In this episode of Fitness Simplified Podcast, Brooke Davis delves into the topic of Ozempic in Perimenopause. We will be discussing the use of semaglutide, a GLP-1 agonist, specifically for women’s health and perimenopausal concerns. She explores the benefits, risks, and mechanisms of action of semaglutide, emphasizing its role in weight management and metabolic health. The conversation also addresses the potential side effects and long-term considerations of using semaglutide, as well as practical tips for effective use. Ultimately, Brooke encourages a holistic approach to health, weighing the benefits and risks of semaglutide in the context of individual health needs.
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Contents
Welcome back to another episode of Fitness Simplified Podcast, I’m Brooke Davis women’s functional nutritionist and fitness specialist with Elysian Women’s Wellness. On today’s episode we’re breaking down the science, trends, and insights in women’s health on a topic that’s getting a lot of attention lately – semaglutide -also known as Ozempic and a lot of different names- but talking about it particularly in the context of perimenopause. With more women considering it for weight management, hormonal balance, and metabolic health, I wanted to address the benefits, risks, and everything in between.
First off, I am not a doctor and this is not medical advice. Please always talk to your healthcare provider before taking, changing or quitting any medications.
Second of all, I will be totally honest. I’ve looked into these a bit, I’ve listened to doctors on podcasts, I’ve read studies…but when I started researching specifically for this podcast, I had a slightly different opinion on these substances and digging in more has actually changed my opinion of them so I’m excited to bring some clarity and voice my thoughts on these peptides, and hopefully help anyone who is considering them or is already on them. Here we go.
Let’s start with the basics: What is semaglutide? The first type of semaglutide is Ozempic. It came on the market for use in 2017, and it’s a “medication” primarily designed to treat type 2 diabetes. It’s actually a bioidentical peptide, which is a short chain of amino acids, held together by peptide bonds and these are the building blocks of protein – which makes up almost everything in our body from, skin to hair, nails, to muscle. Semaglutide specifically belongs to a class of “drugs” called GLP-1 (glucagon like peptide) receptor agonists. Semaglutide, a bioidentical mimic of the GLP-1 peptide naturally produced in the small intestine, colon, pancreas, and brain in response to food. It helps regulate insulin secretion, blood sugar levels, slows digestion, and performs many other functions, which we’ll explore further.
Semaglutide (specifically Ozempic) has gained significant popularity and is being used off-label for weight loss.
This trend has spurred the emergence of many competing brands. Perimenopausal women, in particular, are exploring its potential as a solution for stubborn fat gain caused by metabolic challenges during hormonal changes. I wanted to address all the essential points to help you decide whether these weight loss medications, or a specific type, could be the right choice for you.
As of now, there are many different variations of this drug including Ozempic, Wegovy, Trulicity, and Mounjaro being the most popular so let’s talk about the differences between them.
Starting with Ozempic, semaglutide is the active ingredient. As mentioned before, the FDA approved it only for type 2 diabetes, but doctors often prescribe it off-label for weight loss due to the results people experience. Ozempic starts at 2mg, increasing up to 8mg, and comes in a prefilled shot pen.
Next is Wegovy, which closely resembles Ozempic but has FDA approval specifically for weight loss. It starts at .25mg per week for 4 weeks, increasing every 4 weeks up to 2.4mg, and also comes in a prefilled shot pen.
Trulicity, a GLP-1 drug, contains the compound dulaglutide. Like Ozempic, doctors designed it specifically for type 2 diabetes, and the FDA has approved it only for that purpose. However, many use it off-label for weight loss due to its results. It starts at a dosage of .75mg, increasing up to 4.5mg, and comes in prefilled pens. Trulicity causes more gastrointestinal stress than semaglutide at the starting dosage and shows less weight loss over a 6-month study. However, its A1C results were comparable.
Next, we have Mounjaro and Zepbound, which are not semaglutide but tirzepatide. It’s similar to GLP-1 agonists but belongs to a new class of drugs called GLP-1/GIP agonists, combining glucagon-like peptide and glucose-dependent insulinotropic polypeptide (GIP). When studied against Ozempic, after 40 weeks, the people taking it saw lowered A1C though it did take longer, and greater weight loss than semaglutide. The general starting dosage for tirzepatide is 2.5mg for 4 weeks increasing 2.5mg every 4 weeks after that up to 15mg.
