This expert position statement from the Spanish Menopause Society evaluated how incretin-based therapies (GLP-1 receptor agonists and dual incretin agents) should be integrated into care for peri- and postmenopausal women with overweight or obesity, covering body composition, cardiometabolic risk, musculoskeletal health, and interaction with menopause hormone therapy (MHT).
Semaglutide has the most direct menopause-specific evidence among incretin therapies, though it remains limited and largely observational; tirzepatide and dual incretins show cardiometabolic and obstructive sleep apnea promise but lack menopause-specific data. The observed association between concomitant MHT use and greater semaglutide-related weight loss is hypothesis-generating only — MHT should not be started solely to boost weight loss.
Evidence is synthesized narratively without meta-analysis; most menopause-specific data are observational; dual incretin therapies (e.g., tirzepatide) have not been evaluated in menopause-stratified populations.
For peri- and postmenopausal women with obesity, consider incretin-based therapy within a broader cardiometabolic framework that includes visceral adiposity, skeletal muscle preservation, fracture risk, resistance exercise, and adequate protein intake. Do not initiate MHT solely to augment incretin-related weight loss.
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