Ozempic, Wegovy and Midlife Women — What You Should Know Before You Start
GLP-1 medications are everywhere right now. Ozempic, Wegovy, Mounjaro — most of us know someone who is trying them. Women in midlife are using them in significant numbers, often in response to perimenopausal weight changes they couldn’t shift regardless of what they tried.
If you are considering a GLP-1 medication, or have already started one, this article is for you. Not to talk you out of it — I’m not here to judge your choices — but to tell you what most people don't hear before they begin, and what you can do to significantly improve your experience and your results.
What the Research Actually Shows
The outcomes you read about in GLP-1 studies are real — but they are achieved under conditions most people don't have access to. In the STEP 1 trial — the landmark study behind Wegovy's approval — every participant received structured counselling sessions every four weeks targeting a specific calorie reduction and 150 minutes of physical activity per week. Some STEP trials went further, including intensive behavioural therapy and meal replacement programs. The 14.9% mean weight loss achieved in STEP 1 is the number most often cited in media coverage of these medications — but it is a number achieved with significant support built in. When that support was withdrawn at the end of the trial, participants regained a substantial proportion of the weight lost within the following year.
You probably don't have a research team behind you. But understanding this matters — because it means the medication alone is not the full picture, and the gap between what it can achieve with support and what it achieves without it is significant.
The Side Effects Nobody Prepares You For
Many people start GLP-1 medications and are blindsided by the side effects. The most common are gastrointestinal: constipation, heartburn, indigestion, nausea and in some cases vomiting. These range from uncomfortable to genuinely disruptive.
There are also two considerations that are particularly important for midlife women and often go unmentioned:
Muscle and bone mass loss. Rapid weight loss — which GLP-1 medications can produce — usually results in a loss of muscle and bone mass alongside fat. For women in perimenopause and menopause, who are already at increased risk of sarcopenia and bone density loss due to declining oestrogen, this is not a minor footnote. It is a significant concern that requires an active response to mitigate. Specifically including adequate protein intake and progressive strength training are non-negotiable. This is one of the pillars of long-term weight management on and off the medication.
Rebound weight gain. The evidence on what happens when GLP-1 medications are stopped is not reassuring. Research suggests rebound weight gain is common when the medication is stopped without lifestyle foundations in place. The medication works best as a bridge to sustainable change, not as the change itself.
Prehab — The Preparation Most People Skip
This is the most actionable and the most underused strategy available to women starting these medications.
The concept is simple: prepare your body before you begin. Address the vulnerabilities that will worsen on the medication before the medication amplifies them.
Gut health first. If you are already experiencing constipation, bloating, indigestion or reflux before starting a GLP-1, these symptoms are very likely to worsen once you do. GLP-1 medications slow gastric emptying — which means food moves through your system more slowly, and anything already sluggish becomes more so. Not only is this uncomfortable, but it can be a pathway to polypharmacy (needing more and more medications to offset the effects of other medications. For example, laxatives for constipation, medication for heartburn, etc.)
Taking four to six weeks to address your gut health beforehand — through dietary fibre, hydration, probiotics, improving overall gut health and identifying any food triggers — can significantly reduce your experience of these side effects or eliminate them altogether.
Protein and muscle protection. Before you start losing weight rapidly, establish the habits that will protect your muscle mass during that loss. Think of your muscles less as how you lift things and more as a metabolic organ — one that actively regulates blood sugar, drives your resting metabolism and, in the absence of oestrogen, becomes increasingly difficult to preserve and rebuild. Losing muscle mass rapidly through GLP-1-driven weight loss without deliberate protective measures is a significant risk for midlife women that is rarely discussed at the point of prescription.
Aim for adequate protein at every meal — for midlife women this means a minimum of 25–30g per meal, not a token amount. If you are not strength training, start before you begin the medication, not after. Building this habit when you have full energy and appetite is far easier than trying to establish it while managing nausea and a significantly reduced appetite.
Blood sugar stability. GLP-1 medications work partly by improving insulin sensitivity and slowing glucose absorption. You can support this process by stabilising your blood sugar before you start — reducing refined carbohydrates, eating protein and fibre first at meals, and reducing alcohol (and exercise of course). These habits will improve your response to the medication and reduce the blood sugar fluctuations that contribute to fatigue and cravings.
Nutritional foundations. You can’t just eat less of the same and hope for the best. Targeted nutrition is super important. With a reduced appetite, every mouthful needs to count. A diet of mostly nutrient-dense whole foods — high in protein, fibre, healthy fats and phytonutrients — is very different from a diet of smaller amounts of whatever you currently eat. You might even need to consider supplementation to ensure your nutritional needs are met. Planning this in advance means you are not trying to figure out significant dietary changes while also managing side effects and reduced energy.
What prehab looks like in practice: Four to six weeks of focused preparation — addressing gut symptoms, establishing a protein and strength training routine, stabilising blood sugar and planning your nutritional approach. In my experience, some women complete this preparation and discover they don't need the medication after all. Others go on to start it — and when they do, their experience is significantly better than it might have been without preparation.
If You're Already on the Medication
It is not too late. The same principles apply — gut support, protein adequacy, strength training, nutritional foundations — whether you are preparing to start or have already begun. If you are struggling with side effects, there are specific dietary approaches that can reduce their severity. If you are losing weight rapidly and concerned about muscle loss, strength training and protein intake can be prioritised now.
What I Can Help With
I am not here to prescribe medication or replace your GP. What I can offer is the support that sits around the medication — the preparation, the nutrition, the understanding of what your body needs at this stage of life, and the ongoing accountability that makes the difference between a medication that bridges you to lasting change and one that delivers short-term results followed by rebound.
If you are considering a GLP-1 medication and want to understand how to prepare, or if you are already on one and want support to get the most from it, a Midlife Health Consultation is the place to start. Seventy-five minutes to map out where you are, what your body needs and what your most practical next steps look like.
One more thing: I do not judge you for your medications, your weight, your choices or anything else. My role is to support you — not evaluate you. Whatever you are taking, whatever you have tried, whatever you are considering — you are welcome here exactly as you are.
In health, Milly
Milly Dabrowski | Holistic Midlife PractitionerGood Egg Natural Fertility, Geelong | Online Australia-wide
This article is for general information purposes and does not constitute medical advice.
Please discuss any medication decisions with your GP or specialist.