Ozempic and Menopause: What Changes for Muscle, Weight Loss, and Strength?

By Amanda Boike Fitness For many women, the years surrounding menopause bring changes that are difficult to explain by looking at the scale alone. Your weight may remain relatively stable while your waistline changes. Exercises that once felt manageable may require more recovery. Or you may notice that building and maintaining muscle takes more deliberate effort. If you're also using Ozempic, Wegovy, Zepbound, or another GLP-1-based medication, it can be difficult to separate the effects of menopause from those of weight loss.

Menopause can influence body composition, particularly fat distribution, lean mass, and bone density. GLP-1 medications introduce another variable by reducing appetite and often producing substantial weight loss. That weight loss can include both fat and lean tissue.

Understanding how these processes overlap can help you make informed decisions about nutrition and strength training without attributing every physical change to hormones or medication.

What Happens to Muscle and Body Fat During Menopause?

Menopause is defined as twelve consecutive months without a menstrual period, when no other medical explanation is responsible. The preceding transition, called perimenopause, involves fluctuations in reproductive hormones, particularly estrogen. These hormonal changes can influence body composition, but the relationship is more complicated than a simple decline in metabolism.

One of the most informative investigations comes from the longitudinal Study of Women's Health Across the Nation (SWAN). In a 2019 analysis of body composition during menopause, researchers tracked changes relative to women's final menstrual periods. They found that the rate of fat gain approximately doubled around the menopause transition, while lean mass began to decline. These changes were most pronounced during the roughly four-year period spanning two years before and two years after the final menstrual period.

Interestingly, the rate of overall weight gain did not accelerate in the same way.

This means a woman could experience meaningful changes in fat and lean tissue without seeing an equally dramatic difference on the scale.

Age, physical activity, diet, sleep, and other health factors also contribute to changes in body composition. Menopause is one influence rather than a complete explanation. For a broader look at strength training during this life stage, see our guide to perimenopause and weightlifting.

Do GLP-1 Medications like Ozempic Work Differently During Menopause?

GLP-1 receptor agonists, including semaglutide, act on pathways involved in appetite regulation, blood glucose, and digestion. Tirzepatide, the active ingredient in Zepbound and Mounjaro, targets both GLP-1 and GIP receptors.

These medications can produce substantial weight loss in eligible patients, but individual responses vary.

Menopause may influence treatment response through changes in body composition and hormone signaling. However, researchers are still determining how clinically important those differences are.

What studies in postmenopausal women have found

A 2025 study published in Metabolic Syndrome and Related Disorders examined weight and body-composition changes during four months of semaglutide treatment. Women who were postmenopausal began the study with greater average body weight and fat mass than the premenopausal comparison group.

After treatment, the researchers did not find statistically significant differences between groups in weight loss, fat-mass loss, or lean-mass changes.

This suggests that postmenopausal women can respond to semaglutide. However, the short observation period and nonrandomized comparison limit what the study establishes about menopause itself.

For perimenopausal women using HRT, can it influence GLP-1 effectiveness?

In a 2024 retrospective study of 106 postmenopausal women, those receiving hormone therapy experienced greater average weight loss while taking semaglutide than those who were not receiving hormone therapy. Only 16 women were using hormone therapy, however, and the observational design could not establish whether the hormones caused the difference.

In October 2026, The Menopause Society reported findings from a larger retrospective study involving nearly 2,400 women using semaglutide and nearly 1,500 using tirzepatide. Hormone therapy use was associated with greater sustained weight loss among semaglutide users. The findings were less conclusive for tirzepatide. These results were presented at a scientific meeting and reported in a professional-society press release. They should not be treated as proof from a randomized trial. Hormone therapy is not prescribed solely to improve weight loss. Decisions about treatment for menopause symptoms require an individualized medical discussion.

What About Muscle Loss While Taking GLP-1s?

Substantial weight loss typically involves changes in more than one tissue.

Fat mass decreases, but measurements of lean mass often decline as well.

Lean mass includes muscle, water, organs, and other nonfat tissues. Therefore, a reduction in lean mass measured by DXA does not equal the same amount of skeletal muscle disappearing.

A 2025 body-composition analysis from the SURMOUNT-1 trial examined 160 participants who received DXA scans over 72 weeks. Among participants receiving tirzepatide, average fat mass decreased by 33.9%, while lean mass decreased by 10.9% relative to their respective starting values. Approximately three-quarters of the weight lost was fat mass and one-quarter was lean mass.

The study was funded by Eli Lilly, the manufacturer of tirzepatide, and included company-affiliated researchers. Its body-composition findings are useful, but they do not establish how much of the lean-mass change represented functional skeletal muscle.

Nor do these averages predict exactly what will happen to a particular woman.

For women approaching menopause, preserving strength deserves attention because changes in lean tissue may occur alongside other age- and menopause-related changes. Our guide to GLP-1 body changes and muscle loss explores the distinction between changes in fat, lean tissue, muscle function, and appearance.

Why Strength Training Matters During Menopause

Resistance training gives muscle a reason to adapt. When you lift a challenging weight, the working muscles produce force repeatedly. Over time, appropriate resistance and recovery can improve strength and support muscle growth or maintenance. This is especially important during weight reduction because muscle retention depends on several factors, including training stimulus, nutrition, energy availability, and individual response.

Research in women provides encouraging evidence. A 2026 systematic review and meta-analysis evaluated 126 resistance-training studies involving 4,019 women, approximately two-thirds of whom were postmenopausal. Resistance training improved muscular strength in both premenopausal and postmenopausal participants. The researchers did not find a significant difference in strength improvements between these groups. These studies were not specifically designed around GLP-1 treatment. However, they challenge the idea that menopause necessarily prevents meaningful training adaptations.

