Menopause weight loss with Saxenda is a consideration for women struggling with weight gain during the menopausal transition. Hormonal changes, particularly declining oestrogen levels, often lead to increased abdominal fat and metabolic slowdown between ages 45 and 55. Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed for weight management in adults with obesity or overweight with comorbidities. Whilst not specifically approved for menopausal weight gain, it may be prescribed to eligible menopausal women as part of a comprehensive weight management programme. This article explores how Saxenda works, its effectiveness during menopause, safety considerations, and alternative approaches to managing menopausal weight gain.

Understanding Weight Gain During Menopause

Weight gain during menopause is a common concern affecting many women, typically occurring between the ages of 45 and 55. During this transitional period, hormonal changes—particularly declining oestrogen levels—significantly impact body composition and metabolism. Women often gain around 0.5 to 1 kg per year during the menopausal transition, with fat distribution shifting from the hips and thighs to the abdominal area.

The mechanisms behind menopausal weight gain are multifactorial. Reduced oestrogen levels affect how the body stores fat and regulates appetite, whilst also contributing to decreased muscle mass. This loss of lean muscle tissue further reduces metabolic rate, meaning the body burns fewer calories at rest. Additionally, age-related factors such as reduced physical activity, sleep disturbances, and changes in insulin sensitivity compound these hormonal effects.

Abdominal or visceral fat accumulation during menopause is particularly concerning from a health perspective. This type of fat is metabolically active and associated with increased risks of cardiovascular disease, type 2 diabetes, and metabolic syndrome. Women may notice that previous weight management strategies become less effective during this time, leading to frustration and reduced quality of life.

Understanding these physiological changes is crucial for developing appropriate weight management strategies. Whilst hormonal shifts are inevitable, weight gain is not an unavoidable consequence of menopause. Evidence-based interventions combining dietary modifications, increased physical activity, and in some cases, pharmacological support can help women maintain a healthy weight during and after the menopausal transition.

What Is Saxenda and How Does It Work?

Saxenda (liraglutide 3.0 mg) is a prescription medication licensed by the MHRA for weight management in adults with obesity (BMI ≥30 kg/m²) or those who are overweight (BMI ≥27 kg/m²) with weight-related comorbidities. It belongs to a class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes management but subsequently approved at higher doses for weight loss.

The medication works through several complementary mechanisms. Liraglutide mimics the action of GLP-1, a naturally occurring hormone released by the intestine after eating. By activating GLP-1 receptors in the brain, particularly in areas that regulate appetite, Saxenda reduces hunger and increases feelings of fullness. This leads to decreased calorie intake without the need for conscious restriction. Additionally, it slows gastric emptying, meaning food remains in the stomach longer, prolonging satiety after meals.

Saxenda is administered as a once-daily subcutaneous injection, typically into the abdomen, thigh, or upper arm. Treatment begins with a low dose (0.6 mg daily) and gradually increases over five weeks to the maintenance dose of 3.0 mg daily. This titration schedule helps minimise gastrointestinal side effects that commonly occur when starting GLP-1 receptor agonists.

Whilst Saxenda is licensed for weight management, NICE guidance (TA664) recommends its use within the NHS only in specialist weight management services (tier 3 or 4), generally for people with higher BMI thresholds (typically ≥35 kg/m² or ≥32.5 kg/m² for certain ethnic groups) who also have pre-diabetes and high cardiovascular risk. NICE recommends treatment for a maximum of 2 years. Saxenda should be used as part of a comprehensive weight management programme that includes dietary modification, increased physical activity, and behavioural support. Treatment should be discontinued if patients do not achieve at least 5% weight loss after 12 weeks at the maintenance dose.

Using Saxenda for Weight Loss During Menopause

Whilst Saxenda is not specifically licensed for menopausal weight management, it may be prescribed to menopausal women who meet the eligibility criteria for weight management medication. According to the product licence, Saxenda can be used in adults with a body mass index (BMI) of 30 kg/m² or above, or a BMI of 27 kg/m² or above with at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidaemia.

