GLP-1s, Appetite Suppression, and Midlife Women: What Happens When Hunger Disappears?
When Hunger Goes Quiet
Megan is a 45-year-old mother of two who has consistently prioritized her health through balanced nutrition and joyful movement like dance, walking and yoga several times per week. Back in high school she struggled with an eating disorder, but for over 25 years she has enjoyed a life of recovery, being flexible with her food choices. Recently, however, she began experiencing more irritability over minor frustrations, poor sleep, increased cravings for sugar and carbs, and gradual abdominal weight gain despite not changing her food and exercise habits significantly. Feeling frustrated and self-conscious, she had the urge to diet for the first time in many years. This changing body felt like it belonged to someone else. She thought, “I can just go back to eating more intuitively once I lose theses extra 10 pounds.” After about 6 weeks of counting calories and macros and spending extra time at the gym, she grew discouraged when she didn’t see results. As much as she tried to distract herself from it, more people she knew were talking about being on drugs like Ozempic and Zepbound. The experiences they shared about not being hungry and feeling more confident in their bodies made these drugs sound enticing. But wait.. What does it mean when you no longer feel hunger?
A lot of women share a similar experience to Megan, and for that reason, the use of GLP-1s among perimenopausal and menopausal women is skyrocketing. According to a survey done In 2025, the RAND American Life Panel showed that women aged 30–49 were more than twice as likely as men of a similar age to report current or past use of GLP-1s. Twenty percent of women aged 50–64 reported current or past GLP-1 use, which is the group with the highest use overall.1 while GLP-1s are commonly used by perimenopausal women, this population has been largely ignored in studies of the drugs' risks and benefits. Therefore, women and their healthcare providers are making decisions with incomplete information, potentially leaving women vulnerable to serious risks or missed opportunities for health promotion during one of the most physiologically and psychosocially challenging transitions of their lives. When suppression of appetite is the main feature of these drugs and not the side effect, how well will they navigate this transition? Let’s explore how loss of hunger can have complex metabolic, nutritional, and emotional consequences for midlife women.
Quick Science Overiew of How GLP-1s Suppress Appetite
For context, I will provide a brief overview of what GLP-1 (glucagon-like peptide 1 receptor agonists) medications do in the body. GLP-1 receptors are present in appetite-regulating areas of the brain (especially the hypothalamus). The drugs act on these appetite centers to increase feelings of fullness and satisfaction with smaller portions. They also delay gastric emptying, causing fullness to last longer. With reduced hunger, many users report less interest in high-fat or high-sugar foods. They were originally developed to treat diabetes and do so by stimulating insulin release only when blood sugar is high and suppressing glucagon. They help maintain weight loss because they counteract the body’s usual weight-regain mechanisms, such as increased hunger after weight loss and hormonal signals that promote fat regain. The effect of these drugs can be especially pronounced in midlife women.
Hunger Changes During Perimenopause & Menopause
Perimenopause typically occurs between ages 45 and 55 and is characterized by fluctuating estrogen levels and declining ovarian function that influences a cascade of physiological and psychological changes extending far beyond reproductive health. These changes include increased risk of cardiovascular disease, obstructive sleep apnea, declines in bone density and muscle mass, weight gain, poor sleep quality, changes in mood, and brain fog. As estrogen and progesterone levels decline, grehlin levels rise while leptin levels fall, causing women to feel more hungry and less full. Lower estrogen also makes mid-life women more vulnerable to insulin resistance and stress, which increases cortisol, and in turn increases cravings for high fat/ high sugar foods. Stress levels already tend to peak during midlife due to balancing demands of career, caring for children, and possibly caring for aging parents. To pour salt in the wound, menopausal women are also more prone to weight gain without increased intake because of muscle loss with aging.2
What Happens When Hunger Disappears?
If you know a woman in mid-life taking GLP-1’s for weight loss, you likely hear them celebrating the short-term effects of reduced “food noise” in their head, rapid weight loss and feeling more in control of their eating. But that sense of control comes at a cost. When disconnected from body signals, meals may be unintentionally skipped and loss of bone density and muscle mass can be accelerated. Without adequate intake of protein, calcium, vitamin D and magnesium muscle and bone loss can be severe- increasing risk for osteoporosis. Other common deficiencies with GLP-1 users include iron, B12, vitamins A,C and E and potassium. Symptoms of deficiencies in these nutrients lead to fatigue, hair loss, shortness of breath, weak nails, poor muscle coordination, trouble concentrating and mood changes.3
Another important part of this discussion is metabolism- which slows with aging and with muscle loss. Restricting food intake further slows metabolism to conserve energy. Therefore, mid-life women are already experiencing slower metabolism and loss of muscle mass due to aging. Adding GLP-1’s to the mix slows metabolism even more through inadequate energy intake and loss of muscle mass. Therefore, weight gain often occurs if the medication is stopped, creating a dependency on these medications. Sadly, many patients are not informed that long-term use may be necessary to maintain weight loss.
