Menopause & Weight Loss
Can Wegovy Help Menopause Weight Gain?
Quick Answer: Yes — Wegovy (semaglutide 7.2 mg) can be an effective treatment for menopause-related weight gain. It addresses several of the key biological drivers of weight gain during the menopausal transition, including amplified hunger signalling, increasing insulin resistance and appetite dysregulation driven by declining hormones. Clinical trial data shows average weight loss of approximately 21% of body weight over 72 weeks — a level of efficacy that diet and exercise alone rarely achieve in this hormonal context. Wegovy is available through GPhC-registered pharmacies in the UK following an online clinical assessment.21%average weight loss at 72 weeks (STEP UP)
1.5 kgaverage annual weight gain during menopause transition
3×greater visceral fat risk post-menopause vs pre-menopause
The Biology
Why Menopause Causes Weight Gain
Menopausal weight gain is one of the most common and most frustrating health changes women experience. It is not simply a consequence of eating more or moving less — though both may be factors. The fundamental driver is a profound shift in the body's hormonal environment that affects where fat is stored, how efficiently calories are metabolised, and how effectively hunger and fullness signals are processed.
Understanding the biology behind menopausal weight gain is important for two reasons. First, it validates the experience of women who are doing everything right but still gaining weight — the problem is physiological, not motivational. Second, it explains why pharmacological interventions like Wegovy, which target these biological mechanisms directly, are increasingly recognised as a clinically appropriate tool for this life stage.
Oestrogen Decline and Fat Redistribution
Oestrogen plays a central role in regulating where the body preferentially stores fat. In premenopausal women, oestrogen promotes adipose tissue accumulation in the hips, thighs and buttocks — a subcutaneous fat distribution associated with lower metabolic and cardiovascular risk. As oestrogen declines during perimenopause and menopause, this protective distribution pattern breaks down.
The result is a progressive migration of adipose tissue from peripheral subcutaneous depots to visceral stores — the deep abdominal fat that surrounds internal organs. Visceral fat is metabolically active: it releases pro-inflammatory cytokines, contributes to insulin resistance, and is independently associated with increased risk of type 2 diabetes, cardiovascular disease and certain cancers. Research demonstrates that women can experience a meaningful increase in visceral adiposity even without any change in total body weight during the menopausal transition.
Slowing Metabolic Rate
Resting metabolic rate (RMR) — the number of calories the body burns at rest — declines with age for both men and women, but the menopausal transition accelerates this decline in women. Two mechanisms are principally responsible. First, declining muscle mass (sarcopenia) reduces the amount of metabolically active lean tissue in the body. Second, changes in thyroid function and other metabolic regulators associated with oestrogen decline further reduce basal energy expenditure.
The practical consequence is significant: a woman at 50 may require 200–300 fewer calories per day to maintain the same weight she carried at 35, even if her activity level has not changed. Without accounting for this shift, weight gain is almost inevitable on a previously stable diet — not because willpower has failed, but because the biology has changed.
Insulin Resistance
Insulin resistance — reduced sensitivity to the hormone that regulates blood glucose uptake — increases progressively during the menopausal transition. Oestrogen has insulin-sensitising effects; as it declines, the body requires progressively more insulin to maintain normal blood glucose. Elevated insulin promotes fat storage and makes fat mobilisation harder. This is one of the reasons abdominal fat accumulates preferentially during and after menopause.
Sleep Disruption and the Hunger Hormone Cascade
Hot flushes, night sweats, anxiety and progesterone decline collectively devastate sleep quality during the menopausal transition. Chronic sleep deprivation has well-documented effects on the hormonal systems that regulate hunger and satiety. Ghrelin — the hormone that stimulates appetite — rises with poor sleep; leptin — which signals fullness to the brain — falls. The result is a physiological drive toward overconsumption that operates independently of the individual's conscious intentions. Women experiencing significant sleep disruption during menopause are fighting an uphill battle against their own hormones simply to maintain a stable food intake.