However, NHS access via NICE guidance (TA664) is more restricted, recommending Saxenda only within specialist weight management services (tier 3 or 4), generally for people with BMI ≥35 kg/m² (or ≥32.5 kg/m² for people from certain ethnic backgrounds) who also have pre-diabetes and high cardiovascular risk. NHS treatment is recommended for a maximum of 2 years.

For menopausal women struggling with weight gain despite lifestyle modifications, Saxenda may offer additional support. The medication's appetite-suppressing effects can be particularly beneficial during menopause when hormonal changes increase hunger and cravings. By reducing calorie intake and supporting adherence to dietary changes, Saxenda may help counteract the metabolic slowdown associated with declining oestrogen levels.

Before prescribing Saxenda, healthcare professionals should conduct a thorough assessment including medical history, current medications, and baseline measurements (weight, BMI, waist circumference, blood pressure). Women should be counselled about realistic expectations: Saxenda is not a quick fix and requires commitment to lifestyle changes.

There is no official contraindication between Saxenda and hormone replacement therapy (HRT), and the two can generally be used concurrently if both are clinically indicated. However, women should discuss all medications with their prescriber to ensure appropriate monitoring. Regular follow-up appointments are essential to assess efficacy, tolerability, and ongoing suitability of treatment. Healthcare professionals should also screen for and address any psychological factors contributing to weight gain, such as depression or anxiety, which are more prevalent during the menopausal transition.

Effectiveness and Clinical Evidence for Menopausal Weight Management

Clinical trial data demonstrates that Saxenda can produce clinically significant weight loss when combined with lifestyle interventions. The pivotal SCALE (Satiety and Clinical Adiposity – Liraglutide Evidence) trials showed that patients treated with liraglutide 3.0 mg lost an average of 8-9% of their initial body weight over 56 weeks, compared to 2-3% in the placebo group. Approximately 63% of patients on Saxenda achieved at least 5% weight loss, and 33% achieved at least 10% weight loss.

Whilst these landmark trials did not specifically focus on menopausal women, subgroup analyses suggest that the medication remains effective across different age groups and hormonal states. The evidence for specific efficacy in postmenopausal women is more limited, though some observational data indicates similar weight loss outcomes to premenopausal women. Individual responses vary considerably. Factors such as baseline weight, adherence to lifestyle modifications, and concurrent medical conditions influence treatment success.

Beyond weight loss, Saxenda has demonstrated improvements in cardiometabolic risk factors relevant to menopausal women. Clinical trials have shown reductions in waist circumference, blood pressure, and markers of insulin resistance—all of which tend to worsen during menopause. These metabolic improvements may help reduce the increased cardiovascular risk that emerges after menopause.

However, it is crucial to maintain realistic expectations. Weight loss with Saxenda is gradual, typically occurring over several months, and requires sustained lifestyle changes. Not all patients respond equally, and some may experience minimal weight loss despite adherence. Additionally, weight regain is common after discontinuation, highlighting the need for long-term strategies. Healthcare professionals should discuss these evidence-based outcomes during shared decision-making conversations, ensuring women understand both the potential benefits and limitations of pharmacological weight management during menopause.

Side Effects and Safety Considerations

Like all medications, Saxenda can cause side effects, and understanding these is essential for informed decision-making. The most common adverse effects are gastrointestinal in nature, including nausea, vomiting, diarrhoea, constipation, and abdominal discomfort. These symptoms typically occur during dose escalation and often improve over time as the body adjusts. Taking the injection at the same time each day and eating smaller, more frequent meals may help minimise these effects.

Gastrointestinal side effects can lead to dehydration and, in rare cases, acute kidney injury. It's important to maintain adequate fluid intake while using Saxenda, especially if experiencing vomiting or diarrhoea, and to seek medical advice if you notice reduced urine output or other signs of dehydration.

