Menopause is one of the most important, and often overlooked, turning points in a woman’s metabolic health. Many women notice that despite eating the same foods and maintaining similar habits, weight gain suddenly becomes easier, particularly around the abdomen.
At the same time, exciting new research presented at the European Congress on Obesity (ECO) 2026 suggests that modern obesity medications such as semaglutide (Wegovy®) may offer benefits for women before, during and after menopause. Emerging evidence also suggests that menopausal hormone therapy (MHT/HRT) may work alongside GLP-1 medications to improve weight loss outcomes and body composition.
But what is actually happening in the body during menopause? Does HRT cause weight loss? And should women consider combining HRT with GLP-1 medications?
Here’s what the latest evidence tells us.
Why Does Weight Gain Happen During Menopause?
During perimenopause and menopause, falling oestrogen levels affect appetite, metabolism, body fat distribution and muscle mass. Women tend to lose muscle and gain more visceral fat – the deeper abdominal fat linked to diabetes, fatty liver disease and heart disease.
Poor sleep, hot flushes, fatigue and mood changes can also make healthy eating and regular exercise harder to maintain. The result is that many women experience both weight gain and a decline in metabolic health during menopause.
Does HRT cause weight loss?
One common misconception is that hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), causes major weight loss. Current evidence suggests this is not true. HRT is not a weight loss treatment. However, studies show it may help reduce abdominal fat accumulation, improve insulin sensitivity and preserve muscle mass. It may also improve sleep, energy and quality of life, making healthy lifestyle changes easier to sustain.
The New ECO 2026 Data: GLP-1 Medications and Menopause
Exciting new research presented at the European Congress on Obesity (ECO) 2026 has highlighted the benefits of GLP-1 medications such as semaglutide (Wegovy®) for women before, during and after menopause. Women in these studies achieved substantial weight loss and significant reductions in waist circumference, suggesting important reductions in harmful visceral fat.
Could HRT and GLP-1 Medications Work Together?
This is one of the most interesting emerging areas in obesity medicine. Some early studies also suggest that women using both HRT and GLP-1 medications may achieve greater weight loss than women using GLP-1 medications alone. Researchers believe this may be because HRT improves sleep, energy, body composition and metabolic health. However, larger studies are still needed before firm conclusions can be made.
Muscle Loss: The Hidden Problem During Menopause and Weight Loss
Another important issue is muscle loss. During the menopause, women naturally lose muscle mass, and rapid weight loss can sometimes worsen this if protein intake and strength training are neglected. This matters because muscle is critical for metabolism, strength, falls prevention, physical function and healthy ageing. This is why resistance exercise and adequate protein intake are so important during midlife and menopause.
What Should Women Actually Do?
There is no single solution for weight gain after the menopause. The best approach to menopausal weight gain is usually a personalised combination of healthy nutrition, regular exercise, strength training, good sleep, menopause symptom management and, where appropriate, evidence-based obesity treatments such as GLP-1 medications.
Most importantly, women should understand that menopausal weight gain is not simply about willpower. Menopause changes the body in profound ways. Hormonal changes affect metabolism, appetite and body composition in complex ways. The encouraging news is that modern obesity and menopause treatments are improving rapidly, giving women more options than ever before.
Key Takeaway
Menopause changes the way the body stores fat and regulates metabolism. New data from ECO 2026 suggests that GLP-1 medications such as semaglutide may help some women lose weight but we should focus on improving long-term health, muscle preservation, metabolic health and quality of life — not simply the number on the scales.