Obesity in the menopausal stage

Abstract

The transition to menopause and the postmenopausal period are life stages characterized by profound physiological changes that significantly increase health risks, largely mediated by the development of obesity and alterations in body composition. Clinical management of this population requires a multidisciplinary strategy that combines lifestyle interventions, advanced pharmacotherapy, and, in selected cases, surgical procedures.

Pharmacological strategies for obesity

The current therapeutic arsenal includes potent pharmacological agents. Notable among these are GLP-1 receptor agonists (semaglutide, liraglutide) and dual GLP-1 and GIP agonists (tirzepatide), which promote satiety, reduce appetite, and slow gastric emptying. Additionally, oral options such as the naltrexone-bupropion combination and the lipase inhibitor orlistat are considered. Monitoring gastrointestinal tolerance is crucial, especially given the potential interaction of these drugs with the absorption of other medications.

Hormone replacement therapy and therapeutic synergy

Hormone replacement therapy (HRT) is specifically indicated for the relief of menopausal symptoms (vasomotor symptoms, vulvovaginal atrophy, and dyspareunia) and should not be prescribed based on serum hormone levels, the monitoring of which is not recommended in routine clinical practice.

For patients receiving concomitant treatment for obesity, transdermal estrogen therapy is the preferred systemic formulation. This route avoids first-pass hepatic metabolism, and, crucially, its efficacy is not compromised by the delayed gastric emptying induced by GLP-1 agonists. In cases of persistent or exacerbated menopausal symptoms while undergoing GLP-1 therapy, referral to specialists for optimization of the hormone regimen is recommended.

The successful management of perimenopausal patients with obesity requires a thorough understanding of the interactions between hormonal and metabolic changes. The integration of modern pharmacological therapies for weight loss with optimized hormone replacement therapy (HRT) and, when necessary, bariatric surgery, allows not only for weight control but also a substantial improvement in quality of life and the mitigation of long-term cardiometabolic risks.