Then there’s compounded Semaglutide. I want to explain how compounded medications work because a lot of people aren’t really aware. We have brand name medications that are owned by big pharmaceutical companies like Pfizer, Novo Nordisk, Eli Lilly and others. These are all the medications I just listed, Ozempic, Wegovy, etc. They have a patent on these specific drugs in these specific dosages, like the prefilled shot pens, or hormones that come in specific pill dosages.
Patents for medications typically last about 20 years, after which other companies can begin selling generic versions. However, in the meantime, doctors can prescribe medications from compounding pharmacies. These pharmacies create drugs with the same chemical composition as brand-name medications but often in different dosages or without certain added ingredients. For example, a common progesterone pill contains peanut oil, but a compounding pharmacy can make a version without it. It’s worth noting that these compounded medications are not “FDA approved,” which is something to consider if that matters to you.
Just as a side note, the FDA doesn’t approve raw milk either, and I’ve been drinking it for years. Back to the main point—using compounded medications carries potential risks. Pharmacies might alter the amounts of ingredients in their products over time, fail to include the correct active ingredients, or produce items contaminated with bacteria. These pharmacies also operate without FDA regulation. However, some compounding pharmacies earn accreditation and undergo inspections to ensure proper practices, making them a much safer option for doctors to prescribe from.
The advantages of compounded medications lie in their flexibility with dosages. Many brand-name drugs, like Ozempic injection pens, are only available in set amounts (e.g., no less than 2 mg), making it harder to adjust based on symptoms. Compounded semaglutide allows for precise dosage customization. This flexibility also applies to hormones. FDA-approved hormone pills come in fixed doses, which don’t always work well for every individual. Good doctors often turn to compounded versions to tailor the treatment to the patient’s needs. We’ll dedicate an entire episode to this topic soon.
I’ve mentioned before that the FDA approves some of these medications only for specific treatments. However, doctors have the authority to prescribe medications for any purpose they deem appropriate. This practice, known as “off-label” use, means they’re prescribing the medication for something other than its officially approved use. I think this flexibility is important and necessary for doctors to best serve their patients.
This is essentially how people are using Ozempic for weight loss who don’t have diabetes. This gets a little sticky and controversial because it became an issue at one point (and somewhat still is) because of the demand of people using it for weight loss there people who had type 2 diabetes that couldn’t get their usual life saving medication because people who had 20lbs to lose were using it for weight loss. But, this is when compounding pharmacies really come in handy.
Okay, back to the drugs. How do they work and what are some of the benefits of them?
They essentially all work the same way. They act on the GLP 1 receptor sites – which are actually all throughout the body. It has became popular mainly because of the receptor sites in the small intestines, and pancreas – but they also exist on your muscles and your brain.
It’s these mechanisms through which they support regulation of diabetes and weight loss. What’s crazy though, is as I said previously, there are actually GLP1 receptors throughout your entire body – not just in your small intestines but on your muscles and in your brain- so there are a lot of other benefits as well.
Along with all of that comes more benefits like
Long story short – A lot of really powerful things.
This is where it gets a bit more nuanced. While the drugs themselves technically mimic a hormone, they don’t directly affect our sex hormones like estrogen or progesterone but they do have a pretty significant impact on of course insulin and then indirectly in every way – cortisol, which when used properly can indirectly support better sex hormone balance.
Stable blood sugar levels can then help reduce the rollercoaster of cortisol spikes that a lot of perimenopausal women experience. And since insulin resistance can make hormonal imbalances worse due to stress on the body, especially with cortisol, reducing this might also help manage symptoms like weight gain, fatigue, even sleep dysregulation.
Moving down the line, if cortisol and insulin are regulated properly along with all the other processes that I mentioned earlier, the body has more energy to designate toward adequate sex hormone production reducing symptoms in many other ways. Also, cortisol is an inflammatory regulator so if inflammation is down, cortisol has less work to do.
