An expert consensus from Spain's Menopause Society synthesized evidence on GLP-1 receptor agonists and dual incretin therapies—principally semaglutide and tirzepatide—for peri- and postmenopausal women with overweight or obesity. Across 20 position statements, semaglutide emerged as carrying the most menopause-specific clinical data, though that evidence remains sparse and largely observational. Tirzepatide shows cardiometabolic and sleep-apnea promise but lacks menopause-stratified trial data. Critically, the panel declined to endorse initiating hormone therapy (HRT) solely to amplify semaglutide-driven weight loss, flagging that observed synergy as hypothesis-generating only.
This consensus arrives at a clinically important juncture. Menopause-specific data have historically been excluded from major GLP-1 trials like STEP and SURMOUNT, leaving clinicians to extrapolate from mixed-sex or age-undifferentiated cohorts. The panel's integration of visceral adiposity, skeletal muscle preservation, fracture risk, and cardiovascular prevention into a unified framework reflects a maturing understanding that weight loss alone is insufficient—body composition trajectory matters enormously in postmenopausal physiology, where sarcopenic obesity poses compound risk. The emphasis on resistance exercise and adequate protein intake alongside pharmacotherapy aligns with emerging consensus across aging-medicine literature. The position statement's limitation is inherent: as an expert narrative synthesis rather than a meta-analysis, its recommendations reflect structured opinion more than pooled causal evidence. Still, its clinical granularity makes it an incremental but genuinely useful guide for practitioners navigating an undertreated, evidence-poor population.
