Individualizing Therapy: Considering Hormone and GLP-1 Treatments in Postmenopausal Women

At The Menopause Society (TMS) 2025 meeting in Orlando, Florida, Regina Castaneda, MD, discusses the importance of individualized therapy when using tirzepatide, a dual GLP-1 and GIP receptor agonist, for weight management across different reproductive stages. She explains that tirzepatide is effective in promoting significant weight loss among both premenopausal and postmenopausal women; however, outcomes vary depending on hormone therapy use. Castaneda emphasizes that hormone therapy should not be prescribed for weight loss, but when clinically indicated—such as for managing vasomotor symptoms, it can complement obesity pharmacotherapy. She underscores the need for a patient-centered approach, noting that it is unrealistic to expect patients experiencing severe menopause-related symptoms, like sleep disruption, to adhere to strict exercise recommendations without adequate symptom management.

Pharmacy Times: What did your findings reveal about how reproductive stage or menopausal hormone therapy status affects weight loss outcomes with tirzepatide?

Regina Castaneda, MD: We conducted a retrospective observational study evaluating the impact of reproductive stage on weight loss outcomes with tirzepatide. This is currently the most effective weight loss medication. It is a dual GLP-1 and GIP receptor agonist.

We observed that premenopausal women achieved nearly 20% total body weight loss. However, postmenopausal women who had never been exposed to hormone therapy lost about 15% of their total body weight. In comparison, hormone therapy users in the postmenopausal group experienced a 20% total body weight loss.

So, there is definitely something there that we are not yet seeing. This has many implications in clinical research, but we definitely need more studies to confirm these findings.

Pharmacy Times: How might this information guide treatment selection and patient counseling in clinical practice?

Castaneda: We know that this medication is effective across all reproductive stages, and I want to emphasize the importance of individualized therapy. We understand the indications for hormone therapy—weight loss is not one of them. We are not promoting the use of hormone therapy for weight loss or weight management.

However, when a postmenopausal woman is dealing with the burden of vasomotor symptoms and also wants to begin obesity pharmacotherapy, such as a GLP-1 medication, then we have a different conversation. I think our studies serve as a reminder of the importance of this individualized approach.

Imagine telling a patient who is struggling with vasomotor symptoms to complete 115 minutes per week of exercise when she is not even sleeping well. So again, remember to listen to your patients and tailor therapy to their needs. Hormone therapy is not used for weight loss, but if there is a clinical indication, then it can be considered.