Can HRT Help You Lose More Weight on Semaglutide? New Menopause Research

By Katie Sorensen, NP-C | Weight Loss NP

If you’re taking semaglutide and going through menopause, some new research may be especially interesting to you.

Researchers found that women using menopausal hormone therapy (HRT) experienced greater and more sustained weight loss while taking semaglutide than women who weren’t using hormone therapy.

As a nurse practitioner who works with women managing both menopause symptoms and weight concerns, I’m excited to see more research looking at these treatments together!

The findings are encouraging. They also raise some interesting questions about estrogen, metabolism, and why women can respond differently to weight loss medications during midlife.

What did the new HRT and GLP-1 study find?

On October 8, 2026, The Menopause Society released findings from research scheduled for presentation at its October 20–24 annual meeting.

The researchers studied nearly 3,900 women over age 45 with a BMI above 27 who were taking medications for obesity or overweight.

The group included approximately:

• 2,400 women using semaglutide
• 1,500 women using tirzepatide

Researchers compared weight loss among women using menopausal hormone therapy with women who weren’t.

The most interesting finding was among women taking semaglutide.

Women taking semaglutide alongside hormone therapy experienced significantly greater and more sustained weight loss.

Women using tirzepatide and HRT initially appeared to lose more weight as well. However, the difference was not statistically significant at the final assessment.

You can read the original Menopause Society research announcement.

Keep in mind that this was an observational study. Researchers identified an association between HRT and weight loss, but they haven’t established that HRT caused the additional weight loss.

Women who use HRT may also differ in other ways from women who don’t. We need more research before recommending hormone therapy specifically to improve GLP-1 results.

Why could estrogen affect GLP-1 weight loss?

Estrogen does much more than regulate menstrual cycles.

It also interacts with systems involved in appetite, fat distribution, energy balance, and metabolic health.

During menopause, declining estrogen levels contribute to changes in body composition. Many women notice more abdominal fat, even when their overall weight hasn’t changed dramatically.

Aging also contributes to muscle loss and changes in how our bodies use energy.

Researchers are now looking more closely at how estrogen and GLP-1 signaling interact and whether those hormonal changes affect medication response.

The Menopause Society’s research announcement discusses a possible biological connection between estrogen and GLP-1 activity.

We still don’t know how much of a difference estrogen makes, whether some women benefit more than others, or whether the findings will hold up in randomized clinical trials.

Why was the result different for semaglutide and tirzepatide?

This is one of the questions I’m most interested in seeing researchers explore further.

Semaglutide works through GLP-1 receptors.

Tirzepatide works through both GLP-1 and GIP receptors.

In this study, the association between HRT and additional weight loss was stronger among women using semaglutide. Researchers did not find a statistically significant difference at the final assessment among tirzepatide users.

It’s possible estrogen interacts differently with these medications because they work through different pathways.

But we don’t know that yet.

I would not recommend switching from tirzepatide to semaglutide, or starting HRT just to improve weight loss, based on these findings.

If your medication is working well and you’re tolerating it, there is no reason to assume a different GLP-1 would work better just because you’re taking hormone therapy.

Does HRT help women lose weight?

HRT is not a weight loss medication.

However, treating menopause symptoms can make a meaningful difference in how a woman feels and functions day to day.

For women who are appropriate candidates, hormone therapy can help with hot flashes, night sweats, and sleep disrupted by menopause symptoms. Hormone therapy can also help prevent bone loss in appropriate patients.

Vaginal and urinary symptoms may benefit from hormone treatment as well, although the type of treatment depends on the symptoms.

The Menopause Society’s hormone therapy guidance provides more information about the benefits and risks.

I think women deserve to have their menopause symptoms taken seriously, whether they’re trying to lose weight or not.

If you’re struggling with sleep, hot flashes, fatigue, and stubborn weight gain, I want to understand all of those concerns. Treating the weight without addressing significant menopause symptoms may leave you feeling pretty lousy, even if the scale is moving in the right direction.

Can you take HRT and semaglutide or tirzepatide together?

Yes, many women can safely use menopausal hormone therapy and GLP-1 medications together when both are medically appropriate.

