If you’ve found yourself staring at the scale wondering, “Why is my body suddenly playing by a
completely different set of rules?” you’re not alone. One of the most common conversations I’m having with women right now centers around GLP-1 medications like Ozempic, Wegovy, Zepbound, and Mounjaro.

Maybe you’re considering one. Maybe you’re already taking one.

Or maybe your friend has lost 30 pounds and you’re wondering if you should jump on board too.
Here’s the thing: this isn’t a blog post about whether these medications are good or bad.
It’s about understanding what’s happening in your body and making sure you have the full
picture before deciding what’s right for you.

Because while these medications can be incredibly helpful for some women, there are important
conversations that often aren’t happening—and those conversations matter.

Why Weight Loss Feels So Much Harder in Perimenopause

Let’s start with a truth that many women need to hear: Your body isn’t broken. You’re not lazy. You haven’t suddenly lost all your willpower. Perimenopause creates real physiological changes that affect metabolism. As estrogen begins to fluctuate and eventually decline, insulin sensitivity often decreases. This means your body becomes less efficient at managing blood sugar, making it easier to store
fat—especially around the midsection.

At the same time:

• Muscle mass naturally declines
• Metabolism slows
• Recovery takes longer
• Sleep often worsens
• Stress tolerance decreases

The strategies that worked in your 20s and 30s suddenly stop working. You can be eating the same foods, exercising the same amount, and still gain weight. This is one reason so many women are turning to GLP-1 medications. They can help improve insulin sensitivity, reduce appetite, and support weight loss when traditional approaches seem to have stopped working. And honestly? I understand the appeal.

What GLP-1 Medications Actually Do

GLP-1 medications work by mimicking a hormone your body naturally produces.
They help:

• Slow stomach emptying
• Reduce appetite
• Improve blood sugar regulation
• Increase feelings of fullness
• Support weight loss

For many women, this can feel like finally getting some relief after years of fighting their bodies.
But here’s where I think the conversation needs more nuance. Weight loss is only one piece of the health puzzle. And sometimes what gets lost in the excitement of seeing the scale move is what’s happening
underneath the surface.

The Muscle Loss Nobody Talks About

This is probably my biggest concern for women in perimenopause. Research shows that when people lose weight on GLP-1 medications, they don’t just lose fat. They also lose muscle.
And that’s a problem because muscle is one of the most powerful tools we have for:

• Maintaining metabolism
• Supporting blood sugar balance
• Protecting bone health
• Preserving strength and mobility as we age

Women are already at increased risk of losing muscle during perimenopause due to declining
estrogen levels. When significant weight loss is added to the equation, that loss can accelerate.
I’ve seen women lose weight and feel frustrated because despite being smaller, they feel
weaker, more tired, and less resilient. The goal isn’t simply weight loss. The goal is improving body composition and metabolic health. That’s why adequate protein intake and resistance training become non-negotiable if you’re using a GLP-1 medication.

The Hormone Connection Most Women Don’t Know About

One of the reasons I find this topic so fascinating is because hormones and metabolism are
deeply connected. Your fat tissue actually produces estrogen. As body fat decreases, hormone patterns can shift.
Some women notice:

• Increased fatigue
• Lower libido
• More brain fog
• Mood changes
• Changes in energy levels

They assume something is wrong because they’ve lost weight but don’t feel better. In reality, their hormones may have changed significantly during the process. This is one reason why hormone testing and hormone support can be so valuable during a weight loss journey.

Your body isn’t just changing size.

It’s changing biochemically.

There is also emerging research suggesting that hormone replacement therapy (HRT) and
GLP-1 medications may work particularly well together for some women. Estrogen plays an
important role in insulin sensitivity, muscle preservation, inflammation, and fat distribution. When
hormones are optimized and metabolic health is supported simultaneously, women may
experience better overall outcomes than with either approach alone.

What About Thyroid Health?

Another area that deserves attention is thyroid function. When calories drop significantly, the body often adapts by conserving energy. One way it does this is by slowing thyroid activity. I’ve worked with many women who already have borderline thyroid function before starting a weight loss medication.
If thyroid function isn’t monitored, they can end up feeling:

• More fatigued
• Cold all the time
• Mentally foggy
• Stalled in their progress

This is why I often recommend looking beyond a basic TSH test and evaluating a complete
thyroid picture when appropriate. Because feeling exhausted isn’t something you should simply accept as part of the process.