I want to make clear however, that semaglutide is not a cure for hormonal imbalance. If you’re struggling with symptoms like night sweats, hot flashes, or low libido you’ll need to work on hormone-specific solutions as well. And of course there is one BIG caveat to ALL of this, which we’ll get to at the end – so make sure to stick around.
Now with everything you’ve heard – you might be like, Good Lord why WOULDN’T I take these…
Well, let’s talk about it.
Of course, with any medication, there are risks and contraindications that need to be considered:
And this is what I want to dive deeper into. Metabolism.
The studies vary in results, but it ranges from 20-60% of people who lose weight on these drugs will gain it all back plus some within a year once they stop taking them…and people are losing and gaining MASSIVE amounts of weight.
OR…”they have to stay on them forever” in order to maintain results, and for a lot of people this comes with constant nausea.
And unless you have diabetes, was NOT what they were designed for.
When you lose weight rapidly, you’re not just losing fat. You’re losing muscle.
Muscle is what drives your metabolism. Muscle is what burns & stores energy, it supports blood sugar regulation, supports your hormonal health, and it doesn’t come in a shot.
What we’re seeing is people coming off of these shots and they’ve lost all this muscle, and THEN they gain all the weight back…so now they’re not only overfat, but as Gabrielle lyon likes to call it “under muscled” and not only out a lot of money but they’re metabolically worse off than they were before. The goal for most people isn’t just to be “skinny” it’s to ultimately be healthy.
The amazing thing about GLP1 drugs is that they are actually muscle sparing. Because of their impact on the mitochondria, they have the ability to help you build and maintain healthy muscle BETTER…when paired with the right…wait for it… diet, exercise and lifestyle or what I like to call the BIG 3. The foundational habits of health.
You knew this was coming right?
There is NO MAGIC PILL… or shot.
Side effects…aside. Some of the biggest issues with these peptides being used solely for weight loss, is:
So
How can you combat this?
If you’ve never listened to my podcasts, some of this might come as news to you. If you have heard me talk anywhere ever, this will sound familiar.
To combat this, you need to be very intentional about prioritizing protein in your meals—you should be going for high-quality sources like lean meats, fish and eggs. If you’re struggling to eat enough, try incorporating protein shakes, or smaller, frequent meals, even essential amino acids supplementation. The goal is to maintain muscle mass while losing fat, and adequate protein is non-negotiable for that.
We also want to be very aware of nutrient quality. Especially if you have fat to lose, it’s not necessarily a calorie issue that your body is going to have, it’s a nutrient deficiency issue when restricting food. This is a place that proper supplementation can be really beneficial, so taking a good multivitamin, using things like greens, reds powders, fiber supplements, taking omega 3 supplements in some form can help support your body through this stressful process.
In addition to that, you need to do your best to be eating enough that you’re not losing weight too fast. Even if you’re eating protein, there are other side effects to losing weight too fast including gallstones and pancreatitis (as I mentioned on the side effects) – which ultimately comes down to dosing management. If you can’t eat enough to keep your muscle, you may need to chat with your doctor about lowering your dosage.
Again, if your dosage is too high that you can’t eat enough to sustain the energy to exercise so you can build or at least maintain muscle while you lose fat – you’re doing yourself a disservice.
Now. Here’s where we get to the goods.
If you’re doing these things. You’re addressing the big 3 – you’re eating protein, you’re eating mostly whole foods, you’re eating ENOUGH food, you’re strength training, you’re doing what ‘s in your control to prioritize your rest – but it’s just not enough. Maybe you’ve even hired a coach (which I would absolutely recommend if you’re not already very educated in these things), maybe you’re even using hormone replacement therapy and symptoms have improved and while you might be seeing results there’s still some things that are just off.
As you might already know, during perimenopause, the body undergoes some significant hormonal shifts that impact almost every system. These hormonal changes have a huge impact on several systems in the body, influencing metabolism, appetite, insulin sensitivity, and fat storage—areas where GLP-1 agonists, like semaglutide, can offer crucial support. – areas where GLP 1 agonists could offer some support.
Estrogen and progesterone are the key players in these symptoms and their drastic fluctuations and ultimate decline are what cause the majority of them. Similar to the GLP1, there are estrogen receptors throughout your entire body, from your brain to your joints, and even your gut.
