Weight Loss After Menopause

Medically Reviewed by Larry Siegel, APRN

Weight gain after menopause isn’t just about aging — it’s about biology.

Hormonal shifts slow metabolism, change how your body stores fat, and make it harder to lose weight, especially around the belly. For women over 50, this can feel frustrating and unfamiliar. Even if you’re eating the same and staying active, the scale may still creep up.

But there’s new science offering a different path forward. A 2024 study published in Menopause found that semaglutide — a GLP-1 medication originally used for diabetes — helped postmenopausal women with overweight or obesity lose significant weight, especially around the waist. It’s not a magic fix, but it does offer insight into how weight loss works differently after 50 — and how to approach it with the right tools.

In this guide, you’ll learn why menopause triggers weight gain and belly fat, how semaglutide supports weight loss after 50, what the latest research reveals about its real-world results, and when to consider medical support alongside lifestyle changes.

Let’s take a closer look at the link between hormones, weight, and what’s finally working for women in their 50s and beyond.

Why You Gain Weight During Menopause

Hormonal and metabolic changes after menopause shift how your body stores and burns fat. Lower estrogen levels, a slower metabolism, and changes in insulin sensitivity all contribute to postmenopausal weight gain — midsection especially. Even with healthy habits, many women notice weight becoming harder to manage after 50.

Several internal shifts make weight gain more likely after menopause — even for women who maintain healthy routines:

Lower estrogen changes how and where fat is stored, especially in the abdominal area
Slower metabolism from age-related muscle loss (sarcopenia) reduces daily calorie burn
Increased insulin resistance makes it harder to regulate blood sugar and easier to gain fat

Where Does Menopause Belly Fat Come From?

Before menopause, most body fat is stored just under the skin (subcutaneous fat). After menopause, more fat is stored deeper in the abdomen, surrounding internal organs. This is known as visceral fat and it’s harder to lose.

Visceral fat isn’t just a cosmetic concern. It’s been linked to inflammation, heart disease, type 2 diabetes, and even some cancers. Belly fat after menopause signals a deeper metabolic shift that affects overall health, not just how clothes fit.

What the Science Says: Weight Loss Response to Semaglutide in Postmenopausal Women

A 2024 study in Menopause examined semaglutide’s effects in postmenopausal women both with and without hormone therapy (HT). Researchers wanted to know whether HT changes how well the drug works in real-life settings.

Key Findings from the 2024 Menopause Journal Study

In this retrospective cohort study of 106 women (mean age ~56–59, BMI ~36–39):

Those on HT lost 16% of their body weight after 12 months of semaglutide, compared to 12% in women not on HT (a ~30% greater response)
Women on HT consistently lost more weight at 3, 6, and 9 months — 7% vs 5%, 13% vs 9%, and 15% vs 10%, respectively
Participants on HT were significantly more likely to hit ≥5% and ≥10% total body weight loss (TBWL) targets
Both groups saw improvements in blood sugar, lipids, and blood pressure, but women on HT experienced broader cardiometabolic benefits

Why Semaglutide May Work Better with Hormone Therapy

Hormone therapy and semaglutide work better together. In postmenopausal women, this combination helps restore balance in areas that menopause throws off — appetite, metabolism, fat storage, and energy regulation.

The study suggests hormone therapy supports sleep, reduces hot flashes, and helps preserve muscle mass. These benefits create a more stable metabolic environment, allowing semaglutide to work more effectively.

In other words, hormone therapy fills in the gaps left by dropping estrogen levels, making the body more responsive to semaglutide’s effects. Together, they help women achieve results that are often harder to reach with either option alone.

Semaglutide supports weight loss on its own, but adding hormone therapy may increase that loss by around 30%. The two therapies target different parts of the same problem — and that’s what makes the combination so powerful.

How to Lose Weight During Menopause

Even the best medications work better when supported by strong habits. Semaglutide can help balance your biology, but how you move, eat, sleep, and manage stress still shapes your long-term results. For many women, this is the part that needs a reset.

We break down what works and what doesn’t.

