Latest news with #menopause
CNN
16 minutes ago
- Health
- CNN
Black box warning on menopause hormone therapies should be removed, experts say
All menopause treatments containing the hormone estrogen are mandated by the US Food and Drug Administration to carry a black box warning on the label, stating that the treatments could increase the risk of strokes, blood clots, dementia and breast cancer. Now, that advisory may be going away. Last week, a panel of experts convened by the FDA urged the federal agency to remove the cautionary language on at least some forms of hormone therapy. I wanted to understand more about why these warnings were first added and the arguments for and against removing them now. What are hormone therapies used for, and what are the different forms of treatment? What is the history behind adding black box warnings, and why are some experts pushing to remove them? What should women know about managing menopause symptoms? I turned to CNN wellness expert Dr. Leana Wen to answer these questions. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: When does menopause occur, and what kinds of symptoms do women experience during menopause? Dr. Leana Wen: Menopause is the stage in a woman's life when her menstrual periods permanently stop. It marks the end of fertility and is accompanied by a decline in reproductive hormones such as estrogen and progesterone. In the US, most women begin the menopause transition between ages 45 and 55, and the average age is 52. The definition of menopause is a full year without having a period. Except in situations where menopause is induced by surgery (for example, removal of ovaries) or specific medical conditions, this period is generally preceded by a stage called perimenopause, when women may have irregular periods and start experiencing menopause symptoms. Symptoms associated with menopause can include hot flashes and night sweats. Hot flashes are sudden sensations of heat, skin flushing and sweating that can significantly disrupt daily activities. About one-third of women have more than 10 hot flashes per day. When they occur at night, they can disrupt sleep and increase fatigue and irritability during the day. Menopausal declines in estrogen also may cause vaginal dryness, decreased libido and discomfort during intercourse. Some women experience other symptoms such as mood changes, anxiety, difficulty concentrating, dry skin and weight gain. Moreover, while this is not a symptom of menopause per se, the risk of developing chronic conditions such as cardiovascular disease and osteoporosis increases significantly after menopause. This rise in risk is thought to be linked to the decline in estrogen levels, as estrogen has a protective effect on maintaining healthy blood vessels and supporting bone density. CNN: What are hormone therapies used for? What are the different forms of treatment? Wen: Hormone therapies are prescription drugs that are used to treat menopause symptoms. They replace the hormones that decline during menopause. It's important to differentiate between two types of hormone therapy. The first is systemic therapy in which hormones are given in a way that is absorbed into the bloodstream. That could be through taking pills or using patches, sprays or gels. Systemic therapy is used to treat symptoms that affect the entire body, such as flashes and night sweats. The second type is low-dose vaginal estrogen therapy. This is a cream or suppository administered into the vagina to treat vaginal dryness and reduce tissue thinning. Unlike systemic therapy, this type of therapy works locally; its purpose is not to raise hormone levels throughout the body. CNN: What is the history behind adding black box warnings, and why are some experts pushing to remove them? Wen: For decades, hormone therapy was considered the standard of care for menopause-related symptoms. Then, in the early 2000s, a landmark study called the Women's Health Initiative was published that suggested hormone therapy increased the risk of breast cancer, heart disease and stroke. It concluded that the benefits of this therapy did not outweigh these risks, leading to the FDA adding the black box warning in 2003. Many researchers have since examined the methodological problems of the study. One significant issue was that the average age of participants was 63. The women studied were mostly postmenopausal, so the question answered was regarding the risks and benefits to postmenopausal women, not menopausal women. Last year, scientists — including some of the original researchers of the Women's Health Initiative — published an updated analysis in the journal JAMA. They concluded that, in fact, hormone treatment with a combination of estrogen and progesterone is safe and effective for treating hot flashes and other systemic symptoms if started