Psychological & Emotional Impacts of Not Feeling Hunger
As a therapist who specializes in eating disorders, I would be remiss to not discuss the impact of GLP-1’s on mental health and their relationship to disordered eating. With lack of hunger, there is also loss of pleasure in eating. Food is fuel, but the pleasure principle plays a role in our survival, drawing us towards delicious and nourishing meals. For someone with a history of restrictive eating patterns, being on these drugs reinforces those patterns, and may create a euphoric high by feeling more in control- perpetuating a vicious cycle. Medical providers need to be aware of the risk of these drugs masking disordered eating in midlife. Just as the hormonal shift of puberty can trigger disordered eating when that transition isn’t navigated with strong support, the other major hormonal shift of perimenopause can be a vulnerable time for women, which is why we are seeing more eating disorders occurring in mid-life. At least 1 in 10 women over 50 experience symptoms of an eating disorder, and a 2015 study found that nearly 75% of women in midlife are not satisfied with their weight, which is a risk factor for developing an eating disorder.4 Furthermore, a 2020 study found strong evidence that women who attempt to suppress their weight are at a significantly higher risk of developing anorexia nervosa or bulimia.7 Since use of these drugs is a form of weight suppression, the risk is there. Despite the progress that has been made with body positivity rising up against diet culture, these drugs can contribute to an overall regression through promotion of the “thin ideal” and encourage harmful weight stigma.
Hunger as a Health Signal—Not the Enemy
Hunger is a survival instinct that is to be honored and explored rather than an enemy to defeat. It’s part of our metabolic feedback system, and when it’s absent it is typically due to under-fueling, stress or external appetite suppression. When you silence hunger, you silence other symptoms that may need your attention. It’s hard to deny that GLP-1’s show promising results in treating many medical conditions, but what they don’t do is regulate reproductive hormones. They also don’t replace health-promoting habits. All women deserve individualized, menopause-informed care and if you don’t feel that your doctor can provide that, then it’s time to look for a new doctor. I’m grateful for the work of Dr. Mary Claire Haver who has been a very influential advocate for menopause-informed care. In her book, The New Menopause, she provides updated information on hormone replacement therapy (HRT) and practical guidance on which hormone tests and labs to request and what questions to ask. She also emphasizes the importance of lifestyle factors such as nutrition, weight-bearing exercise and sleep that can help build resilience during this transition. When looking for a new provider, she recommends searching for a Certified Menopause Practitioner using this site: https://menopause.org/patient-education/choosing-a-healthcare-practitioner.
Supporting the Body While on GLP-1s (If Used)
Before closing, I do want to further acknowledge that healthcare choices are individualized, and for some, the benefits of taking GLP-1’s may outweigh the risks. For example, there is strong evidence that for adults with Type 2 diabetes, use of GLP-1’s can reduce their hemoglobin A1C by 0.8% - 1.6% which is significant.6 They have also shown to reduce risks of major cardiovascular events, offer protection from stroke, increase cell sensitivity to chemotherapy and decrease dementia symptoms. In addition, limited research shows promising effects of GLP-1’s used to treat addiction and binge eating disorder. Whatever the condition, it’s important that the patient is informed of the risks. What’s concerning is that with the increased demand for these drugs, they are now being prescribed by paraprofessionals or health spa employees who are not equipped to educate on the risks.
If taking these drugs, it’s important to prioritize intentional nourishment with protein first at meals. Especially for menopausal women, nutrients to support bone health such as calcium, vitamin D and magnesium need to be included in adequate amounts. Resistance training needs to be done several times per week, while staying adequately hydrated with water and electrolytes.
Conclusion: Be curious and compassionate through change.
Remember our friend, Megan? Thankfully, she first consulted with a doctor who understood her history and how to best support her during the menopause transition. She was also strongly advised to avoid GLP-1’s due to the risk factors discussed and her history of disordered eating. She’s learning to be curious again about her hunger, and compassionate towards her body’s changes. What if the goal isn’t to erase hunger—but to understand it?
Sources:
3. https://www.health.com/nutritional-deficiencies-glp1s-118545124.
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4452130/
5. UptoDate Dungan, K., DeSantis, A. June 2024 “GLP-1 based therapies for the treatment of diabetes mellitus.
6. https://pubmed.ncbi.nlm.nih.gov/32534455/