Alternative Therapies, Diet, HRT, Managing Weight
At ENDO 2025 in San Francisco, an important study was presented exploring the effect of hormone replacement therapy (HRT) on weight loss in postmenopausal women taking tirzepatide (Mounjaro), a medication licensed for the management of type 2 diabetes and obesity.
What Was the Study About?
The real-world, retrospective cohort study looked at 120 postmenopausal women who were prescribed tirzepatide for overweight or obesity.
40 women were also taking HRT (either transdermal or oral oestrogen, with or without progestogen).
80 were on tirzepatide alone.
Participants were followed over a median of 18 months.
What Were the Results?
Women who were taking both HRT and tirzepatide had:
✔️ A greater median percentage weight loss (17% vs 14%)
✔️ A higher rate of achieving 20%+ weight loss (45% vs 18%)
These findings suggest that concomitant HRT may positively influence weight loss response when using incretin-based therapies like tirzepatide.
However, as with all retrospective studies, we must interpret the findings cautiously. These are associations—not proven cause and effect—and more robust research is needed to understand the biological mechanisms involved.
Prescribing Considerations
The British Menopause Society (BMS) has issued guidance on using oral HRT alongside medications like tirzepatide or semaglutide (Wegovy). These treatments can slow gastric emptying, which may interfere with the absorption of oral progestogens. This can potentially lead to insufficient endometrial protection in women with a uterus, increasing the risk of unscheduled bleeding or endometrial hyperplasia.
To mitigate this, clinicians may consider prescribing:
Transdermal oestrogen
Alongside a non-oral progestogen (e.g., micronised progesterone or an intrauterine system), especially in patients on GLP-1 receptor agonists or GIP/GLP-1 dual agonists like tirzepatide.
Supporting Womens Health with Personalised Care
At Bristol Menopause & Wellwoman Clinic, we support women navigating the complex relationship between weight, hormones, and menopause. Whether you're struggling with weight changes, perimenopausal symptoms, or looking for medically supervised weight management, we're here to help.
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