Menopausal Hormone Therapy May Enhance Weight Loss With Tirzepatide

With MHT again in the headlines on both benefits and risks for women, we’ll review the basics and talk about new potential benefits for weight loss when combining MHT with tirzepatide, a DPP4 inhibitor that is a dual GIP and GLP-1 receptor agonist.

A New Era of Combined Therapeutics

The good news for the postmenopausal obese/overweight woman is that there are treatments for her symptoms which can actually improve her health. For decades we have been treating the vasomotor symptoms (hot flashes) and the metabolic symptoms (weight gain) of the menopausal woman separately. What is exciting is that we have discovered that these two groups of symptoms are linked and can be treated simultaneously producing what we call a “therapeutic multiplier effect”.

Why It Matters

The Food and Drug Administration (FDA) last month approved labeling changes for over-the-counter and prescription menopausal hormone therapy (MHT) products. After reviewing existing scientific evidence regarding the risk of heart disease, breast cancer, and probable dementia, FDA removed the boxed warnings for estrogen and estrogen plus progestin products. The FDA said it strives to provide accurate, up-to-date information so that patients and health care providers can make informed medical decisions. Today, about 41 million U.S. women are in their 40s and 50s, the age group for which hormones are prescribed to treat symptoms of menopause. Yet, according to the FDA, in 2020 only about 2 million women in this age group received a hormone-therapy prescription.

The Menopause-Obesity Intersection

The intersection of menopause and obesity has emerged as an important public health issue. While some women may experience an increase in weight during the menopausal transition, weight gain is not universal. Importantly, even after weight stabilization, many women experience a shift in body composition during the postmenopausal years characterized by increased visceral fat mass.

Estrogen-Metabolism Connection

Weight gain has many causes; hormonal changes are one of them. As our estrogen falls, we tend to hold onto fat. While estrogen is typically known as a reproductive hormone, it’s also a critical metabolic hormone that dictates where fat will go, how the body will respond to insulin, and how it will burn calories. As the level of this hormone falls, metabolism falls with it – and typically, whatever weight you do lose will come back in the form of even more fat. The reason is simple: diet and exercise alone aren’t enough to overcome the natural drop in your body’s metabolic engine. Many women are concerned that their low estrogen levels will cause them to be “flabby and fat” during the menopausal transition. However, weight gain, particularly around the abdomen, is a major problem for many women at this time of life. The belly fat of menopause is particularly problematic because it is highly inflammatory and a major risk factor for metabolic syndrome.

Rise of Tirzepatide in Women’s Health

Tirzepatide, a potential new diabetes treatment, has already been shown to help people in the general population lose a lot of weight. Now, secondary analyses of clinical trial data reveal that postmenopausal women have an especially tough time shedding pounds—perhaps more so than younger women or men. But here’s a bigger finding: Postmenopausal women taking both tirzepatide and MHT (hormone replacement therapy) lost significantly more weight—often several percentage points—than those taking tirzepatide alone. The results could point the way for obesity treatment tailored to the needs of individual women.

Hormonal balance is key to weight loss. The combination of major hormone talking (MHT) and tirzepatide to “re-priming” postmenopausal women for weight loss, can once again offer hope for improving quality of life and long-term health for these vulnerable women.

Economic and Public Health Ramifications

Many healthcare providers will now have the opportunity to counsel women on a regular basis regarding cardiovascular disease, which is the leading cause of death for women and risk multiplies after menopause. By addressing the symptoms of menopause and obesity at the same time, healthcare providers can help women avoid life threatening heart attacks and strokes as well as prevent the development of type 2 diabetes. Millions of dollars can be saved in lifelong treatment of complications of obesity and hormonal deficiencies that could have been prevented with better education and management.

Who It Affects

Widening Circle of Impact

The development is of relevance to a number of patient groups / disease states as well as healthcare companies and associated industry bodies. These would include companies and groups involved in Osteoporosis, Post Reproductive Health, Urogynaecology, Sexual Health, Andropause, ageing men, FSH regulation.