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by Katy Hecker, PharmD, PCCA Clinical Services
In a woman’s life, the absence of menstruation for 12 months marks the official beginning of menopause. Waning ovarian function coupled with declining circulating hormone levels spark natural menopause, but menopause may also occur as result of surgical procedures such as following a hysterectomy and/or oophorectomy. Commonly reported symptoms of menopause include hot flashes, night sweats, vaginal dryness, sleep disturbances, mood swings and weight gain,1 with an estimated 70% of menopausal women experiencing weight gain.2
Menopause triggers body composition changes such as increased abdominal adipose tissue and decreased lean muscle mass. This change in body composition intensifies the risk of diabetes, cardiovascular disease, dyslipidemia (abnormal levels of lipids in the blood) and metabolic dysfunction-associated steatotic (fatty) liver disease. Heart disease is the leading cause of death in women; therefore, it is critical to address menopausal weight gain and the cardiometabolic changes that occur. Hormone replacement therapy, lifestyle modification and in some instances medication therapy may be beneficial to help combat menopausal weight gain.2,3
GLP-1 is a hormone naturally produced in the central nervous system, intestine and pancreas. It is released in response to the consumption of fats and carbohydrates.2,4 GLP-1 increases insulin secretion, decreases glucagon release, slows gastric emptying and reduces food intake. Research also suggests it may reduce food reward behavior. The appetite suppressing effect of GLP-1 is due to its action in the hypothalamus and brainstem. Interestingly, this is the same region of the brain responsible for the food intake reduction effects of estrogen. Glucagon-like peptide-1 (GLP-1) receptor agonist and dual agonist therapies are FDA-approved for the treatment of obesity, weight management, type 2 diabetes mellitus and cardiovascular mortality reduction.4
Combining hormone replacement therapy with semaglutide, a GLP-1 receptor agonist, may lead to better outcomes for total body weight loss and subsequent improvements in cardiometabolic health. A recent retrospective review compared weight loss response and cardiometabolic changes in post-menopausal women using semaglutide in combination with and without hormone therapy. At three, six, nine and 12 months following semaglutide initiation, women using hormone therapy experienced approximately 30% greater total body weight loss than the non-hormone therapy users. Both groups showed improvements in cardiometabolic health marked by lower fasting blood glucose, blood pressure, LDL, total cholesterol and triglycerides.2
Reward eating is comprised of two categories, “wanting” and “liking.”5 Liking is associated with the palatability of the food and wanting is food craving triggered by a cue or stimuli which then leads to motivation to obtain a specific type of food.4 Research suggests women may exert a greater response to a centrally administered long acting GLP-1 agonist on food reward due to the activation of central estrogen receptor alpha. This reduction was noted with the “wanting” subtype of reward eating in women greater so than men. A reduction in the “liking” subtype of reward eating was displayed in both men and women. Administration of an estrogen receptor antagonist was sufficient to blunt the effects of the central GLP-1 agonist on food reward behavior in both men and women. This evidence suggests the activation of central estrogen receptor alpha may be critical for central GLP-1 agonist’s effect on reward eating.4,5
There are many treatment strategies that may help menopausal women with the natural challenges and health risks associated with this phase of life. Combining therapies has yielded compelling results, and compounded medications can be personalized to meet the needs of each patient, offering a unique solution for various medication related concerns. For example, SubMagnaTM SL HMW can be used to deliver semaglutide in a sublingual dosage form. This may improve adherence in patients who have trouble swallowing or who are fearful of needles.
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These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care or encourage its abandonment.