The Nutrient Deficiency Risk

Another hidden challenge? Many women simply aren’t eating enough. When appetite decreases significantly, overall nutrient intake often drops too.
Over time this can affect levels of:

• Iron
• Vitamin B12
• Magnesium
• Zinc
• Vitamin D
• Other key nutrients needed for energy, hormones, and metabolism

If you’ve ever thought: “I’m losing weight but I don’t feel great.” This may be one piece of the puzzle.
Weight loss and health are not always the same thing. True health means your body is nourished, resilient, and functioning well.

Don’t Forget the Nervous System

As a functional medicine practitioner, I also look at something many conventional approaches
overlook: the nervous system. Your metabolism doesn’t operate in isolation. It responds to stress. It responds to sleep. It responds to your perception of safety and threat.

Many women entering perimenopause are carrying years of chronic stress, overcommitting,
caregiving, perfectionism, poor sleep, and nervous system dysregulation. When the body perceives stress as ongoing, it can influence blood sugar regulation, inflammation, hormone balance, digestion, recovery, and even weight management.

This doesn’t mean your symptoms are “all in your head.” It means your nervous system is part of the equation. That’s why my approach often includes nervous system regulation alongside nutrition, lifestyle,
lab testing, and targeted supplementation. The goal is to help your body feel safe enough to heal and function the way it was designed to.

My Functional Medicine Perspective

If you’ve followed me for any length of time, you know I believe in asking a different question.
Instead of asking: “How do I lose weight?” I ask:“Why is my body struggling to regulate weight in the first place?”
Sometimes the answer involves:

• Blood sugar imbalance
• Chronic stress
• Poor sleep
• Gut dysfunction
• Inflammation
• Thyroid issues
• Hormone imbalances
• Nervous system dysregulation

For some women, a GLP-1 medication may be a helpful tool. But it’s still a tool. It doesn’t replace addressing the root causes that created the problem. Because eventually, we want your body working with you, not relying solely on a medication to compensate for deeper imbalances.

The Bottom Line

If you’re considering a GLP-1 medication, I want you to know this: There is no shame in using available tools. You don’t get extra points for suffering. You don’t have to prove your worth by struggling harder.
At the same time, I want you to have the whole picture. Protect your muscle. Monitor your nutrients.
Support your hormones.

Pay attention to your thyroid, prioritize protein and strength train with progressive overload. And don’t forget that the goal isn’t simply a lower number on the scale. The goal is feeling like yourself again.

More energy.
Better sleep.
Clear thinking.
Stable moods.
Confidence in your body.

That’s the kind of health worth pursuing. And whether you’re using a GLP-1 medication or not, that’s exactly what functional medicine is designed to help you achieve.

Let’s Keep the Conversation Going

If reading this sparked questions, you’re not alone.
The truth is, there are so many health topics that deserve more than a quick social media post
or a rushed doctor’s visit. Hormones, metabolism, gut health, nervous system regulation, thyroid
function, supplements, and lab testing are topics that are all connected. Understanding them can
completely change how you approach your health.

That’s exactly why I created Open Office Hours with Dr. Angie.

Every Thursday, we come together for a bite-sized health topic and live Q&A where you can
learn, ask questions, and get practical guidance in a supportive, judgment-free environment.
Think of it as having a trusted functional medicine practitioner in your corner every
week—helping you connect the dots and take the next right step in your health journey.

Whether you’re navigating perimenopause, struggling with fatigue, trying to understand your lab
work, or simply looking for trustworthy health guidance, you’ll find a community of people
committed to learning, growing, and taking ownership of their health.

You don’t have to figure it all out on your own.

If that sounds like something you’ve been looking for, I’d love to welcome you inside.
Learn. Connect. Heal. Thrive.

_{**A Note About AI: The knowledge, thoughts, experiences, and opinions in this blog come from me. I occasionally use AI as a writing assistant to help organize my ideas, improve readability, and—quite simply—help me say things a little better. I personally review and approve everything before it is published.**}