By Lew Kizer — 2026-11-04 — Health & Nutrition
The short answer
In a Mayo Clinic study of women 45 and older, those using menopause hormone therapy lost more weight on semaglutide than those who were not: 11.9% vs. 10.9% of body weight at last follow-up. On tirzepatide, hormone therapy users lost slightly more early on, but the difference was no longer significant later. The study was observational and cannot show that hormone therapy caused the difference. The lead author says weight loss is not a reason to start hormone therapy.
Key facts
- Presented at The Menopause Society 2026 Annual Meeting, Oct. 20-24 in San Diego. Lead author: Dr. Regina Castaneda, Mayo Clinic Florida.
- Retrospective study of women 45 and older with a BMI of at least 27: 2,379 on semaglutide and 1,476 on tirzepatide, about 3,855 in all.
- Semaglutide, hormone therapy vs. none: 9.8% vs. 8.2% weight loss at 9 months, 11.6% vs. 9.7% at 15 months, 11.9% vs. 10.9% at last follow-up.
- Semaglutide users on hormone therapy were more likely to lose at least 10% (55% vs. 51%) and at least 20% (22% vs. 18%) of body weight.
- Tirzepatide: 6.6% vs. 5.9% at 3 months, then no significant difference through 15 months.
- A smaller Mayo study published in January 2026 (120 people on tirzepatide) had found 35% more weight loss with hormone therapy.
- The society says about one in five women ages 50 to 64 report current or past use of a GLP-1-based obesity medicine.
KINGSPORT, Tenn., Nov. 4, 2026 — A Mayo Clinic study first presented at The Menopause Society's annual meeting in late October is back in the news this week after Newsweek picked it up on Nov. 3. It found midlife women using menopause hormone therapy lost more weight on semaglutide, the medicine in Wegovy and Ozempic, than women who were not. On tirzepatide, the medicine in Zepbound and Mounjaro, the gap showed up early and then faded. Many headlines skip that second part.
This article reports medical news and is not medical advice. SmashMeals is a food company, not a medical provider, and is not affiliated with the companies or researchers named here. Talk with your prescriber before you start, stop or change any medicine.
What the researchers did
The team led by Dr. Regina Castaneda of Mayo Clinic Florida looked back at health records for women 45 and older with a BMI of at least 27. There were 2,379 on semaglutide and 1,476 on tirzepatide. Within each group, women using hormone therapy were matched to similar women who were not, by age, BMI, diabetes and past use of weight medicines. The average woman was 57.
A note on the numbers: some coverage lists the study size as 2,379. That is only the semaglutide group. With the tirzepatide group, it is about 3,855 women.
What they found
| Semaglutide | Hormone therapy | No hormone therapy |
|---|---|---|
| 9 months | 9.8% | 8.2% |
| 12 months | 11.0% | 9.5% |
| 15 months | 11.6% | 9.7% |
| Last follow-up | 11.9% | 10.9% |
| Lost 10% or more | 55% | 51% |
| Lost 20% or more | 22% | 18% |
Figures are average body weight lost, as reported by Patient Care and Healio from the meeting presentation.
On tirzepatide, hormone therapy users lost 6.6% vs. 5.9% at 3 months. After that, the differences were not statistically significant through 15 months. That is different from a smaller Mayo study in January, which found 35% more weight loss with hormone therapy among 120 people on tirzepatide. Small studies often find bigger effects than large ones. "Interestingly, the effect was stronger with semaglutide than with tirzepatide, which deserves further study," Castaneda said.
What it does not show
This was an observational study. It cannot prove hormone therapy caused the extra weight loss. Women who use hormone therapy may be different in ways the records do not capture. "It is too early to draw firm conclusions," Castaneda said in the society's release. "It's important to remember that weight loss is not an indication for menopause hormone therapy."
Dr. Stephanie Faubion, the society's medical director, said the findings "suggest that hormone therapy may influence how some women respond to GLP-1-based weight loss medications" and highlight "the importance of considering menopause-specific factors." Talk with your own doctor about what fits you.
Where food fits
The study did not test diet. What it does underline is that midlife weight care is personal, and the eating side still has to work every day: smaller appetite on a GLP-1, protein that has to fit into less food, and changes that come with menopause. Our menopause meal delivery page covers how women use our meals in these years, GLP-1 meal planning covers eating with a smaller appetite, and GLP-1 maintenance meals covers the stretch after the goal weight.
“There's never a question. There's never a worry. We want people to have good, delicious, nutritious, macro-counted food — and none of the guesswork.” — Lew Kizer, Founder, SmashMeals
Pick up locally or order for shipping; checkout confirms timing. See this week's meals.
Commentary, not medical advice
The SmashMeals perspective
Midlife bodies change, and a lot of women tell us the old ways of eating quit working. Whatever medicine a woman and her doctor choose, the daily part is still food. We cook portioned, protein-forward meals with posted nutrition so that part is one less thing to figure out.
Frequently asked questions
Is this a new study?
It was presented at The Menopause Society meeting in late October 2026. It drew new coverage this week, including a Newsweek story on Nov. 3. It has not been published as a full journal paper.
Does hormone therapy make GLP-1 medicines work better?
This study cannot say. It looked back at health records and found an association. Women who use hormone therapy may differ in other ways, such as being more engaged in their care. The authors say prospective trials are needed.
Should I start hormone therapy to lose more weight?
No, not based on this study. The lead author said weight loss is not an indication for menopause hormone therapy. Hormone therapy decisions belong with your doctor and depend on symptoms and personal health history.
Why did the tirzepatide result differ from the January study?
The January study had only 120 people. This one had 1,476 women on tirzepatide and found an early gap that did not last. Larger studies often shrink or erase effects seen in small ones. The lead author said the stronger effect with semaglutide deserves more study.
How big was the semaglutide difference?
About one percentage point of body weight at last follow-up (11.9% vs. 10.9%), and closer to two points at 9 to 15 months. For a 200-pound woman, two points is about 4 pounds.
Sources and credits
Follow the original sources for context and verification. A reference is not an endorsement of SmashMeals.
- Hormone Therapy May Increase Weight Loss Effectiveness of GLP-1s (opens in a new tab)
The Menopause Society
Why it matters: The primary release with the cohort sizes, the semaglutide and tirzepatide findings and quotes from the lead author and the society's medical director.
- Menopause Hormone Therapy Linked to Greater Weight Loss With Semaglutide in Real-World Study (opens in a new tab)
Patient Care
Why it matters: Meeting coverage with per-timepoint results and p-values for both medicines.
- Hormone therapy plus GLP-1 may equal greater, sustainable weight loss for menopausal women (opens in a new tab)
Healio
Why it matters: Independent meeting coverage of the semaglutide results and study limits.
- Hormone Therapy Linked to How Some Women Respond to GLP-1 Weight Loss Drugs (opens in a new tab)
Newsweek
Why it matters: Nov. 3, 2026 coverage that brought the study back into the news, with an outside expert's view.
- New study links combination of hormone therapy and tirzepatide to greater weight loss after menopause (opens in a new tab)
Mayo Clinic News Network
Why it matters: The earlier, smaller tirzepatide study from the same team.