The Spanish Menopause Society published an expert position statement on 25 August covering the use of GLP-1 and dual incretin medications in peri- and postmenopausal women with overweight or obesity. It sets out 20 positions across body composition, cardiometabolic risk, musculoskeletal health, monitoring and interaction with hormone therapy. The most useful thing in it, for anyone in that group considering these drugs, is how plainly it states what is not yet known.
What the statement says
The group searched MEDLINE, Embase and the Cochrane Library through 30 April 2026 for studies of GLP-1 receptor agonists and dual incretin therapies in peri- or postmenopausal women, in menopause-stratified populations, and in broader obesity populations. Evidence was synthesised narratively rather than pooled statistically, and the resulting positions were reviewed by senior society members.
On the drugs themselves, semaglutide has the most direct menopause-specific evidence — but the statement immediately qualifies that this evidence is limited and largely observational. Tirzepatide and other dual incretins are described as clinically promising, particularly for cardiometabolic disease and obstructive sleep apnoea, while explicitly requiring menopause-specific evaluation that has not yet happened.
The framework it recommends is broader than the prescription. It asks clinicians to consider visceral fat rather than weight alone, skeletal muscle health, fracture risk, cardiovascular prevention, resistance exercise, adequate protein intake, and structured monitoring of functional as well as metabolic outcomes. That emphasis on muscle and bone is not incidental: rapid weight loss after menopause carries a real risk of losing lean mass at a life stage when bone density is already falling.
The hormone therapy question, answered carefully
There has been circulating interest in whether taking menopause hormone therapy alongside semaglutide produces greater weight loss. The statement addresses it directly and refuses to endorse it: the association is described as hypothesis-generating, and it says plainly that this should not justify starting hormone therapy solely to augment weight loss.
That is the sentence worth carrying away. An observed association between two treatments in existing data is not a reason to begin a second treatment with its own risk profile. Where a body of experts could have left an inviting ambiguity, it closed it.
What is not known
Almost everything menopause-specific. This is a narrative synthesis and expert consensus, not a meta-analysis, and consensus is what a field produces when trial data is too thin to settle a question. The underlying evidence is largely observational, no dual incretin has been evaluated specifically in this population, and the search closed at the end of April 2026.
None of that makes the guidance unhelpful — a structured framework built by people who treat these patients is worth more than nothing, which is the alternative. But it is guidance in the absence of strong evidence rather than guidance derived from it, and the authors are appropriately clear about which of those they are offering.
