GLP-1s can have a huge impact on women’s bodies. The primary intended side effects are weight loss; other impacts include a reduction in cholesterol, inflammation, and lower rates of heart failure and stroke, among others. What is missing from the cultural dialogue is how GLP-1 drugs alter the way women’s bodies function and behave on a monthly, if not daily, basis. 

How do GLP-1 drugs impact us around our menstrual cycle, for example? Does it enhance or hinder the experience of perimenopause? How do you know if you’re losing muscle or fat? How do you know if your dose is too strong? 

Women need practical information in order to stay closely connected to their bodies during this time of immense change. Danimás sought advice from our resident nutritionist Ashley Damaj to bring you a comprehensive guide for GLP-1 use—one that goes beyond the headlines. 

Whether you’re taking Tirzepetide or Semaglutide, here’s everything else you need to know. 

HOW DO YOU KNOW WHEN YOUR DOSAGE IS RIGHT?

Achieving the right dosage of medication is a delicate dance. Users typically start on a low dose which gradually increases, usually in two-to-four week increments. Dosage is always prescribed by a doctor, but doctors are also reliant on your ability to help determine when you’ve hit the sweet spot for your body. Without knowledge around exactly what the sweet spot is, it can be hard to gauge. 

GLP-1s aim to blunt the appetite, so not being hungry and being less interested in food can make this look and feel like a win. Dramatic weight loss from a vast deficit can also feel (mistakenly) like the medication is working. We get it: it feels good to get fast results. 

However, it’s very easy to under-eat on this medication. Not only does this wreck recovery nutrient intake, it can also affect your mood. 

“We need to look at biofeedback, not just calories,” she says. “If a GLP-1 user is recovering, sleeping, hitting her protein, lifting well, with reasonably regular bowel movements, and her body fat % and SMM (skeletal muscle mass) metrics are trending how we want, the intake is probably close,” says. Data from wearables such as Oura or Whoop can help track recovery and sleep. 

However, “If you are freezing, flat in the gym, constipated, food obsessed, exhausted, or feeling your strength crater, the deficit is probably too aggressive— even if [food tracking] apps say you are being “good.” 

GLP-1 medication generally has a five-day shelf life, so it’s normal to feel a little hungrier in the days prior to your next injection. If you don’t get hungry before your next jab, the dosage is too aggressive. 

“Dose the medication so appetite is reduced, not erased,” says Damaj.

WHAT SHOULD YOU EAT AND WHEN? 

When your appetite increases prior to your injection, it’s essential to use that time to load up on vegetables and minerals you may not feel like eating during the week. 

Women need to eat a minimum of 25g protein with every meal, counsels Damaj. Look to lean sources such as ground beef, eggs, egg whites, chicken and turkey for nutrient-dense options. Creating a roster of go-to foods helps take the guesswork out of it, especially when appetite suppression curbs inspiration. 

As the body loses weight, food needs can change. “The answer is not to simply further restrict food and continue eating smaller and smaller portions,” says Damaj. The scale might drop two pounds, but ultimately that’s not successful. “Make small adjustments to carbohydrate and total calories intake. Keep protein high and fats adequate enough to support satiety, hormones, and diet quality.”

HOW DO I EAT TO FUEL TRAINING AND WEIGHT LOSS? 

Women taking this medication need to strength train to prevent muscle loss, but strength training can cause a more extreme deficit that can lead to major underfueling. Achieving the deficit needed for GLP-1 medication to work and adequately fueling workouts can feel contradictory: achieving the right balance is another delicate dance. 

Damaj has created an easy-to-remember framework. 

“Instead of obsessing over one perfect calorie number per meal, I would give women this simple guide,” she counsels.

“If you are training three days per week, most meals will often land somewhere around 350 to 450 calories, built around 30 to 40 grams of protein, a real serving of produce or fiber, and enough fats and carbs to make the meal hormonally and physiologically useful. Even during fat loss phases, you need at least 50 grams of dietary fat per day to support hormonal health.

If you are training five days per week, meals often need to land a bit higher, more like 400 to 550 calories, with the increase usually coming from carbohydrates rather than fats. That is not because five training days requires some dramatic bulk. It is because women who train more need a little more fuel to recover.” If you’re properly fueled, you’ll also enjoy your workouts.

HOW DOES GLP-1 MEDICATION IMPACT MY PERIODS?

Our menstrual cycle can wreak havoc on our hormones, and while women are becoming more self-aware around how they feel during different phases—often powered by period-tracking technology like Natural Cycles and Oura—this can be harder to gauge when taking a GLP-1 drug. 