before age 60 or within 10 years of starting menopause and if the woman does not have specific contraindications — for instance, an estrogen-sensitive breast cancer. This updated analysis is one reason cited by many advocates to remove the warning. Another major reason is that the black box warning is currently on all types of hormone treatments, including vaginal therapies that deliver far lower doses and do not have the systemic effect of, say, an estrogen-containing pill. Advocates argue that putting all forms of hormone therapy under the same warning misrepresents risk and makes it harder for women to receive relief from troublesome symptoms. Women are still able to access the therapies despite the warning, but some may be more hesitant to use them after seeing the warnings. CNN: What are other arguments for and against this change? Wen: In his opening argument, FDA Commissioner Dr. Marty Makary remarked that systemic hormone therapy, when started within 10 years of the onset of menopause, can actually reduce cardiovascular disease. This finding is suggested by some recent studies, which also show a benefit for bone health. Not everyone agrees that hormone therapy should be taken for preventive purposes. There is also some controversy about process; specifically, the panelists who spoke at last week's FDA meeting were all selected by Makary and all favored hormone therapy. Some have said they would appreciate more balance by hearing from experts who have more nuanced views. In addition, there was no presentation by internal FDA scientists, who, in the past, have given their own analysis during these types of meetings. CNN: While the FDA is considering changing the warning label, what is your advice for women about managing menopause symptoms? Wen: The most important thing is that women who are experiencing significant symptoms during menopause don't need to suffer in silence. Effective treatments exist. Women should speak with their physicians about lifestyle measures that can help as well as hormonal and nonhormonal prescription therapies. They should also speak with their providers about preventive care to improve heart health and prevent bone loss. Those who want additional resources should look to the Menopause Society, which also has a searchable database of clinicians who are certified menopause practitioners and trained to guide women through this transition.
CNN
24 minutes ago
- Health
- CNN
Black box warning on menopause hormone therapies should be removed, experts say
Women's health Federal agenciesFacebookTweetLink Follow All menopause treatments containing the hormone estrogen are mandated by the US Food and Drug Administration to carry a black box warning on the label, stating that the treatments could increase the risk of strokes, blood clots, dementia and breast cancer. Now, that advisory may be going away. Last week, a panel of experts convened by the FDA urged the federal agency to remove the cautionary language on at least some forms of hormone therapy. I wanted to understand more about why these warnings were first added and the arguments for and against removing them now. What are hormone therapies used for, and what are the different forms of treatment? What is the history behind adding black box warnings, and why are some experts pushing to remove them? What should women know about managing menopause symptoms? I turned to CNN wellness expert Dr. Leana Wen to answer these questions. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: When does menopause occur, and what kinds of symptoms do women experience during menopause? Dr. Leana Wen: Menopause is the stage in a woman's life when her menstrual periods permanently stop. It marks the end of fertility and is accompanied by a decline in reproductive hormones such as estrogen and progesterone. In the US, most women begin the menopause transition between ages 45 and 55, and the average age is 52. The definition of menopause is a full year without having a period. Except in situations where menopause is induced by surgery (for example, removal of ovaries) or specific medical conditions, this period is generally preceded by a stage called perimenopause, when women may have irregular periods and start experiencing menopause symptoms. Symptoms associated with menopause can include hot flashes and night sweats. Hot flashes are sudden sensations of heat, skin flushing and sweating that can significantly disrupt daily activities. About one-third of women have more than 10 hot flashes per day. When they occur at night, they can disrupt sleep and increase fatigue and irritability during the day. Menopausal declines in estrogen also may cause vaginal dryness, decreased libido and discomfort during intercourse. Some women experience other symptoms such as mood changes, anxiety, difficulty concentrating, dry