Something you should know about Gennev is that we’re not afraid to go there. We’ve covered topics many people are tempted to talk about in whispers, if they talk about them at all: Vaginal atrophy. Lichen sclerosus. Ovarian cysts. Inverted nipples. You may never have thought to search for those phrases, and you may never want to, but if you ever need to, you deserve evidence-based, expert-backed information. Women’s healthcare has long been under-researched, under-served, and under-funded (you could even say it’s under siege...), but that’s all the more reason to have a trustworthy source of accurate answers to your most important questions. This is no time to be coy about our health.
Today, we’re going there to unpack a topic with a lot of chatter around it: the skyrocketing popularity of GLP-1 drugs, a class of medications gaining attention for their use in treating obesity and diabetes.
These drugs are no secret, and weight is not a shameful topic, but we want to acknowledge that not everyone wants to read about weight-related matters for a range of totally valid reasons. If this is not the post for you, that’s okay.
At Gennev, we believe that healthy bodies come in all shapes and sizes, and that if weight management is something you’re interested in, it should be one part of a comprehensive plan to have the kind of healthy life you want, regardless of your age, where you are in menopause, and what’s going on in your world.
That said, we live in a culture that talks a lot about weight: how to lose it, how to keep it off, how to manage it safely and sustainably, why we gain it back. The messaging is hard to miss, and during menopause, it seems to get even louder, as women wonder what’s behind the mysterious “meno belly” and try to figure out why they seem to gain weight overnight. It’s no wonder, then, that weight loss drugs with a high success rate are getting so much airtime in the cultural conversation.
Since so many are curious about GLP-1s, and Gennev MDs can prescribe them in appropriate circumstances as part of our weight management program, we want you to have all the information you need about this potential option in your menopause weight management toolkit.
But first, some science.
How GLP-1 drugs work
Let’s make the proper introductions: this drug class is broadly known as Glucagon-like Peptide-1 Receptor Agonists. You may know them by their generic pharmaceutical names, like semaglutide, or their commercial brand names like Ozempic or Wegovy (FYI: both Ozempic and Wegovy are brand names for semaglutide, but the drugs are approved and formulated to treat different conditions, so they get different names. The more you know!).
In the body, these medications mimic GLP-1, a naturally occurring hormone that helps manage blood sugar and regulate the appetite. When you eat, the small intestine secretes GLP-1, which signals to other cells that it’s time to perform several digestive and metabolic functions.
The signals that GLP-1 puts out can:
- Help the body process glucose by increasing insulin and blocking glucagon
- Slow gastric emptying (AKA how quickly the food being digested leaves the stomach and releases glucose into the bloodstream) to help you feel full
- Turn on “satiety neurons” in the brain, which balance the hunger and fullness signals that help determine your appetite (and can lead to cravings and “food noise” when imbalanced)
And what about “receptor agonists”? If that sounds like a job title for a secret agent in a spy movie, well, they do kind of act like undercover operators when the body’s systems aren’t working as they should be.
An agonist is a manufactured substance (in this case, synthetic GLP-1 molecules) that binds to a compatible receptor site in or on the surface of a cell. This triggers the effects of the naturally occurring substance (the GLP-1 hormone the body should produce) and tells that cell what to do next (carry out the digestive and metabolic processes the body may struggle to perform on its own).
GLP-1 Receptor Agonists, or just GLP-1s, as you may see them called, have been approved for the treatment of Type 2 diabetes to help regulate blood sugar since 2005. Researchers took notice when patients taking GLP-1s for diabetes also experienced significant weight loss, and in 2014, the FDA approved the first GLP-1 to treat obesity.
Since then, multiple GLP-1 drugs approved for obesity and diabetes treatment have hit the market, with more in development. They also show some promise for treating or lowering the risk of other conditions; while much more data is needed, it’s unsurprising that the drugs have become such a hot topic given all their potential applications.
Criteria for using GLP-1 drugs
Before we go much further, let’s get specific about some terms. With full acknowledgement that GLP-1s are casually called “weight loss drugs” in headline after headline, we’ll mostly refer to “obesity” and “weight management,” rather than “weight loss” in the rest of this article. It’s important to anchor the conversation around GLP-1s on the fact that they’re indicated for something specific: Managing weight concerns, like obesity, associated with metabolic dysfunction and chronic disease—not the normal, gradual weight gain associated with aging (and yes, sometimes menopause).
Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, says this is an important distinction.