“During the luteal phase, many women naturally experience slightly higher energy needs and stronger carbohydrate or fat cravings,” says Damaj. Women have gotten used to the “clockwork chocolate cravings” right before their periods. “It’s scientifically proven!” says Damaj. 

But the medications can override your natural menstrual cycle cues, meaning your blunted appetite suppresses those cravings for sugar, fats and comfort despite your body still being in need. 

“During this phase, I often encourage slightly higher carb and fat intake and slightly lower training intensity if your body is asking for it,” she says. “Understanding this rhythm becomes even more important when hunger cues are muted by medication.”

Awareness is key. Try jotting down notes for each day of your cycle for a few months. Having visibility could unlock your personal pattern so you can better gauge your needs. 

“Remember, anytime we take a medication that mutes a biological signal, we need to sharpen intellectual awareness around it,” says Damaj. “If you’re on pain medication, you may not notice a cut on your leg. If you’re on an appetite suppressant medication, you may not notice when you require more food.”

HOW DOES GLP-1 IMPACT PERIMENOPAUSE?

Many women are finding GLP-1 medication reduces their symptoms. During perimenopause, estrogen levels begin to fluctuate and eventually decline. Estrogen is relevant to the GLP-1 conversation because it influences how fat is distributed in the body. “I’ll take mine in the hips and glutes, please,” jokes Damaj. 

Typically, women experiencing perimenopause find they gain weight, and it’s often around their abdomen. “This is more strongly associated with insulin resistance,” says Damaj. GLP-1 drugs can help reverse some of this weight gain, while improving insulin sensitivity and, through weight loss, reduce overall visceral adipose tissue. Menopause is also said to increase systemic inflammation, which GLP-1 medication can reduce. 

Perimenopause also increases the loss of muscle, which starts declining in women over the age of 40 “unless they actively train to preserve it,” says Damaj. “Muscle is a metabolic sponge for glucose; when muscle mass declines, the body’s ability to regulate blood sugar declines with it. Combine declining estrogen, reduced muscle mass, and disrupted sleep… you have a perfect storm for insulin resistance. Which is exactly why resistance training becomes non-negotiable,” she says. 

GLP-1s do not minimize the daily side effects, however. Hot flushes, night sweats, mood swings and sleep disruption would need to be treated with doctor-approved hormonal therapy. 

HOW MUCH WEIGHT SHOULD I BE LOSING? 

“Losing about half a pound to one pound per week while maintaining strength is generally a healthier trajectory than rapid weight loss that sacrifices muscle,” says Damaj. It’s a slower process for sure, but it’s the one that’s most sustainable and which will allow your body to naturally adapt to a lower calorie intake. It could also reduce skin laxity, if skin can adapt over time. 

HOW TO KNOW IF YOU’RE LOSING MUSCLE OR FAT? 

DEXA scans, which offer detailed metrics including body fat and muscle mass, are helpful for those taking a GLP-1 medication. Why? As weight declines, the number on a traditional scale lacks context: women could drop pounds or even kilograms but standard scales offer no information about whether this is a loss of muscle or a loss of fat. 

DEXA scans can cost $250 per time, but at-home weighing scales now offer comparative data; they’re ideal for your weekly check in. They’re also helpful for women who are regularly training and those wanting to drop a few pounds during a short-term caloric deficit. 

“I strongly suggest anyone on a GLP (or, in fact, every woman) get a BIA (bioimpedance analysis scale) to assess body fat percentage and skeletal muscle mass instead of total body weight exclusively,” says Damaj. “Trends matter more than specific data points. You can get a BIA scale on Amazon anywhere from $20-$400.” 

WHAT HAPPENS WHEN YOU COME OFF A GLP-1 MEDICATION?

“Most women regain weight after stopping them if their behavior and habits don’t change,” says Damaj. 

“When nutrition, resistance training, and behavioral coaching are integrated with GLP use, most clients maintain their results after stopping the medication. When weight loss occurs without those changes, rebound weight gain is near guaranteed. For the best outcome, look to build sustainable, long-term habits that will continue to empower you. Behaviour is the key to long term success,” says Damaj. 

Editorial disclaimer:

This article is for informational purposes only—even if it includes insights from medical professionals, fitness experts, nutrition specialists, or other wellness advisors. It is not a substitute for medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider before making any changes to your diet, exercise routine, supplement or medication regimen, or lifestyle habits. We make no guarantees about the effectiveness or safety of the strategies, products, or services mentioned. Never disregard professional medical advice or delay seeking it because of something you have read in this article. Your reliance on any information provided by Danimás is solely at your own risk. In no event will Danimás be liable for any loss or damage, including, without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever, arising from the use of or reliance on any information provided in this article.