skin and weight gain. Moreover, while this is not a symptom of menopause per se, the risk of developing chronic conditions such as cardiovascular disease and osteoporosis increases significantly after menopause. This rise in risk is thought to be linked to the decline in estrogen levels, as estrogen has a protective effect on maintaining healthy blood vessels and supporting bone density. CNN: What are hormone therapies used for? What are the different forms of treatment? Wen: Hormone therapies are prescription drugs that are used to treat menopause symptoms. They replace the hormones that decline during menopause. It's important to differentiate between two types of hormone therapy. The first is systemic therapy in which hormones are given in a way that is absorbed into the bloodstream. That could be through taking pills or using patches, sprays or gels. Systemic therapy is used to treat symptoms that affect the entire body, such as flashes and night sweats. The second type is low-dose vaginal estrogen therapy. This is a cream or suppository administered into the vagina to treat vaginal dryness and reduce tissue thinning. Unlike systemic therapy, this type of therapy works locally; its purpose is not to raise hormone levels throughout the body. CNN: What is the history behind adding black box warnings, and why are some experts pushing to remove them? Wen: For decades, hormone therapy was considered the standard of care for menopause-related symptoms. Then, in the early 2000s, a landmark study called the Women's Health Initiative was published that suggested hormone therapy increased the risk of breast cancer, heart disease and stroke. It concluded that the benefits of this therapy did not outweigh these risks, leading to the FDA adding the black box warning in 2003. Many researchers have since examined the methodological problems of the study. One significant issue was that the average age of participants was 63. The women studied were mostly postmenopausal, so the question answered was regarding the risks and benefits to postmenopausal women, not menopausal women. Last year, scientists — including some of the original researchers of the Women's Health Initiative — published an updated analysis in the journal JAMA. They concluded that, in fact, hormone treatment with a combination of estrogen and progesterone is safe and effective for treating hot flashes and other systemic symptoms if started before age 60 or within 10 years of starting menopause and if the woman does not have specific contraindications — for instance, an estrogen-sensitive breast cancer. This updated analysis is one reason cited by many advocates to remove the warning. Another major reason is that the black box warning is currently on all types of hormone treatments, including vaginal therapies that deliver far lower doses and do not have the systemic effect of, say, an estrogen-containing pill. Advocates argue that putting all forms of hormone therapy under the same warning misrepresents risk and makes it harder for women to receive relief from troublesome symptoms. Women are still able to access the therapies despite the warning, but some may be more hesitant to use them after seeing the warnings. CNN: What are other arguments for and against this change? Wen: In his opening argument, FDA Commissioner Dr. Marty Makary remarked that systemic hormone therapy, when started within 10 years of the onset of menopause, can actually reduce cardiovascular disease. This finding is suggested by some recent studies, which also show a benefit for bone health. Not everyone agrees that hormone therapy should be taken for preventive purposes. There is also some controversy about process; specifically, the panelists who spoke at last week's FDA meeting were all selected by Makary and all favored hormone therapy. Some have said they would appreciate more balance by hearing from experts who have more nuanced views. In addition, there was no presentation by internal FDA scientists, who, in the past, have given their own analysis during these types of meetings. CNN: While the FDA is considering changing the warning label, what is your advice for women about managing menopause symptoms? Wen: The most important thing is that women who are experiencing significant symptoms during menopause don't need to suffer in silence. Effective treatments exist. Women should speak with their physicians about lifestyle measures that can help as well as hormonal and nonhormonal prescription therapies. They should also speak with their providers about preventive care to improve heart health and prevent bone loss. Those who want additional resources should look to the Menopause Society, which also has a searchable database of clinicians who are certified menopause practitioners and trained to guide women through this transition.
