A new match for menopausal weight gain: Ozempic

Experts worried over long-term, unknown effects

Kymberly Smith had had enough. It was February 2020, and she was grieving the sudden death of her husband when COVID lockdowns began. She was alone, without any access to her support network, and she was “in the throes of menopause.”

Eventually, Smith, 57, started using antidepressants for her grief. She was also on hormone therapy to ease her constant hot flashes and disruptive night sweats. But when it came to the 20 pounds she had gained around her belly, she “just couldn’t shake it away.”

That weight gain, she said, is difficult to untangle from her circumstances — it might have been caused by the antidepressants or by the fluctuations in hormone levels during menopause. But it made her feel like she had no control over her life and body. “You lose yourself,” she said. “You feel a little bit helpless.”

This past April, Smith started using Wegovy, the weight loss drug that, along with the diabetes drug Ozempic and others like it, has soared in popularity. She has since lost about 35 pounds.

Women going through menopause raise concerns about weight and body changes almost as often as they do about hot flashes and night sweats, said Dr. Stephanie Faubion, medical director for the Menopause Society and a director of the Mayo Clinic’s Center for Women’s Health. “They come in, and they’re often in tears about it. They don’t know what’s happening,” she said. Some estimates suggest that roughly 70 percent of women gain up to 1.5 pounds per year during the menopause transition, which can last as long as a decade.

This weight gain can affect women’s self-esteem and quality of life and can also increase the risk of diabetes, cardiovascular disease, and other health issues. Excess weight is also correlated with more hot flashes and night sweats; the Menopause Society recommends weight loss as an effective nonhormonal treatment for those symptoms.

Now, some women going through menopause are seeking drugs such as Ozempic, despite the steep costs: Without insurance coverage, the drugs can run around $1,000 a month. “We’re getting requests daily,” Faubion said.

And some doctors are beginning to oblige. Given the prevalence of obesity in the United States, “a majority of midlife women actually meet the criteria to receive these medications,” said Dr. Daniela Hurtado, an assistant professor of medicine, endocrinologist, and obesity medicine specialist at the Mayo Clinic.

Experts worry that these medications — which are relatively new, and whose long-term effects are still being studied — may exacerbate the loss of muscle mass and bone density already common among menopausal women, potentially putting them at greater risk for fractures, falls, and osteoporosis.

“That is a concern to me, definitely,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity.

“The fact of the matter is that for lots of adults, but particularly menopausal women, those hormonal changes make it extremely difficult to lose weight no matter what you’re doing,” said Dr. Elaine Eustis, a gynecologist whose South Carolina practice specializes in menopause care.