So how could GLP-1’s help support you through perimenopause when you’re applying the big 3?
As estrogen levels drop, a lot of women experience a natural slowdown in their metabolism, and energy levels which shows up as increased body fat, especially around the belly, a lot of times even if there haven’t been changes in diet or exercise. Estrogen helps regulate how fat is distributed in the body, and without it, the body tends to store fat more easily, especially visceral fat around the organs which increases the risk of cardiovascular disease. This hormonal change can make weight loss more challenging and fat gain more likely.
Using GLP-1 could actually help the body to use fat for fuel more efficiently. This helps prevent the rapid fat accumulation that often comes with perimenopausal hormonal fluctuations.
One of the lesser-known but major effects of fluctuating hormones in perimenopause is a reduction in insulin sensitivity. Estrogen helps the body respond to insulin and regulates blood sugar levels so as production slows, a lot of women develop insulin resistance, which leads to increased blood sugar levels and a greater risk of weight gain and type 2 diabetes.
Of course as we know, GLP-1 agonists improve insulin sensitivity by reducing excessive glucose production by the liver. By better regulating blood sugar, it reduces the risk of insulin resistance and as I mentioned earlier supports cortisol regulation in turn – which can play a big role in the symptoms of perimenopause like belly fat, energy levels and even appetite regulation.
Hormonal fluctuations and stress can cause cravings and difficulty feeling satisfied after meals. Progesterone, in particular, can stimulate appetite, while estrogen’s role in regulating hunger hormones like leptin and ghrelin decreases. You can see why this is a problem.
Like I mentioned this peptides role in regulating appetite and increasing satiety could help perimenopausal women manage hunger and reduce overeating or reaching for the wrong kinds of foods when the natural hunger signals in the body become less consistent.
Perimenopause also brings an increased risk of cardiovascular issues, partly due to declining estrogen, which has a protective effect on heart health. The changes in fat distribution, insulin sensitivity, and blood sugar regulation further increase the risk of high blood pressure, high cholesterol, and cardiovascular disease.
Along with it’s many other roles, GLP1 peptides also have cardiovascular benefits, including reducing blood pressure and improving lipid profiles (cholesterol and triglycerides). For women in perimenopause, this means not only support for weight and insulin regulation but also a potential reduction in the risks associated with heart disease, which tend to rise as hormones fluctuate and metabolism slows.
And lastly, these wild hormone fluctuations lead to a decrease in muscle mass up to 10% throughout perimenopause, as estrogen plays a key role in maintaining lean muscle mass. This loss of muscle, combined with slower metabolism, makes it even harder for women to maintain their weight and metabolic health during perimenopause.
The amazing thing about GLP1 drugs is that while they don’t directly build muscle GLP-1 they are muscle sparing which means when applied properly can actually help protect muscle mass during weight loss.
This really hasn’t been officially studied, but I’ve listened to multiple podcasts from different doctors and even went a little deeper on Dr. Tyna Moore’s 4 part series Uncovering Ozempic, on the benefits of microdosing semaglutide.
What she shares to make a long story short is this:
The majority of risk from side effects, including nausea, gallstones, pancreatitis, gastroperesis, and of course muscle loss (as a byproduct of rapid weight loss), can all be at the very least greatly reduced by reducing the dosage at which you take semaglutide. A lot of these studies done that produced these side effects came from people who already had diabetes, which in and of itself, puts them at risk for these things. Then of course, the supra-physiological doses that people are being put on, only increases the risk. She discusses the benefits even of starting dosages at LESS THAN HALF of the full brand name prescription in the shot pens by using compounded semaglutide and seeing so many of the benefits, without the side effects.
This makes so much sense to me. It’s JUST like hormone replacement therapy. GLP1 agonists are identical to a peptide that our body produces, and as we become metabolically unhealthy or as we age, our body reduces the amount that it makes which causes the vicious cycle of degradation. Everyone is different, everyone makes and needs different amounts but the current ability to manage that is difficult, if your doctor is even willing to do it.
So instead of doing keg stands of Ozempic for everyone and their mother, if we instead sip delicately with the pinky out and only replace what our body no longer makes ALONG with implementing the nutrition, exercise and lifestyle habits that support it, you may be able to actually reverse damage, improve your health, get the results you want – then maintain them with changed habits and remove the peptide completely, or possibly she mentions cycling it as needed like a 3-6 months on, 3-6 months off for anyone over 40.