Yahoo
20 hours ago
- Health
- Yahoo
If Your Body Feels Like It's Falling Apart After 45, It's Not In Your Head—It's A Medical Syndrome
"Hearst Magazines and Yahoo may earn commission or revenue on some items through these links." Of the more than 47 million women in the world who begin the menopause transition each year, more than 70 percent of them will experience musculoskeletal symptoms—and 25 percent will be disabled by them. Those startling stats are based on research by Vonda Wright, MD, an orthopaedic sports surgeon and author of Unbreakable. And yet, many women that Dr. Wright sees in her practice are only aware of more-talked-about symptoms like night sweats, hot flashes, and brain fog. The musculoskeletal symptoms—which includes arthritis, tendonitis, and osteopenia, and are linked to the drop in estrogen that happens during menopause—seem to come as a surprise. '[Women] come into my office and, without prompting, they'll say, 'I don't know what's happening, but I feel like I'm falling apart because it's not just one body part, it's multiple body parts,'' Dr. Wright says. Many of these female patients also mention being dismissed by their PCPs and having their issues chalked up to aging. "We are getting older, but that is not the end of the explanation," Dr. Wright says. She hopes that her paper—and giving these symptoms a name—helps to solve this problem: 'If the woman goes into a doctor's office and says, 'my knee hurts, my back hurts. I'm gaining weight'—that is a lot to talk about in 15 minutes. But with the power of nomenclature, a midlife woman who educates herself can say, 'I'm 46, I know my estrogen is going down. I think I have the musculoskeletal syndrome of menopause.' And that is something that you can wrap a conversation around versus trying to solve each problem individually.' This approach of using a name to label and identify a health issue has had success in the past. In 2012, a team of experts put forth the term genitourinary syndrome of menopause (GSM) to describe symptoms including genital dryness, pain during sex, and urinary urgency or recurrent urinary tract infections. Like with musculoskeletal symptoms, 'if you go in naming five or six things [related to the genital or urinary organs], it's overwhelming, but if you give a name to it, then we can research it, and then we can talk about it with a common language,' Dr. Wright says. Other experts in the field agree that publicizing a term like this and getting the information out to more women and providers is important: 'Coining this term 'musculoskeletal syndrome' gave patients validity that this is a real thing that happens in menopause,' says Paru David, MD, an internist in Women's Health Internal Medicine at Mayo Clinic Arizona. Dr. David sees many patients exhibiting the symptoms of this syndrome. '[They] will tell me 'I became postmenopausal and, overnight, I felt like I became an old lady... everything hurts.'' The good news is that understanding why this happens—and how to fight back—can help you treat or prevent these symptoms altogether. What Musculoskeletal Syndrome Actually Is The symptoms related to this syndrome all have to do with the loss of estrogen that leads to inflammation in the body. 'Estrogen is a potent anti-inflammatory, so without estrogen, we're highly inflamed,' Dr. Wright says. Estrogen sits on the receptors on every tissue in the body, including the musculoskeletal system, which includes tendon, ligament, bone, the discs in your back, cartilage, fat, muscle, and stem cells. Less of the hormone can lead to excruciating pain and loss of motion without an injury or event. Dr. Wright has patients come in knowing something is wrong but insisting nothing happened, exactly, to trigger it. 'As I explore their age and that they're perimenopausal, I know that means their estrogen has declined,' she says. How the Loss of Estogen Impacts the Body Tendons and ligaments: 'The ligaments and tendons become more brittle and are more susceptible to injuries such as tennis elbow, Achilles tendonitis, [and] plantar fasciitis,' Dr. Wright says. This weakening of the tendons and ligaments can also lead to tendon tears while lifting weights or playing sports—even if you lifted the same amount of weight you'd done in the past or didn't make any new moves, Dr. David says. Muscle: 'Although it's critical at this time of life to make muscle, we make it less effectively,' Dr. Wright says. In a 2024 systematic review in Muscles, researchers noted that the decline in estrogen during menopause leads to reduced muscle strength in addition to mass, although hormone replacement therapy (HRT) can mitigate some of this in addition to resistance training, and certain dietary interventions. (More on those soon.) Bone: Bone is dependent on estrogen for a process known as remodeling. 