Start With Strength and Movement

Muscle loss speeds up after menopause, and that slows your metabolism. Building strength is one of the most effective ways to support fat loss, mobility, and energy.

Use resistance bands, light weights, or bodyweight exercises 2–3 times a week
Walk daily or aim for low-impact movement that keeps you active without stressing joints
Stretch or do balance work to prevent falls and support flexibility

Eat to Support Hormones, Not Just Calories

Your body processes food differently after 50. The goal is to create a meal plan that supports hormone balance and satiety.

Get protein at every meal to maintain muscle and reduce cravings
Add fiber from vegetables, beans, and whole grains to improve digestion and estrogen metabolism
Stick to slow-digesting carbs like oats, quinoa, and sweet potatoes to stabilize blood sugar

Small food changes make a bigger impact when your body is already working harder to stay balanced.

Sleep and Stress Matter More Than You Think

Sleep and stress don’t just affect mood — they affect metabolism, hunger, and fat storage. Menopause often disrupts both.

Keep a regular sleep schedule and create a calm wind-down routine
Limit screens and caffeine in the evening to help your brain shift into rest mode
Practice stress reduction through walking, deep breathing, or quiet rituals

When cortisol stays high, your body holds onto fat, especially around the belly.

Avoid Quick Fixes That Backfire

Extreme calorie cuts or trendy diets can slow your metabolism even further. After menopause, your body is more sensitive to stress, including nutritional stress.

Instead of over-correcting with restrictions, focus on building habits that support your health long term. Fat loss may be slower, but it’s more sustainable when your body feels safe and supported.

When to Consider Medical Support for Menopause Weight Gain

Lifestyle changes are foundational, but they may not be enough for everyone. If weight gain continues despite your efforts, it might be time to explore medical options like semaglutide or hormone therapy.

1. Your BMI is over 27 with other health risks

Weight-related conditions like high blood pressure, prediabetes, or joint strain may signal a need for medical support.

2. Your BMI is over 30

This level of obesity significantly raises your risk for chronic illness, especially after menopause.

3. Your waist circumference is over 35 inches

Excess belly fat increases your risk of heart disease, insulin resistance, and metabolic dysfunction.

4. You have insulin resistance, PCOS, or metabolic syndrome

These conditions make weight loss more difficult and often worsen with hormonal changes during menopause.

5. You’re doing everything right — and still gaining

If your lifestyle is already in check, persistent weight gain may point to a deeper hormonal or metabolic imbalance.

6. You want to explore hormone therapy to manage menopause weight gain

HRT may improve semaglutide response and help counteract metabolic slowdowns triggered by estrogen loss.

If any of these apply, talk to a provider about what’s making weight loss harder and what tools might help you take back control.

What to Ask Before Starting Semaglutide or Other Medical Options

Before starting semaglutide, hormone therapy, or any weight loss medication, ask your provider:

1. Am I a good candidate for semaglutide based on my weight, age, and health conditions?
2. Will semaglutide interact with my current medications or hormone therapy?
3. What side effects should I expect in the first few weeks?
4. How will we monitor progress and adjust the dose if needed?
5. Are there long-term safety concerns for someone my age?
6. Should I make any changes to my diet or exercise routine while on semaglutide?
7. What happens if I stop taking the medication later on?
8. Would hormone therapy help improve my weight loss results or overall health?

No matter how advanced a treatment may be, every body responds differently. The key is individualization.

Choose a provider who will fine-tune your plan based on your biology, lifestyle, and goals. And if your doctor isn’t asking more questions than you are, it may be time to find a clinic that does.

Realistic, Sustainable Weight Loss After 50

Weight loss after menopause takes more than motivation. It takes a personalized strategy that accounts for hormone changes, insulin resistance, and how your body responds to stress, sleep, and aging.

Whether you’re exploring semaglutide, hormone therapy, or just want a data-driven way to lose stubborn belly fat, we build plans that are aligned with your biology and backed by ongoing lab analysis.

Every woman’s body reacts differently, so we measure. We adjust. And we stay with you through each stage of the process.

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Let’s build a weight loss strategy tailored to your biology.

Semaglutide and Weight Loss After Menopause: What Women Over 50 Should Know