If you are someone who already has type 2 diabetes, has 100+ lbs to lose – you may need larger doses to get the same results as someone who isn’t, you MAY be at a larger risk for those side effects, specifically gastroperesis – but this is where you have to weigh the risks and benefits for yourself because being metabolically unhealthy comes with it’s own set of risks.
But I can tell you that the expectations of this peptide have become far more than what the body can handle, which is why we’re seeing and hearing so much about the downsides of it. You can’t just take megadoses of this peptide, continue to eat mainly processed foods, not exercise and come out on the other side happy & healthy.
I’ve had so many women come to me after attempting to use it in this way and now we’re dealing with the aftermath, and it’s not only money lost but health and potentially lifespan because of misuse.
I also have to throw out that Novo Nordisk who created Ozempic has paid out 25.8 million dollars in the last 10 years to medical professionals to prescribe it, so doctors often have an incentive to prescribe it even to people who may not need it – and as we know there’s rarely any mention of nutrition or lifestyle from your general practitioner.
To conclude my thoughts: I believe semaglutide to be the best thing to come about for perimenopausal women since hormone replacement therapy. It offers some really promising benefits for women in perimenopause, particularly when it comes to weight management and insulin sensitivity, not just offering longevity but quality of life. If you are doing “all the right things” but still have 15-20lbs of visceral fat that won’t come off, this could be extremely beneficial for you in SMALL doses.
I also believe it could be greatly beneficial for people who are metabolically damaged, obese, have diabetes – not only is losing fat hard for anyone – of course you have the usual battle of changing your mindset, your habits etc. but once you’re obese it becomes extremely difficult as your body in so many facets is actually fighting against you, from hunger hormone dysregulation to fat producing estrogenic side effects, and this is the first thing we have to truly combat almost all of it.
I know there’s a stigma with it, it’s seen as cheating or taking the easy way out (I used to think that) – but the reality of it is that if you don’t ALSO do the things that “everyone else” is doing to lose weight like strength training, working out, eating the right things and changing your habits – you will end up not only less healthy at the end of it, but you will likely not maintain your results. This just makes doing those things, actually produce significant change in someone who’s body is extremely resistant to it.
That being said – if you’re 20-30 years old, have 10-20 lbs of subcutaneous fat that is not impacting your organs, it maybe makes your thighs and butt a little bigger, is semaglutide worth the potential risks and cost? Obviously you can decide but I’d say no. And unfortunately this is a lot of what I’ve been seeing, again with detrimental outcomes because it’s not done right.
It’s not magic, and it’s crucial to consider the potential risks, side effects, and long-term impacts before starting it.
If you’re thinking about using semaglutide or are curious about microdosing, I strongly recommend having a detailed conversation with a healthcare provider who understands your big picture of health. While it may help with weight loss and metabolic health, don’t forget that perimenopause and hormone balance is multifaceted, and addressing it holistically is key.
Of course, above all else – it’s essential to have a thorough consultation with your healthcare provider to weigh the benefits and risks based on your personal medical history.
I hope this was helpful! I’m excited to have more of these resources and the ability to better support my clients in their decision making and even usage of these peptides. I will link all the resources I’ve used while creating this podcast in the show notes so if you want to dive deeper you can.
If you have any questions like Ozempic in Perimenopause, suggestions for future topics or just want to chat, feel free to reach out to us on Instagram at @Brooke_Elysian and Facebook linked in the show notes or via our website Elysian Women’s Wellness dot com.
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Women’s Functional Nutritionist & Fitness Specialist along with CEO of Elysian Women’s Wellness.
God, family, fitness – in that order. Fitness isn’t my job, it’s my passion. My favorite things include traveling the world, being a mama and making a difference.
14 years of experience in the wellness industry has brought me to an understanding that when you’re ready – you’ll do it. So when you are, we’re here to keep you simply well.
The last “program” you’ll ever buy. Your individualized training & nutrition plan that teaches the why & how to create lasting changes with me by your side every step of the way!
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