'Bone is in a consistent state of building and breaking down; every 10 years, we get a whole new skeleton,' Dr. Wright says. 'When the cells that break down bone [are] not controlled, then we have more breakdown than we do building, and that's when we become osteopenic, which is moderate loss of bone density, or osteoporotic, which means weak bone, [which] puts us in much more danger of fracture.' Dr. Wright says her personal 'hill to die on' is the fact that bone health is a lifelong concern. 'Yet none of us pay attention to our bones unless we're looking in the mirror at our gorgeous cheekbones or our clavicles,' she says. 'But the reality is that without estrogen, we're going to lose 15 to 20 percent of our bone density in the five to seven years surrounding perimenopause and menopause. And if we have not laid down enough bone by the time we're 30, which is very common, then we get to perimenopause and we rapidly start losing bone to the tune of one in two women will develop an osteoporotic fracture in their lifetime.' Joints: 'Before age 50, men have a much higher incidence of arthritis usually due to trauma,' Dr. Wright says. But after 50, women are the ones typically experiencing rapid progression of arthritis in the knee and hip, she adds. This is because cartilage—which helps with shock absorption—has estrogen receptors and without estrogen sitting in those receptors, the cartilage starts to break down. That leads to women over 50 dealing with joint pain in their hands, knees, and hips. Similarly, the gel-like cushions between the disks in your spine can break down and cause back pain, which impacts 50 percent of women, Dr. Wright says. Frozen shoulder—when the joint becomes stiff and starts to hurt for no apparent reason—is another condition she often sees in menopausal women. 'The other thing from an inflammatory standpoint that women experience, which I think is often mislabeled as fibromyalgia, is arthralgia, which is total-body pain due to inflammation,' Dr. Wright says. 'It's not one joint. It is your whole body [that] feels inflamed and painful.' How to Know If You Have Musculoskeletal Syndrome There's no quick and easy test for this syndrome. 'You can't really do an x-ray or imaging that confirms and says, 'this is definitely due to the loss of estrogen,'' says Dr. David. Instead you need to work with your provider to put together a full picture. If a woman is postmenopausal and not on hormones and says she cannot exercise the way she has in the past, or that she's dealing with more injuries or pain, and/or other symptoms like hot flashes and night sweats, those would be clear indicators, Dr. David says. Both doctors say that women tend to underreport symptoms—don't be one of them. 'Sometimes patients will say, 'oh, it's just in my mind,' and they're doubting themselves, but then when they come in, I tell them, no, this is a real thing that's happening due to that loss of estrogen,' Dr. David says. 'Don't feel like you can't come to your provider or to a menopause specialist to discuss this, because women need to have these things addressed.' How to Reverse (Or Prevent!) Musculoskeletal Syndrome 'What I want women to do to treat the musculoskeletal syndrome of menopause is multifactorial,' Dr. Wright says. Here, all the ways to empower yourself to prevent—and fight—back. 1. Stay educated. 'Number one, you have to be educated,' Dr. Wright notes. For this reason, she and her team decided to pay whatever money was necessary so that the paper on the syndrome would not be placed behind a paywall. 'I encourage people to print the paper, read the paper, print another one, take it to your doctor, [and] give it to five girlfriends so that everybody knows,' she says. 'The more literate you are in midlife, the more powerful you can be to feel better.' 2. Talk to your provider about hormone therapy—asap. "I encourage all of my patients to go on hormone optimization with estradiol [and], if they have a uterus, with micronized progesterone,' Dr. Wright says, adding that sometimes she gives them low-dose testosterone as well. 'Women just want to feel like themselves and do what they've always done, and these three things, I have found in my own life and [in] the women that I serve, can go a long way [in combatting] the root cause of some of the reasons we don't in midlife,' Dr. Wright says. Dr. David's patients, too, tell her they feel much better—they're joints and muscles don't hurt as much, for example—once they're on hormone therapy. That said, hormone optimization is a decision every woman needs to make for herself and with her provider, the doctors agree. But, Dr. Wright says to make that decision sooner rather than later. 