The Menopause

Considering weight loss injections to shift menopausal weight gain? Read this first

From celebrities dramatically dropping dress sizes to experts weighing in on the potential side effects of using such drugs, there has been a lot of buzz surrounding weight loss injections.

And, with evidence suggesting that the average woman gains an extra 10kg by the time she arrives at menopause, it’s little wonder so many of us are curious about getting a helping hand when it comes to dropping additional pounds.

There are questions, however, as to what these weight loss injections are actually doing to our bodies. And, will they do more harm than good in the long run? Here, we chat to the experts to find out just how these drugs work and what using them might mean for our midlife health.

What are weight loss injections?

There are a number of weight loss injections available on the market (big brand names include Ozempic, Wegovy and Mounjaro). These prescription-only drugs were originally designed for other means – Ozempic, for example, was created to help people manage type 2 diabetes.

But, as Dr Ashwin Sharma, a medical doctor for MedExpress explains, other effects were quickly noted.

“Despite not being initially developed for weight loss, clinical observations have shown significant weight reduction in patients using this medication,” he says. “Ozempic, for example, employs an active ingredient that’s also approved under the branding Wegovy for obesity treatment.”

How do they work?

Weight loss medications work differently, depending on the one you choose. Most are injectables, but others can be taken orally as a pill.

Some help to suppress appetite, meaning we consume fewer calories overall, whereas others might help our body to burn more calories at rest. Orlistat, also known as Xenical, interferes with the absorption of fat, meaning the body absorbs fewer calories from the food we eat.

“Weight loss medications differ in their biological mechanisms, but they are primarily influenced by the hormonal pathways that they emulate,” says Ashwin.

“Semaglutide [an active ingredient in some weight loss medications] functions by mimicking the natural hormone GLP-1 (Glucagon-like peptide-1). This is what our body releases when we eat food and plays a crucial role in promoting satiety and reducing appetite.”

This means that we feel fuller and consume less calories, leading to weight loss.

“A newer weight loss injection called Mounjaro uses a different active substance called Tirzepatide, which imitates two natural hormones, GLP-1, and GIP (glucose-dependent insulinotropic polypeptide),” continues Ashwin. “This works to aid better glycemic control by boosting insulin output and curbing glucagon secretion. It also slows the gastric emptying process, enhancing the feeling of fullness.”

As with any new health treatment, most medical studies are in the preliminary stage, but the general consensus is that these medications are effective for weight loss. At least, intially.

One 2022 peer-reviewed study from the Journal Nature Medicine showed that, over two years, taking semaglutide led to substantial weight loss in adults who were overweight or obese, compared to a placebo drug.

Can you stop once you’ve started?

But, there are significant drawbacks.

One crucial factor that people tend to overlook when looking for weight loss solutions is that extreme weight loss is very rarely sustainable. Once we stop using such meds, the weight will come creeping back.

“It is vital to recognise obesity as a chronic medical condition requiring continuous management, akin to managing heart disease or high blood pressure,” states Ashwin. “Discontinuation of these treatments can lead to weight regain and exacerbate obesity-related health issues.”

Research from a 2022 study published in the journal Diabetes, Obesity and Metabolism, found that individuals who were on a 2.4mg dose of semaglutide regained around two-thirds of the weight they had shed after discontinuing the medication.

Plus, it’s important to consider the less-than-appealing side effects. Commonly reported ones (though not limited to) include abdominal pain, nausea, vomiting and constipation. And, when you consider the cost of weight loss injections, it’s an awful lot to pay to feel less than our best.

Can women in midlife use weight loss injections?

Weight gain can become more of a challenge as we age, especially during perimenopause and menopause. Hormonal changes kick in, impacting everything from our appetite and sleep, leaving our bodies clinging to every extra pound.

“During the perimenopause and menopause, our bodies look to combat decreasing levels of oestrogen by trying to obtain it elsewhere, chiefly a different form of the hormone produced by fat cells,” explains Dr Louise Newson, a GP, menopause specialist and founder of Newson Health.

“This type of oestrogen, oestrone, is less effective than oestradiol and also more inflammatory in the body. Many also have strong cravings for foods high in sugar or unhealthy fats, which the body will, in turn, lay down as oestrone-producing abdominal fat.

“Another reason for weight gain can be reduced exercise, poor sleep, and declining testosterone levels. This can lead to a decrease in muscle mass and lower energy levels.”

Louise says that there is no current published research looking at taking HRT and GLP-1 medications together.

“If you are considering using weight loss medication then this needs a very individual conversation between you and a healthcare professional to weigh up whether it is the right option for you,” she says. “Do you fit the criteria? Do you have any pre-existing conditions that would be a contraindication? Have you talked through potential side effects that could limit use? It’s also worth remembering that these medications do require long-term use over several months.”

The side effects in midlife women

Another factor to consider is that weight loss medications cause disturbances to our gut.

The common side effects of these drugs mentioned previously can all impact how well our body absorbs nutritents from food.

For women in midlife, nutritional deficiencies, such as low vitamin D levels, can increase the risk of developing conditions like osteoporosis. Opting to take weight loss medication increases the likelihood that we won’t be getting enough essential vitamins and minerals to keep our body fighting fit.

How to find a healthy weight in midlife

While the buzz around weight loss medications is understandable, experts advise against them being the first point of call if we want to lose weight. This is especially true for midlife women.

HRT is the first line treatment for managing menopause-related symptoms, by replacing the hormones your body is lacking,” says Louise. “In addition to getting the right treatment for you, eating a balanced diet and being active are both important ways to help manage your menopause. Maintaining a healthy weight can also reduce your risk of conditions such as type-2 diabetes and cardiovascular disease.

“If you have already tried strategies yourself and are still struggling with your weight, speak to a healthcare professional about options available to you, such as local support groups.”

Watch Liz’s tips for managing menopausal weight gain

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