The Menopausal Weight Trap: The convergence of declining oestrogen (redistributing fat to the abdomen), reduced metabolic rate (requiring fewer calories), increasing insulin resistance (promoting fat storage) and disrupted sleep (amplifying hunger hormones) creates a perfect storm for weight gain. Addressing only one of these factors through diet or exercise is rarely sufficient — which is why many women find that approaches which worked before menopause are no longer effective.
Appetite & Hormones
How Menopause Disrupts Appetite Regulation
Appetite is not simply a matter of willpower. It is a complex biological system governed by hormones, brain chemistry and metabolic signalling. Menopause disrupts this system at multiple points simultaneously, creating a state in which the biological drive to eat is elevated even as the body's ability to utilise calories efficiently declines.
The GLP-1 Deficit
Glucagon-like peptide-1 (GLP-1) is a gut-derived hormone released after eating that signals fullness to the brain, slows gastric emptying and reduces appetite. Research suggests that GLP-1 responsiveness may be reduced in women with higher levels of visceral adiposity — precisely the body composition pattern that menopause drives. This creates a biological scenario in which the natural satiety mechanism becomes less effective just as food cravings and hunger increase through other hormonal pathways.
This is where Wegovy's mechanism of action is particularly relevant: by providing a pharmacological dose of a synthetic GLP-1 analogue, it bypasses the blunted natural GLP-1 response and reinstates a robust satiety signal — restoring a degree of physiological appetite control that the body's own systems can no longer reliably provide.
Progesterone, Cravings and Comfort Eating
Progesterone has mood-stabilising and appetite-modulating effects. Its decline during perimenopause removes a natural buffer against food cravings — particularly for high-carbohydrate, high-fat foods that activate dopamine reward pathways. This is not emotional eating in the pejorative sense; it is a neurobiologically mediated response to hormonal change. The brain is seeking dopamine through food because other neurobiological sources of mood regulation have been destabilised by progesterone decline.
Women experiencing progesterone-driven cravings during perimenopause often describe a qualitative change in their relationship with food — finding it harder to resist specific foods, eating past fullness more readily, and experiencing less satisfaction from previously enjoyable meals. These are symptoms of a disrupted neurobiological system, not character failings.
Cortisol and Stress-Driven Appetite
The psychological demands of the menopausal transition — including mood disruption, identity change, anxiety and disrupted sleep — activate the body's stress response, elevating cortisol chronically. Cortisol directly stimulates appetite, particularly for high-calorie comfort foods, and promotes fat storage around the abdomen. Women who are simultaneously experiencing perimenopause and significant life stressors are particularly vulnerable to cortisol-driven weight gain.
Why Diets Fail
Why Traditional Diets Often Fail During Menopause
One of the most important conversations in menopause-related weight management is the honest acknowledgement that conventional dietary approaches — calorie counting, low-fat diets, intermittent fasting — frequently produce disappointing results in this life stage, even for women who have used them successfully in the past. There are clear biological reasons for this.
The Adaptive Thermogenesis Problem
When calorie intake is significantly restricted, the body responds by reducing its metabolic rate — a survival mechanism known as adaptive thermogenesis. For younger women with higher baseline metabolic rates, this adaptation is less immediately problematic. For perimenopausal and menopausal women whose RMR is already declining, the metabolic response to calorie restriction can be rapid and severe, meaning that the calorie deficit required to lose weight becomes a moving target that is progressively harder to achieve through dietary restraint alone.
Wegovy sidesteps this problem by working through appetite reduction rather than conscious calorie restriction. The body does not perceive semaglutide's appetite-suppressing effect as a starvation signal in the same way it does deliberate dietary restraint, which means the pronounced adaptive metabolic response that sabotages conventional dieting is less likely to occur.