'I think we should be making it in the critical decade, which in my book is 35 to 45 when most of us still have our estrogen flowing,' she says. That way, when you start feeling perimenopause, and possibly overwhelmed, you already know what you're going to do and where you're going to get it. 3. Start lifting heavy if you're not already. 'I have a lot of patients that think that they have to go into a gym and do heavy lifting, and I tell them small weights can really help preserve your bone density and probably help with keeping your muscle mass,' Dr. David says. 'Make sure that you're not doing more than what your body can do,' she says. 'Especially if you've had a period of time where you haven't done physical activity, you can't necessarily jump in and begin where you left off. You might have to build back up to that level.' 4. Follow the 80-20 rule of exercise. 'We can stop burning ourselves out with high-intensity interval training every day and do the 80-20 method,' Dr. Wright says. That means that 80 percent of the time, you work at a lower heart rate with activities like brisk walking, cycling, or using the indoor rower. Then, twice a week, you push your heart rate as high as your doctor says is safe for you—but for short (perhaps 30 seconds) periods of time with longer (say, one to two minutes) periods of recovery. Master these six exercises in your 60s for longevity Working at those ends of the spectrum, in addition to heavy lifting, is the key to changing body composition and maintaining muscle. Dr. David adds that stretching regularly is also important to prevent joint injuries. 5. Consider working with a physical therapist. If you're experiencing some of these symptoms already, working with a physical therapist can be very beneficial, Dr. Wright says, because they can assess you, understand where you are, understand your limitations, and then prescribe exercises that you can build upon. Dr. David, too, says finding a physical therapist that's educated around menopause can be a wise move during this time of life: 'I do get worried that sometimes patients will say, 'I just need to work out with a personal trainer, and that will really help me,' and they may not understand where you're coming from,' Dr. David says. 'A physical therapist, especially one who understands musculoskeletal syndrome, can understand where these patients are coming from, what they are able to do without harming themselves further, and then build upon that.' 6. Eat an anti-inflammatory diet. 'I prescribe anti-inflammatory nutrition,' says Dr. Wright. The key components of this, she says, are to avoid added sugar and to focus on protein and specifically fiber-rich carbs (e.g., whole fruit instead of fruit juice). 'For bone health, make sure that you're getting enough calcium [and] that you're getting enough vitamin D to help absorb that calcium,' Dr. David adds. The aforementioned 2024 review also notes that omega-3 fatty acids can be effective in supporting muscle health across all life stages. If this list has you feeling overwhelmed, fear not, Dr. Wright says. Just start with one thing. Maybe start by taking two walks this week, then cut back on sugar next week, then layer on protein, and finally, weight lifting. 'You layer on one at a time [and] it simply becomes your lifestyle,' she says. 'It's not a diet. It is not a six-week exercise program. It's just how you live—and all of these things will help your musculoskeletal pain stay in check.' And while the sooner you start some of these lifestyle habits, the better, it's also never too late: 'There is never an age when your body will not respond to the positive stress, the strategic stress, in the form of all the things on this list," Dr. Wright says. You Might Also Like Jennifer Garner Swears By This Retinol Eye Cream These New Kicks Will Help You Smash Your Cross-Training Goals
Daily Mail
20 hours ago
- Health
- Daily Mail
Save 60% on the 28-day fasting challenge helping thousands of midlife women shed stubborn pounds fast
Daily Mail journalists select and curate the products that feature on our site. If you make a purchase via links on this page we will earn commission - learn more At any age, weight loss can be a challenge. Throw in the hormonal and physiological changes that occur during perimenopause and menopause, though, and it can seem almost impossible. With the right program, you can actually find your way to success. That's what thousands who joined the Reverse Health 28-day fasting challenge discovered. At 60 percent off (just 56 cents a day!), it's an amazing value. Reverse Health 28-Day Fasting Challenge Four weeks to a healthier, fitter, and more confident you! This program is designed to meet the needs of midlife women. Hormonal fluctuations can make weight loss a challenge, but through a carefully scheduled fasting plan, coupled with delicious recipes and invaluable support and