Combining HRT with weight loss medications: what you need to know

For women going through both menopause and obesity, managing weight while relieving menopausal symptoms often involves two combined treatment paths: hormone replacement therapy (HRT) and GLP-1 medications (such as Mounjaro or Wegovy). But is it safe - and effective - to take them together?

The latest guidance from the British Menopause Society (BMS) confirms that yes, these therapies can be used concurrently.¹ But it’s not always straightforward. Thoughtful prescribing, patient education, and tailored delivery formats are important to ensure treatment is both safe and effective.

Why might women need both?

Menopause often leads to weight gain, especially around the abdomen. Hormonal changes shift fat distribution, reduce metabolic flexibility, and exacerbate insulin resistance.² Meanwhile, UK data show that over 60% of women aged 45–64 are either overweight or living with obesity.³ It’s a double burden that heightens risks of cardiovascular disease, type 2 diabetes, and endometrial cancer.

GLP-1 receptor agonists are commonly used to support weight loss. They can help people feel full for longer, reduce appetite, and improve metrics like blood sugar and cholesterol levels. At the same time, HRT is used to ease common symptoms of menopause such as hot flushes, sleep problems, mood changes, and vaginal dryness.⁴ Using both of these treatments together can help improve both your quality of life and long-term health, but they do need to be used carefully in accordance with your clinician’s advice.

How GLP-1s may affect HRT absorption

GLP-1 medications slow down how quickly your stomach empties, which helps you eat less. However, they can also affect how your body absorbs other medicines, including forms of HRT which are taken orally.⁵

This is particularly important for women who take oestrogen and still have a womb, as they also need a hormone called progestogen to protect the womb lining. If the progestogen doesn’t get absorbed properly, it could increase the risk of womb problems in the long term.¹ That being said, more research is still needed for a more definitive answer regarding the safety of this combination, and it is recommended that you discuss all your options with your doctor beforehand.

You should be aware that like all medicines, HRT doesn’t come without side effects. Some excess bleeding is common during the first few months of HRT, especially as your body adjusts to the medication. However, because GLP-1s may affect how well certain hormones are absorbed, this could impact how your HRT works, particularly the balance between oestrogen and progestogen. If you experience ongoing or unexpected bleeding while on both treatments, it’s important to speak to your doctor.¹

Typical menopause treatments

For the safest and most effective approach to treatment of menopause, the BMS advises:¹

• Transdermal oestrogen (patches, gels, sprays) instead of oral oestrogen, especially in women with obesity or diabetes, as this avoids increased risk of blood clots, particularly in the legs.

• Non-oral progestogens such as the levonorgestrel-releasing intrauterine device (IUD), which though are used for contraceptive protection, can offer endometrial safety. It is unaffected by GLP-1 use.

Other alternatives include progestogen patches or vaginal progesterone, though the latter is off-licence for HRT and not suitable for all women.

The numan take

Managing menopause and weight at the same time can feel overwhelming, but the right combination of treatments can make a real difference. Using GLP-1 medications alongside HRT is considered safe for many women, as long as both are prescribed thoughtfully and monitored closely. The most important thing is to make sure your treatment plan is tailored to your needs, with the right hormone delivery methods and regular check-ins with your doctor.

Note: this article is intended for informational purposes only and should not be taken as medical advice. Using medicines in ways other than as prescribed by your healthcare professional can be dangerous.

References

1. British Menopause Society. Use of incretin-based therapies in women using hormone replacement therapy (HRT). thebms.org.uk. https://thebms.org.uk/wp-content/uploads/2025/05/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E [Accessed 22nd May 2025].

2. Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, et al. Understanding weight gain at menopause. Climacteric: the journal of the International Menopause Society. 2012;15(5): 419–429.

3. Part 2: Overweight and obesity. NHS England Digital. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021/part-2-overweight-and-obesity [Accessed 22nd May 2025].

4. Alfaris N, Waldrop S, Johnson V, Boaventura B, Kendrick K, Stanford FC. GLP-1 single, dual, and triple receptor agonists for treating type 2 diabetes and obesity: a narrative review. EClinicalMedicine. 2024;75(102782): 102782.

5. Website NHS. Menopause - treatment. nhs.uk. https://www.nhs.uk/conditions/menopause/treatment/ [Accessed 22nd May 2025].

6. Calvarysky B, Dotan I, Shepshelovich D, Leader A, Cohen TD. Drug-drug interactions between glucagon-like peptide 1 receptor agonists and oral medications: A systematic review. Drug safety: an international journal of medical toxicology and drug experience. 2024;47(5): 439–451.