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Obesity Management During Reproductive Years
Clinical Queries: Expert Insights to Improve Obesity Management During Reproductive Years 

Released: January 20, 2026

Celia Egan
Celia Egan, MD, MSCP, DABOM
Kimberley Sampson-Paine
Kimberley Sampson-Paine, MD, MSc, FACOG, DipABLM, DipABOM, MSCP, FOMA
Samantha B. Schon
Samantha B. Schon, MD, MSTR
Activity Information

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Case Conclusion
Rita (46 years old, G2P2) continued to gain weight since the birth of her youngest child 7 years ago, and at her well woman appointment, she said she felt overwhelmed and tired due to caring for her 2 children. Her current BMI was 34 kg/m2, up from her prepregnancy BMI of 29 kg/m2. She wanted to lose 22 lb (10 kg), 12% of her bodyweight. She had history of preeclampsia, MASH with fibrosis, prediabetes, and metabolic syndrome. She was trying to lose weight on her own through lifestyle modifications, but she was having limited success and wanted to know about alternatives that would fit into her life. She is not planning to have more children and is open to using contraception. After discussing options with you, she decided to start treatment with semaglutide. After 1 year, she lost 13% of her bodyweight and is still losing weight. She is continuing with semaglutide treatment and adhering strictly to her lifestyle modifications to prevent weight regain.

Discussion Summary
As women progress through their reproductive years to perimenopausal and menopausal stages, they experience a range of changes—hormonal fluctuations, weight gain, altered energy utilization, shifts in body composition and fat tissue distribution—that contribute to cardiometabolic and other weight-related health risks.1,2 Patient-centered, individualized care is key to treating obesity for improved health.3,4

Effective obesity management starts with unbiased, nonstigmatizing, person-centered communication.3,5 Self-assessment and training related to weight bias and stigma are important starting points for HCPs.6 Listening, communication, and shared decision-making are also critical and should be supported by respectful, person-centered, nonjudgmental language and conversation practices: asking patients’ permission to discuss weight, avoiding language that places blame or devalues, and using person-first language.5,6

Current guidelines emphasize individualized, complication-centric obesity management that leverages the full range of available treatment modalities, including lifestyle modification, metabolic/bariatric surgery, and AOMs.3 The second-generation incretin-based AOMs, semaglutide and tirzepatide, are associated with robust weight loss. In a head-to-head trial, semaglutide and tirzepatide treatment led to mean weight loss of 13.7% and 20.2%, respectively, at 72 weeks (P <.001).7 Recent evidence has also shown that these AOMs have significant and similar weight loss efficacy and cardiometabolic benefits regardless of patients’ menopausal state (pre-, peri-, or postmenopause).1,8

To facilitate titration and adherence, HCPs should counsel patients receiving incretin-based AOMs that gastrointestinal (GI) reactions (eg, nausea, vomiting, diarrhea) are the most common adverse events (AEs). In pivotal clinical trials, nausea was most common, affecting 42% and 28% of people receiving semaglutide 2.4 mg or tirzepatide 15 mg, respectively.9,10 However, there are strategies to mitigate GI effects.11 To limit nausea, patients should eat more slowly, plan smaller meals, and avoid high-fat foods, alcohol, and carbonated beverages.11 Slower dose titration or dose reduction may also help patients with persistent GI symptoms.9-11 Changing to a different incretin-based AOM may also be an option, as patients who do not tolerate one incretin-based AOM may do well when switched to another.11  

With regard to safety in the context of reproductive health, AOMs are not recommended for use during pregnancy, and prescribing information for long-acting incretin-based AOMs includes information regarding potential fetal risk.9,10 Discontinuation allowing adequate time for clearance of these agents is advised before trying to conceive—at least 2 months is recommended for semaglutide and 1 month is reasonable for tirzepatide.9,10,12,13 For women in perimenopause, who may not be trying to become pregnant, effective contraception remains important, and patients and HCPs should be aware of agent-specific recommendations. Both semaglutide and tirzepatide have pregnancy exposure registries.9,10

In addition to FDA-approval for weight loss and chronic weight management in adults with obesity, semaglutide and tirzepatide have additional indications. Tirzepatide is currently approved to treat moderate to severe obstructive sleep apnea in adults with obesity, and semaglutide is currently approved to reduce the risk of major adverse cardiovascular events in those with established cardiovascular disease who have obesity or overweight and to treat noncirrhotic MASH with moderate to advanced liver fibrosis, regardless of obesity status.9,10 These indications, as well as weight-loss efficacy, should be considered as part of individualized obesity care, particularly among patients such as women in later reproductive life who may be at increased risk of these obesity-related complications.2,3