education, you can feel better than ever in just 28 days. The benefits of fasting are unmatched! Your body shifts from burning glucose to burning stored fat, helping you lose weight. It can also stabilize blood sugar and even improve your mood and sleep quality. Sign up today for 60 percent off (that's just $15.65, or 56 cents a day). Save 60% Shop It's time to feel your best, and there is no time like now to get started on the Reverse Health fasting challenge Designed specifically to help women in midlife, the program takes a personalized approach to helping you shed unwanted pounds and improve your overall health. It's the combination of the two that is so vital to your wellbeing, especially during this transitional period of life when the body undergoes so many dramatic changes. Intermittent fasting can play a significant role in helping your body handle them. Fasting doesn't have to be a challenge thanks to this manageable program that's tailored to your specific needs Studies have found that by fasting, you can manage your weight more efficiently. It's not even just a theory. Centuries ago, people wouldn't eat for hours upon hours while they hunted and gathered for their next meal. Between the larger portions and the tempting snacks at every turn, though, food culture has obviously evolved. But fasting still exists, and it can be a great way to control how your body responds to your food intake. Under normal circumstances, your body uses glucose as its primary source of energy. When there's no more glucose left to burn though, your body shifts to mobilizing your stored fat. That's the key to weight loss — but there are other benefits to fasting, too, like reducing blood sugar, supporting heart health, and even boosting memory and sleep. The beauty of the Reverse Health is that it's tailored specifically to your body's changing needs during perimenopause and menopause. Packed with features, the Reverse Health app has all that you need to enjoy a successful challenge, including meal tips, reminders, trackers, and more Because estrogen drops during this time, it can affect how you respond to fasting. That's taken into account when creating your schedule, which is specifically designed to help you meet your personal goals. And you get a built-in support system, with helpful features like timers to help you stick to good habits and useful videos that teach you all about fasting and its impact on hormonal inflammation, along with access to the Reverse Health community. That's on top of other extras, like healthy recipes to enjoy during your eating windows, tips to support your overall wellness, and the kind of motivation you need to stick to the program and see results. Within just 28 days, you could both see and feel an incredible difference! Your confidence and health are worth it. Get started and enjoy 60 percent off when you join the Reverse Health 28-day fasting challenge today.
Vogue
a day ago
- Health
- Vogue
Are GLP-1s a Cure for Menopausal Weight Gain?
It was night sweats, wild mood swings, and, ironically, significant hair loss that first sent Kate, 54, a New York–based hairstylist, to her doctor in her late 40s looking for relief; she was prescribed an estrogen patch. 'It made me feel like myself again,' says Kate, whose name has been changed to protect her privacy. 'I was sleeping, I wasn't losing my temper, and my mood really evened out, but I was still overweight.' Despite a healthy diet and regular exercise, there were a dozen or so pounds that just wouldn't budge. So she started taking Wegovy. For Shelby Meade, 55, an LA-based publicist, regular doses of estrogen helped temper her sometimes 30-day periods but did nothing for her perpetually bloated state. 'I was heavier than I'd ever been and there was a constant pressure on my lower abdomen,' says Meade, who, like Kate, exercised regularly and had a healthy diet. A family doctor suggested Wegovy. 'I just wanted to feel better in my body, and that flipped a switch,' says Meade. 'It was a game changer.' While vasomotor symptoms like hot flashes and night sweats are recurring topics in conversations about menopause, weight gain is just as pervasive: Around 60 percent of women gain weight during this transition, putting on an average of 1.5 pounds per year throughout their 40s and 50s. 'I have 16 patients a day, and usually 16 out of 16 are reporting weight gain to me,' says Tara Iyer, MD, medical director of the Menopause and Midlife Clinic at Brigham and Women's Hospital in Massachusetts. 'Many had never struggled with weight but now have gained 15 or 20 pounds.' And that will happen to women without any changes in diet or exercise. 