or menopause and struggling with stubborn weight, low energy, or feeling unlike yourself, you don’t have to figure it out alone.

At Atlas Health & Wellness in Mount Vernon, Ohio, we specialize in personalized hormone optimization and medical weight loss for women in midlife and beyond. We’ll look at your whole picture—hormones, metabolism, lifestyle, and goals—and decide together whether HRT, GLP-1s, or a combination makes sense for you.

If you’re ready to lose weight, balance your hormones, and feel like yourself again, book your consultation today.