Menopause hormone therapy GLP 1 study finds a small extra weight loss on semaglutide but not tirzepatide

A menopause hormone therapy GLP 1 analysis presented at The Menopause Society's 2026 meeting found that midlife women taking semaglutide lost somewhat more weight when they also used hormone therapy. For women on tirzepatide, the extra loss appeared only at three months and did not last. The study used health records from 3,855 women, matched groups by key traits and has not been peer reviewed. It shows an association, not a cause, and hormone therapy is not approved for weight loss.

What the Mayo Clinic team measured

Regina Castaneda of Mayo Clinic Florida presented the work at the meeting in San Diego, held from 20 to 24 October. With co authors including Maria Hurtado Andrade, she drew electronic health records from the nSights federated platform for February 2017 to December 2025. Women qualified if they were aged 45 or older, had a body mass index of at least 27 and took semaglutide or tirzepatide for at least 12 months. Hormone therapy meant oral or transdermal estrogen, with or without progesterone. Women with past bariatric surgery, active cancer or another obesity medicine at the same time were excluded. Each hormone user was then matched with two non users on age, starting body mass index, earlier obesity drug use and type 2 diabetes.

The semaglutide group held 2,379 women, 793 of them on hormone therapy, and the tirzepatide group 1,476 women, 492 of them on hormone therapy. Mean age was 57 and mean body mass index 36 in both. Median follow up was 26 months on semaglutide and 16 to 17 months on tirzepatide, according to the meeting coverage in Patient Care. The main outcome was the percentage of total body weight lost at 3, 6, 9, 12 and 15 months and at the last visit. A second outcome was the share of women who passed set thresholds, from 5% up to 30% of starting weight. The menopause hormone therapy GLP 1 findings exist so far only as a conference abstract and a presentation, so the full methods have not been checked by outside reviewers.

Semaglutide results with hormone therapy

On semaglutide, the two groups ran level for the first months and then separated. At 9 months, women using hormone therapy had lost 9.8% of their weight on average against 8.2% for non users. At 12 months the figures were 11.0% and 9.5%, and at 15 months 11.6% and 9.7%. At the last follow up the gap had narrowed to 11.9% against 10.9%, still statistically significant. Hormone users were also a little more likely to reach bigger milestones. At last follow up, 55% against 51% had lost at least 10%, 22% against 18% at least 20%, and 6% against 4% at least 30%. These are small absolute gaps, of one to two percentage points of body weight, in women who all lost a meaningful amount.

At the last follow up the gap had narrowed to 11.9% against 10.9%, still statistically significant.

Why estrogen would add to semaglutide is not settled. Reviews link the menopause transition to more fat around the waist, and outside doctors quoted by Healthline offered a simpler route too. Sherry Ross, an obstetrician at Providence Saint John's Health Center, said hormone therapy can ease hot flashes, poor sleep and mood changes, which may make exercise easier. Betul Hatipoglu of University Hospitals Cleveland Medical Center, who was not involved, called the results encouraging but said, "This is an association." She advised against starting hormone therapy only to boost weight loss. Responses to these drugs vary for many reasons, and a GLP1R gene variant has been tied to slightly more loss in other work.

Why tirzepatide showed no lasting gap

Tirzepatide told a different story. Women on hormone therapy lost 6.6% of their weight at 3 months against 5.9% for non users, a gap that was statistically significant. After that the curves came together, with no significant difference at 6, 9, 12 or 15 months or at the last visit. The only later sign was in the lowest threshold: 88% of hormone users had lost at least 5% by last follow up, against 84% of non users. No difference appeared at the 10% to 30% thresholds. Tirzepatide acts on both the GIP and GLP 1 receptors and usually produces more weight loss than semaglutide, so one possibility is that any extra effect of estrogen is harder to see on top of it. The study did not test that idea.

Follow up on tirzepatide, the newer drug, was also about ten months shorter, so the analysis had less time and fewer women at later points to detect a gap. The abstract did not break results down by menopausal stage, type of hormone therapy, drug dose or how regularly women took their medicines, all of which could change the picture. Women who use hormone therapy may differ from non users in ways the matching did not capture, such as income, contact with doctors or general health habits. The Patient Care meeting report gives the full set of numbers. A similar study design, with similar caveats, lies behind many other results in our clinic section.

What menopause hormone therapy GLP 1 data cannot show

The main limit is the design. In observational records, women chose hormone therapy with their doctors for their own reasons, and propensity matching can balance only what was measured. Residual confounding is therefore possible, as the authors say, and they call for larger prospective studies. The analysis also required at least a year on the weight loss drug, which leaves out women who stopped early. Like a recent digital programme study in women, it describes a selected group that stayed on treatment. And because the work is not yet published in a journal, details such as the exact statistical models and the handling of missing weights cannot be checked.

Hormone therapy has its own risks and benefits, and in the United States it is approved to treat menopause symptoms such as hot flashes and night sweats, as the FDA explains for consumers. Weight loss is not one of its indications. Both outside experts quoted by Healthline stressed that the decision should rest on symptoms, health history and goals, and Ross called for randomised trials to test whether hormone therapy directly improves and maintains weight loss. Until those trials exist, the most a woman with both menopause symptoms and obesity can take from this study is that combining the two treatments did not appear to blunt weight loss, and on semaglutide may have helped a little.

Conclusion

This menopause hormone therapy GLP 1 study links estrogen use with one to two points of extra weight loss on semaglutide from 9 months onward, but with no lasting difference on tirzepatide. It is an unpublished, observational analysis of records from 3,855 women, so it cannot show that hormone therapy causes the extra loss. Prospective trials are needed before the finding should shape any treatment choice.

Source Castaneda R, Murugadoss K, Hurtado Andrade MD and colleagues. Menopause hormone therapy and weight loss response to GLP-1-based therapies in midlife women: a retrospective cohort study. The Menopause Society 2026 Annual Meeting (abstract, not peer reviewed).

Amino Weekly reports research. It is not medical advice and never gives doses.