Each treatment needs its own evaluation.

A woman might benefit from hormone therapy because she’s experiencing bothersome hot flashes or night sweats.

She might also be a good candidate for semaglutide or tirzepatide because of obesity or another approved medical indication.

There is no reason we can’t evaluate both concerns during the same treatment plan.

Of course, medical history still comes into play. A history of certain cancers, unexplained vaginal bleeding, blood clots, stroke, or significant liver disease may affect whether systemic HRT is appropriate.

GLP-1 medications have their own contraindications and considerations.

The goal is to choose treatments that make sense for your particular health history and symptoms.

Learn more about women’s hormone replacement therapy at Weight Loss NP.

What if you’re on a GLP-1 and still struggling with weight during menopause?

There are several things I would look at before assuming your medication isn’t working.

1. Is your medication plan working well for you?

We look at your appetite, side effects, dose, weight loss progress, and how you’re feeling overall.

The highest dose isn’t automatically the best dose. Sometimes adjusting treatment makes sense, and sometimes we need to look beyond medication.

2. Are you getting enough nutrition?

Some women taking GLP-1 medications have such a low appetite that they struggle to eat enough.

Protein is particularly important for preserving muscle during weight loss.

I don’t recommend obsessively tracking every bite of food. But when progress stalls or nutritional intake seems inadequate, a brief review of what you’re eating can be helpful.

3. How are you sleeping?

Night sweats, hot flashes, and frequent waking can make maintaining healthy routines much more difficult.

If menopause symptoms are keeping you awake, that’s something I’d want to address.

4. Are you maintaining your muscle?

Muscle loss becomes an increasing concern as we age, and significant weight loss can include loss of lean tissue.

I encourage women to prioritize strength training and adequate protein intake.

We want you to feel stronger and healthier as you lose weight, not simply weigh less.

5. Are menopause symptoms going untreated?

If you’re experiencing hot flashes, sleep problems, vaginal dryness, or other symptoms, you may benefit from a menopause evaluation.

That doesn’t automatically mean you need hormone therapy. We can review your symptoms, discuss treatment options, and determine what’s appropriate.

At Weight Loss NP, our Metabolic Success System™ addresses medication optimization, metabolic health, sustainable habits, muscle preservation, and long-term maintenance.

Learn more about our GLP-1 weight loss program.

Should you start HRT to get better results from semaglutide?

Not based on this research alone.

I’m encouraged by these findings, but we still need studies that can determine whether adding HRT actually improves semaglutide-related weight loss.

For now, I would continue recommending HRT based on a woman’s menopause symptoms, medical history, risk factors, and treatment goals.

However, if you’re already taking a GLP-1 and struggling with menopause symptoms, this is a good reason to discuss both with your provider.

You don’t need to put up with miserable menopause symptoms while focusing all your attention on weight loss.

HRT and GLP-1 care in Denver, Arvada, Colorado, Utah, and Florida

At Weight Loss NP, we help women with menopause, weight changes, and metabolic health through individualized medical care.

Our practice has local roots in Denver and Arvada, with eligible medical services available through telehealth in Colorado, Utah, and Florida.

We offer both women’s hormone care and medically supervised GLP-1 treatment, so we can evaluate these concerns together.

Depending on your needs, treatment may include hormone therapy, GLP-1 medication, nutrition guidance, strength training, and long-term maintenance support.

I’ve also written about perimenopause, hormone therapy, and GLP-1 weight loss if you’d like to learn more about combining these approaches.

Frequently asked questions

What I hope comes from this research

Many women tell us that losing weight in midlife feels different from what they experienced in their 20s and 30s.

They’re often doing many of the same things that worked before, but their bodies are responding differently.

I love seeing researchers pay more attention to the relationship between menopause hormones, metabolism, and weight loss medications.

This study gives us another piece of information, although we’re not ready to use HRT solely to improve GLP-1 weight loss.

For women who are struggling with both menopause symptoms and weight changes, we can evaluate those concerns together and develop a treatment plan that addresses both.

If that’s where you are right now, meet with us at Weight Loss NP. We’d be happy to help you explore your options.