Does menopause require a completely different workout?

Current evidence does not establish that every woman in perimenopause needs an entirely different set of exercises or a special hormonal training schedule.

The same fundamental training variables remain relevant:

• Resistance: How much force the muscle must produce.

• Effort: How challenging the repetitions are relative to your current ability.

• Volume: How many demanding sets you perform over the week.

• Recovery: Whether you're recovering adequately between sessions.

• Progression: Whether the exercise continues to provide an appropriate challenge over time.

  
  

The 2026 American College of Sports Medicine position stand emphasizes that resistance training can improve strength and muscle size across a range of methods and equipment choices.

For someone new to lifting, two nonconsecutive sessions each week may be a manageable beginning. A woman with several years of training experience may benefit from continuing a more substantial established workload. The goal is to choose a dose that serves her strength and muscle goals while accounting for her current ability and recovery.

How to Adjust Training When Appetite or Energy Changes

One practical challenge during GLP-1 use is that appetite suppression and gastrointestinal symptoms can make it difficult to fuel exercise. The 2025 joint advisory on nutrition and GLP-1 therapy emphasizes adequate nutrition, resistance training, and clinical management of medication side effects.

If appetite is reduced, protein intake may require more planning. The advisory discusses proposed protein targets around 1.2–1.6 grams per kilogram of body weight daily during active weight reduction, while noting that calculations based on actual weight may overestimate needs for some people with obesity. A registered dietitian can help determine an appropriate target based on body composition, medical history, kidney health, and overall energy intake.

Training may also need to change temporarily. Consider someone who normally performs three sets of squats and two sets of rows. During a week of mild fatigue, she might reduce the session to two sets of each while maintaining comfortable, controlled resistance. This reduces the overall workload without abandoning strength training entirely. Someone can also modify their workouts by choosing exercises that emphasize localized muscle fatigue over systemic fatigue. This could look like replacing squats with supine hip thrusts, an overhead press with side-lying shoulder abduction, and push ups with a floor chest press. This reduces overall energy expenditure, while stimulating the muscles effectively for muscle growth.

If low energy is accompanied by dizziness, persistent nausea, vomiting, or dehydration, addressing those symptoms takes priority over completing a workout.

For more detailed adjustments, see how to strength train when GLP-1 fatigue makes exercise difficult.

What Else Deserves Attention During Menopause?

Strength training is important, but muscle is only part of the picture.

Bone health

Declining estrogen increases concern about bone loss and osteoporosis, particularly after menopause. Progressive resistance training can provide useful skeletal loading, while weight-bearing and impact exercise may offer additional bone-specific benefits when appropriate. Women with osteoporosis or previous fractures may need individualized exercise modifications from a BoneFit-certified personal trainer, or qualified medical professional.

Sleep and recovery

Night sweats, disrupted sleep, and other symptoms can affect how a workout feels and how consistently someone can train. When sleep has been particularly poor, changing the number of sets, choosing supported exercises, or allowing longer recovery between exercises may be reasonable.

Persistent symptoms deserve appropriate evaluation rather than treating exercise modifications as the only solution.

Cardiovascular fitness

Resistance training and aerobic exercise serve overlapping but distinct purposes.

Walking, cycling, swimming, dancing, and other aerobic activities can support cardiovascular health alongside strength training. A program that combines both is generally more comprehensive than relying on either one alone.

How Can You Tell Whether Your Training Is Working?

During weight loss, the scale is a poor measure of muscular progress. Instead, observe the performance of a few exercises over several weeks.

Are you using a heavier dumbbell for the same controlled repetitions? Can you complete more repetitions before reaching a similar level of muscular fatigue? Do ordinary tasks such as carrying groceries or rising from a low chair feel easier?

These changes provide evidence of improvements in performance, although they cannot independently establish changes in muscle mass.

If body composition or bone density is a clinical concern, your healthcare team can help determine whether further measurements would be useful.

Putting Strength Training Into a Consistent Routine

For women navigating menopause and GLP-1 treatment, one of the biggest practical challenges is making strength training consistent without turning it into another complicated project.

ABF Online provides guided, 30-minute, low-impact strength workouts with two-, three-, and four-day weekly plans.

The program includes exercise demonstrations and positioning cues to help you understand the movements and select resistance appropriate to your current strength.

It can provide structure for regular home training while leaving medication management, menopause treatment, and individual nutritional needs to the appropriate healthcare professionals.

References

1. Greendale GA, Sternfeld B, Huang M, et al. (2019). Changes in body composition and weight during the menopause transition. JCI Insight.

2. Effectiveness of Low Doses of Semaglutide on Weight Loss and Body Composition Among Women in Their Menopause. (2025). Metabolic Syndrome and Related Disorders.

3. Hurtado MD, Tama E, Fansa S, et al. (2024). Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause, 31(4), 266–274.

4. The Menopause Society. (October 20, 2026). Hormone Therapy May Increase Weight Loss Effectiveness of GLP-1s. Conference research announcement; not a peer-reviewed randomized trial.

5. Look M, et al. (2025). Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study. Diabetes, Obesity and Metabolism, 27, 2720–2729.

6. Isenmann E, Geisler S, Havers T, et al. (2026). It's never too late: The impact of resistance training on strength and body composition in females across the lifespan. Journal of Science and Medicine in Sport, 29, 1174–1185.

7. Currier BS, D'Souza AC, Fiatarone Singh MA, et al. (2026). Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults. Medicine & Science in Sports & Exercise, 58, 851–872.

8. Mozaffarian D, Agarwal M, Aggarwal M, et al. (2025). Nutritional priorities to support GLP-1 therapy for obesity. Obesity, 33, 1475–1503.