The Role of Ultra-Processed Foods
Ultra-processed foods are engineered to override satiety signals — combining fat, sugar, salt and texture in ways that maximise palatability and minimise the brain's fullness response. For women whose natural satiety signalling is already compromised by declining GLP-1 responsiveness and disrupted leptin signalling, the environment of highly palatable ultra-processed foods is particularly difficult to navigate without pharmacological support. Wegovy does not eliminate the palatability of ultra-processed foods, but it substantially reduces the intensity of cravings for them — giving patients a meaningful biochemical advantage in their food environment.
| Myth | Fact |
|---|---|
| Menopause weight gain is just about eating too much. Eat less, lose weight. | Hormonal changes alter fat distribution, metabolic rate and appetite signalling independently of calorie intake. Many women gain weight during menopause without increasing their food intake at all. |
| If you exercise enough, you can outrun menopausal weight gain. | Exercise is essential for health and body composition but is insufficient as a solo intervention. Resistance training preserves muscle mass; aerobic exercise supports cardiovascular health — but neither reverses declining oestrogen's effect on fat distribution. |
| Calorie restriction works for everyone regardless of hormonal status. | Severe calorie restriction triggers adaptive thermogenesis — the body reduces its metabolic rate in response. In women with already declining RMR, this metabolic adaptation is particularly rapid and pronounced, making sustained calorie restriction progressively less effective. |
| Weight gain during menopause is inevitable and nothing can be done. | Significant, clinically meaningful weight loss during menopause is achievable with appropriate support. Wegovy's clinical trial data — generated in a population whose mean age was 46 and majority were women — demonstrates average weight loss of 21% of body weight over 72 weeks. |
How Wegovy Helps
How Wegovy Works for Menopause Weight Gain
Wegovy (semaglutide 7.2 mg) is a GLP-1 receptor agonist — a synthetic version of the gut hormone GLP-1 that is active at a pharmacological dose for approximately one week after each injection. Its mechanisms of action address several of the specific biological challenges that drive menopausal weight gain.
Slowing Gastric Emptying
Wegovy slows the rate at which food moves from the stomach into the small intestine — a process called gastric emptying. This prolongs feelings of fullness after meals, reduces the speed at which glucose enters the bloodstream, and diminishes the desire to eat again shortly after a meal. For women experiencing the accelerated gastric emptying and reduced satiety associated with declining GLP-1 responsiveness, this effect is particularly beneficial.
Central Appetite Regulation
Beyond its peripheral gut effects, semaglutide acts on GLP-1 receptors in the hypothalamus and brainstem — areas of the brain directly involved in appetite regulation and food reward. This central action reduces not just the physical sensation of hunger but also the psychological preoccupation with food and cravings for high-calorie foods. Women who describe an obsessive quality to their food thoughts during perimenopause frequently report that this mental noise diminishes substantially on Wegovy — often within the first two to four weeks of treatment.
Improving the Metabolic Environment
By improving insulin sensitivity and reducing post-meal glucose excursions, semaglutide directly counteracts one of the key metabolic barriers to weight loss in menopausal women. Lower insulin levels reduce the physiological drive toward fat storage, while improved glucose metabolism supports more stable energy levels and reduces the blood sugar fluctuations that drive mid-afternoon hunger and cravings.
Appetite Suppression
GLP-1 receptor agonism directly counters the hormone-driven appetite increase of menopause — reducing hunger signals in the brain and gut simultaneously.
Insulin Sensitivity
Semaglutide improves insulin sensitivity and reduces post-meal glucose spikes — directly addressing the worsening insulin resistance driven by oestrogen decline.
Visceral Fat Reduction
Clinical trials show significant waist circumference reductions — targeting the abdominal fat that accumulates most aggressively after menopause.
Clinical Evidence
Clinical Evidence: Wegovy and Menopausal Women
The STEP clinical trial programme provides the primary evidence base for Wegovy's efficacy. While none of the STEP trials specifically targeted menopausal women, the demographics — with a mean participant age of 46 years, the majority female, and a substantial proportion likely to be in perimenopause or post-menopause — mean that the trial results are broadly representative of this group.