“GLP-1s are for obesity, not menopause weight gain. In general insurance companies will not cover these medications for those with a BMI of less than 30, or 27 if they have medical comorbidities related to obesity [like diabetes or heart disease]. We tend to follow these guidelines, as the medications are very expensive if not covered.”
As effective as they are, she says, GLP-1s are not a quick fix, and they’re not for people who need or want to lose the 10-15 pounds that can accompany the transition into midlife (for those folks, Gennev’s menopause-trained MDs and RDNs have many weight management strategies that can be tailored to patient goals). GLP-1s do come with some risks, and can be expensive, subject to shortages, or not covered by insurance, so it’s wise to make an informed decision about whether they’re the right choice before starting them.
That said, there's always nuance to consider. We know that the hormonal havoc of menopause can raise the risk of metabolic syndrome emerging in those who are genetically predisposed to conditions like high cholesterol, insulin resistance, high blood pressure, and obesity. Sometimes, it does make sense to consider GLP-1 drugs for menopausal patients dealing with metabolic dysfunction identified via lab work.
What to know about taking a GLP-1 for weight management
In an upcoming paper, Gennev physicians Dr. Hana Mikdachi and Dr. Rebecca Dunsmoor-Su note that as popular as GLP-1 drugs have become, they haven’t specifically been studied in peri- or post-menopausal women. This is a major opportunity for further study for a few reasons: many women report that weight gain during menopause feels harder to manage and less responsive to their usual eating and exercise habits, and some anecdotally cite GLP-1s as the most effective intervention they’ve tried.
Also, women in midlife may have other health concerns alongside weight, such as bone health, cardiovascular health, and loss of muscle, which could affect how they respond to GLP-1s. More research on the use of GLP-1s for weight loss during menopause will help both patients and providers understand what kinds of risks and benefits to expect.
The decision to start a GLP-1 should be made with your doctor, who should take a thorough medical history and current health status, including your weight, metabolic profile (for example, cholesterol and blood glucose levels), and consider additional health conditions like heart disease, Type 2 diabetes, or even pre-diabetes—the drugs’ effectiveness at regulating blood sugar levels can help lower the risk of developing more severe metabolic disease.
Dr. Dunsmoor-Su says that patients who come in with questions about the drugs usually want to know about the risks and side effects, and whether they can use them for a short period of time, or if they're a lifelong commitment.
We’ll break it all down below.
Risks & side effects of GLP-1s
Most GLP-1 medications are administered via injection with a small dosing pen that patients can learn to use at home. As with any drug, GLP-1 side effects can range from mild to severe, and will vary from patient to patient.
More common side effects:
- Gastrointestinal upset like nausea, vomiting, diarrhea, or constipation—these side effects are common and usually resolve as your body adjusts to the medication.
- Injection site skin irritation, itching, or swelling.
Severe but less common side effects:
- Pancreatitis—large-scale studies haven’t consistently shown an increased risk of this side effect, but it may be something to consider if you've dealt with pancreatitis or gallstones before.
- Thyroid concerns—some animal studies have linked GLP-1s to thyroid cancers, though this doesn’t suggest an increased risk in humans. Data doesn’t show strong evidence for the connection, but it’s something researchers will continue to study.
- Gastroparesis—one expected function of GLP-1s is to slow gastric emptying. Some people experience an extreme version of this in which stomach muscles move food too slowly, causing abdominal discomfort and trouble with digestion.
Who shouldn’t take GLP-1s?
The FDA recommends that patients with certain conditions avoid GLP-1s. Some of these contraindications are due to known serious risks, and others are out of an abundance of caution based on early or inconclusive studies.
These conditions include:
- Medullary thyroid cancer or a family history of the disease
- Multiple endocrine neoplasia, a group of disorders that cause tumors on hormone-producing glands in the endocrine system
- Pregnancy, due to potential risk for birth defects—so if you're perimenopausal, take note! Even irregular periods mean you could still get pregnant, so please talk to your doctor if you’re considering GLP-1s during perimenopause.
Do people have to stay on GLP-1 drugs forever?
The answer to this is quite complicated and may depend on the patient and why they’re taking the drug. The medical community is still learning about the long-term outcomes of GLP-1 usage for weight management, and what happens when the drugs are discontinued.
Here’s what we do know:
- Lifestyle adjustments alongside GLP-1 use are important no matter what dosage is being taken or for how long. A healthy diet and physical activity are essential complements to GLP-1 use, and maintaining these habits can help patients get to a healthy weight.