'It's a very unfair paradigm,' says Caroline Messer, MD, a New York City–based endocrinologist. Much of that midlife weight gain tends to be concentrated in the midsection, earning the unfortunate moniker 'meno belly.' This happens due to a combination of factors. Estrogen—which, much like the collagen in our faces, we lose at a rapid rate come midlife—has many important functions related to weight and body composition: It helps women maintain muscle mass, and it contributes to the regulation of appetite and metabolism. 'Essentially women are losing muscle, gaining fat tissue, and where we store our weight changes,' says Iyer. A drop in estrogen can lead to insulin resistance, meaning that it becomes more difficult for the body to regulate sugar, and for many women that glucose gets turned into fat. Addressing excess weight around the midsection isn't just about vanity, it can pose a health risk: Associated metabolic complications can include fatty liver disease and hypertension, the latter of which, says Reena Bose, MD, an internal medicine and obesity medicine specialist at Cleveland Clinic, increases almost 30 percent with even a 10-pound weight gain. The American Heart Association also highlights the menopause transition as a time of heightened risk for women's cardiovascular health. The hormonal changes of menopause can make the weight gain more resistant to traditional diet and lifestyle adjustments, says Peminda Cabandugama, MD. But studies have found that GLP-1s can be a very effective reinforcement of diet and exercise GLP-1s—that is, the class of drugs that includes semaglutide, packaged in brand-name form as Ozempic and Wegovy, and tirzepatide, like Mounjaro—'act on estrogen receptors in the body, and they improve insulin resistance,' explains Judi Chervenak, MD, a reproductive endocrinologist at Montefiore with a clinical focus on menopause. They also slow GI motility, so you feel full. That last part 'can be essential because women are often simply hungrier during the menopause transition,' says Bose, adding that estrogen is also responsible for keeping the body's hunger-balancing hormones, ghrelin and leptin (which tell us when we're full), in check. The hormonal changes of menopause can make the weight gain more resistant to traditional diet and lifestyle adjustments, says Peminda Cabandugama, MD, an endocrinologist and obesity specialist at Cleveland Clinic. But studies, like a recent one in the journal Obesity, found that GLP-1s can be a very effective reinforcement of diet and exercise. Research is also growing about the potential benefits of combining GLP-1s with the menopausal hormone treatment (MHT) that has long been recommended, and there are new companies to support the regimen. Alloy Women's Health, an expansive digital menopause platform that connects board-certified physicians to women across the country (a boon in health care deserts), launched with estrogen creams and patches, but earlier this year they started offering GLP-1s as well. 'Women really wanted it,' says Monica Molenaar, cofounder and co-CEO of Alloy. Now 35 percent of Alloy's customers are on both a GLP-1 and hormonal treatment. Another platform, Noom, started as a digital weight-management platform and first offered semaglutide in 2023; it expanded into hormonal treatment this year. 'These drugs are addressing different problems, but they work together in the sense that they both bring down inflammation,' says Karen Mann, MD, medical director at Noom. Messer is a huge proponent of coupling the treatments (she favors low doses of tirzepatide, which often has fewer side effects than semaglutide). A recent study by the Mayo Clinic found that overweight or obese postmenopausal women using hormonal treatments and semaglutide lost about 30 percent more weight than those using semaglutide alone. Chrisandra Shufelt, MD, an internal medicine doctor specializing in women's health at the Mayo Clinic and one of the authors of the study, emphasizes that the findings don't necessarily mean that hormone therapy supercharges the effects of semaglutide, but rather that hormones help the body respond more optimally to the drugs. (A larger study is expected to be published soon.) In lay terms, it makes sense: Hot flashes, night sweats, mood shifts, joint pain, and sleep disruptions—all of that can dramatically impact your quality of life and, in turn, lead to weight gain. There are doctors, of course, who remain conservative about prescribing GLP-1s to women who don't fit a specific set of criteria. 'We have to be careful about using them willy-nilly, like with someone, for example, who has a normal BMI and may just not be happy because of a slight increase in body weight,' says Chervenak. 'These drugs are not without risk.' There are the common side effects of GLP-1s, like gastrointestinal issues, abdominal pain, and nausea, and women should assess their risk factors with their doctor before starting any treatment.
