- GLP-1 medications like Ozempic and Zepbound are transforming chronic disease and weight management, with perimenopausal women among the most common users.
Despite their high use in this group, women in the perimenopausal stage are largely absent from research on the drugs' risks and benefits.
Experts warn this knowledge gap may lead to poor clinical decisions, missed opportunities for care, and increased physical and mental health risks.
A revolutionary drug with a dangerous blind spot
Once used primarily to treat Type 2 diabetes, glucagon-like-peptide-1 receptor agonists (GLP-1s) like Ozempic and Zepbound have rocketed into mainstream medicine in recent years, earning FDA approvals for obesity, cardiovascular protection, kidney disease, and even sleep apnea. These drugs deliver powerful results: average weight loss ranges from 10% to 21%, with nearly 90% of users shedding at least 5% of their body weight.
But as these medications become staples in clinics and social feeds, one key demographic is being left behind in research—despite being among the most common users. Perimenopausal women, typically aged 45–55, are turning to GLP-1s in record numbers, but the scientific community has largely overlooked how these drugs interact with the unique physiological and psychological changes occurring during this life stage, a report from nonprofit research organization RAND cautions.
Perimenopause: A storm of change
Perimenopause affects more than 1.5 billion women globally and brings a complex mix of hormonal, metabolic, cardiovascular, and mental health changes. Weight gain, sleep issues, mood instability, and muscle and bone loss are all hallmarks of this transition. GLP-1s, with their impact on appetite and weight, might seem like a silver bullet.
Yet experts quoted by RAND warn that the absence of targeted research could leave women vulnerable. For example, GLP-1s reduce both fat and muscle mass—potentially problematic for women already experiencing natural declines in muscle and bone density. Discontinuation of GLP-1s often leads to rapid weight regain, primarily as fat, further compounding the risks.
“There’s a very real possibility we’re unintentionally compromising long-term health outcomes by ignoring how these drugs function in perimenopausal women,” the paper cautions.
Usage rates tell the story
Recent data from the RAND American Life Panel underscores the urgency: Women aged 50–64 reported the highest overall GLP-1 use, with 20% saying they currently or previously used the drugs. Among women 30–49, usage was more than double that of men the same age. And yet, clinical studies on GLP-1s largely exclude this population.
This disconnect is emblematic of a broader pattern in medicine, where women—especially during life transitions like perimenopause—have been underrepresented in trials and overexposed to off-label or under-evaluated therapies.
Sleep, mood, and the unknowns
GLP-1s are now FDA-approved for treating obstructive sleep apnea, a condition that also spikes in prevalence during perimenopause. But their effectiveness in addressing this surge in risk remains untested in women undergoing hormonal shifts. Similarly, while GLP-1-induced weight loss may improve self-esteem and body image, the psychosocial impacts—especially around body norms, stigma, and weight cycling—are largely unknown.
Given the already heightened emotional vulnerability during perimenopause, this could be dangerous. Regaining weight after GLP-1 use has been linked to shame, hopelessness, and even disordered eating. Coupled with the hormonal and psychological upheaval of perimenopause, the fallout could be severe for some women.
A Call for Inclusive Science
While GLP-1s promise major breakthroughs in the treatment of obesity and chronic illness, experts say these medications cannot be a one-size-fits-all solution. The intersection of GLP-1 use and perimenopause presents a prime opportunity for more inclusive, life-stage-specific research that could not only prevent harm but also optimize care for millions of women.
Without this data, doctors and patients are left to navigate treatment during one of the most biologically complex periods of a woman's life—with far too many unknowns.