- Discontinuing GLP-1 use can result in rebound weight gain. When a GLP-1 no longer influences metabolic, digestive, and neurologic processes, dysfunctions like poor blood sugar regulation and abnormal appetite cues from the brain can start up again, which can lead to the patient regaining weight. The important takeaway here is that these drugs help manage the metabolic conditions that contribute to weight gain, but do not permanently cure them.
- Some researchers suspect that reducing GLP-1 medication dosage through a slow, sustained taper (instead of rapidly decreasing dosage over a short period of time, or stopping them suddenly altogether), could help some patients prevent rebound weight gain, but we’ll need more data to confirm this with any confidence or say why it might be the case. Several studies are underway to determine whether this would be an effective method for patients who wish to stop using GLP-1s but still maintain their weight.
Compounded semaglutide: Why we don't recommend it
We promised you real talk, so let’s touch on another important topic in the GLP-1 conversation: compounded drugs.
Compounded drugs are not generic versions of brand-name formulas, but custom-made compounds assembled in pharmacies or independent labs. They’re sometimes used when a patient can’t tolerate an ingredient in a generic or branded drug, and are often cheaper to purchase and not subject to ingredient shortages that can make drugs harder or more expensive to make.
The catch? Compounded drugs aren’t FDA-approved, and the standards of the facilities that produce them vary widely. This makes it virtually impossible to guarantee the safety, effectiveness, quality, or dosage accuracy of compounded formulas and the ingredients used to create them.
Compounded semaglutide for weight loss can look like an appealing option to those starting to explore the GLP-1 landscape. It's custom-made, may be more widely available and more affordable than prescription medications like Wegovy, particularly when insurance won’t cover them, and comes tidily marketed by direct-to-consumer companies with slick branding. Some companies even make it easy to buy compounded semaglutide online without an in-depth conversation with a doctor—sounds fast and simple, but this can be dangerous.
Another thing to watch for is murky labeling issues, since some companies describe their compounded GLP-1 formulas as “generics.” This is misleading, since generic drug formulas are FDA-regulated and must meet the same ingredient, safety, dosing, manufacturing, and quality standards as their brand-name counterparts. As of February 2025, when we’re writing this, there is no approved generic formula for any GLP-1 drug—anywhere. What this means is that any medication being marketed as “generic” semaglutide is, in fact, a compounded drug using unregulated imported ingredients. That’s a significant ethical and health concern, since there's no easy way to know what these ingredients are, how much of them the formula actually contains, or what risks they present to patients.
We don’t want to scare or shame anyone for being curious about compounded semaglutide or other compounded GLP-1 drugs, but the unfortunate truth is that these formulas can come with serious safety concerns, so we at Gennev do not prescribe or recommend them. The FDA issued a statement in December 2024 about the risk of using unapproved GLP-1 formulas, and all North American obesity medicine societies recommend against their use as well.
Gennev’s approach to menopause weight management
It’s an incredible time to be in women’s healthcare, breaking taboos and giving women the information they need to make responsible decisions about their well-being. We know everyone has a unique relationship to the topic of weight, shaped by decades (okay, an eternity) of cultural conditioning and personal experiences, but that’s why we speak candidly about it—particularly during times like menopause, when our bodies start pulling stunts we’ve never seen before and it’s hard to know what advice to trust.
We’ve created a patient-focused, evidence-based weight management program (eligible for self-referral under some insurance providers) meant for exactly that situation: your body’s changing, you’re not sure how to feel about it, and you want to protect your long-term health. GLP-1 medications may or may not ultimately be part of your strategy, but the good news is you’ll have plenty of ways to reach and stay at a healthy weight, overseen by our menopause-trained Registered Dietitian Nutritionists and MDs.
Dr. Dunsmoor-Su sums it up: “We designed the program to focus first and foremost on lifestyle changes and the support to make those [by] working with an RDN. These are the changes that will over the long term make the most difference. When thinking about medications (GLP-1 or others) we consider other medical conditions, other symptoms and what medication interactions might be an issue. Even if GLP-1 medications are inaccessible due to cost there are other medications that might help, and we can discuss risks and benefits of these.”
So if menopausal weight gain is on your mind, and the chatter about semaglutide and other GLP-1 medications has you curious, please don’t be shy. We hope we’ve given you plenty of information to consider about these drugs and the variety of options for healthy, body-positive weight management through Gennev. If you have more questions or are ready to try something new, book your intake to get started.
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