Other frequently reported side effects include injection site reactions (redness, itching), headache, fatigue, and dizziness. Hypoglycaemia (low blood sugar) is uncommon in patients without diabetes but may occur in those taking other glucose-lowering medications, particularly insulin or sulfonylureas, which may require dose adjustment.

More serious but rare adverse effects require careful consideration. Saxenda carries warnings regarding acute pancreatitis—patients should be instructed to stop the medication and seek immediate medical attention if they experience severe, persistent abdominal pain. Animal studies have shown a theoretical risk of thyroid C-cell tumours, though this has not been confirmed in humans.

Saxenda should not be used during pregnancy or breastfeeding, and women of childbearing potential should use effective contraception during treatment. The medication is not recommended in patients with severe renal or hepatic impairment and should be used with caution in patients with severe gastrointestinal disease, including diabetic gastroparesis. Healthcare professionals should monitor patients for changes in mood or suicidal thoughts, which have been reported with GLP-1 receptor agonists.

When to contact your GP:

• Severe or persistent abdominal pain

• Signs of pancreatitis (pain radiating to the back, nausea, vomiting)

• Persistent neck swelling or voice changes

• Severe allergic reactions (rash, difficulty breathing, swelling)

• Persistent vomiting leading to dehydration

• Signs of gallbladder problems (upper abdominal pain, fever, yellowing of skin or eyes)

• Changes in mood or thoughts of self-harm

If you experience any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed above. You can also report side effects directly via the Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

Alternatives and Lifestyle Approaches to Menopausal Weight Loss

Whilst Saxenda may be appropriate for some women, lifestyle modifications remain the cornerstone of weight management during menopause and should be attempted before considering pharmacological interventions. Evidence-based dietary approaches include adopting a Mediterranean-style diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats. Reducing processed foods, added sugars, and alcohol can significantly impact calorie intake and metabolic health.

Physical activity is particularly important during menopause. The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity aerobic activity weekly, combined with strength training exercises at least twice weekly. Resistance training is especially valuable as it helps preserve muscle mass, which naturally declines with age and oestrogen loss. Increased muscle mass supports metabolic rate and improves insulin sensitivity. Activities such as brisk walking, swimming, cycling, and yoga can be adapted to individual fitness levels and preferences.

For women experiencing significant menopausal symptoms contributing to weight gain, hormone replacement therapy (HRT) may be considered. Whilst HRT is not primarily a weight loss treatment, it can alleviate symptoms such as hot flushes and sleep disturbances that may indirectly affect weight. Some evidence suggests HRT may help prevent the shift toward abdominal fat distribution, though it does not typically cause weight loss. Women should discuss the risks and benefits of HRT with their GP or menopause specialist, in line with NICE guidance (NG23).

Other pharmacological options for weight management include orlistat, which reduces fat absorption, and newer medications such as semaglutide (Wegovy). Semaglutide is another GLP-1 receptor agonist approved for weight management, but like Saxenda, NICE guidance (TA875) recommends its use only in specialist weight management services with specific eligibility criteria. Bariatric surgery may be considered for women with severe obesity (BMI ≥40 kg/m² or ≥35 kg/m² with comorbidities, with lower thresholds for certain ethnic groups) who have not achieved adequate weight loss with non-surgical interventions, as outlined in NICE guidance (CG189).

Behavioural and psychological support should not be overlooked. Cognitive behavioural therapy (CBT) can address emotional eating, improve body image, and develop sustainable behaviour change strategies. Many NHS services offer weight management programmes that provide structured support, education, and accountability. Women should be encouraged to seek support from healthcare professionals, registered dietitians, or accredited weight management services rather than attempting unsupervised restrictive diets, which are often unsustainable and may be harmful. A comprehensive, individualised approach addressing diet, physical activity, sleep, stress management, and, when appropriate, medical interventions offers the best chance of successful long-term weight management during and after menopause.

Frequently Asked Questions