Real-World Evidence
Post-approval real-world data from UK and international clinical settings confirms that menopausal women represent a significant proportion of Wegovy users, and that outcomes in this population are consistent with trial results. Clinicians report that menopausal women often find Wegovy particularly impactful because the appetite suppression addresses one of their most significant barriers — the amplified hunger and cravings that have resisted dietary efforts — in a way that diet modification alone cannot.
What the Evidence Does Not Show
Wegovy does not reverse the hormonal changes of menopause, nor does it restore the body composition of premenopause. It does not specifically target hormonal imbalances, and it is not a treatment for menopausal symptoms such as hot flushes, night sweats or mood changes. What it does is address the downstream consequences of those hormonal changes on appetite, fat storage and metabolic function — making it a complementary tool in a broader approach to menopausal health rather than a standalone solution.
| Outcome | Semaglutide 7.2 mg | Placebo | Relevance for Menopause |
|---|---|---|---|
| Mean weight loss at 72 weeks | ~21% | ~2.4% | Clinically meaningful in a majority-female, middle-age population |
| Waist circumference reduction | Significant | Minimal | Directly targets menopausal visceral fat accumulation |
| Systolic blood pressure | Significant reduction | Minimal | Relevant as CVD risk rises sharply post-menopause |
| HbA1c / glucose control | Significant improvement | Minimal | Addresses menopausal insulin resistance |
| Achievement of ≥5% loss | >9 in 10 patients | ~4 in 10 | Most patients achieve clinically meaningful weight loss |
| Achievement of ≥25% loss | ~1 in 3 patients | ~0% | A significant proportion achieve near-surgical outcomes |
| Weight loss from body fat | ≥84.5% of loss | Lower proportion | Preserves lean mass — key for menopausal bone and metabolic health |
Broader Benefits
Benefits Beyond Weight Loss for Menopausal Women
For menopausal women, the clinical benefits of Wegovy extend significantly beyond the number on the scales. Weight loss — particularly the reduction in visceral fat — has a cascade of positive effects on the health conditions that become more prevalent during and after menopause.
Cardiovascular Health
Post-menopausal women face significantly elevated CVD risk as the cardioprotective effects of oestrogen decline. The SELECT trial (2023) demonstrated a 20% reduction in major cardiovascular events in overweight adults on semaglutide.
Blood Glucose Control
Improving insulin sensitivity and reducing visceral fat on Wegovy reduces the risk of progression from insulin resistance to type 2 diabetes — a particular concern as oestrogen declines.
Joint Health
Excess weight compounds the joint inflammation associated with oestrogen decline. Meaningful weight loss reduces joint load; patients frequently report significant improvement in knee, hip and lower back pain.
Sleep & Mental Wellbeing
As weight decreases, sleep-disrupting conditions including sleep apnoea and reflux improve, creating a positive cycle. Patients consistently report reduced food preoccupation and improved mood alongside weight loss.
Metabolic Syndrome Risk
Improvements in waist circumference, blood pressure, fasting glucose and lipid profiles collectively reduce the risk of metabolic syndrome — a cluster of conditions whose prevalence rises sharply post-menopause.
Psychological Benefits
For women who have experienced their weight as a source of shame or loss of control during menopause, the psychological benefits of meaningful weight loss — improved confidence, sense of agency — are clinically significant.
Expected Results
Expected Results for Menopausal Women on Wegovy
Menopausal women can expect broadly similar weight loss outcomes to those reported in the STEP trials overall. The hormonal context of menopause may influence the pace and pattern of results — with some women experiencing a less linear trajectory due to ongoing hormonal fluctuation — but does not prevent meaningful, sustained weight loss.
Managing Expectations During Hormonal Fluctuation
Women in active perimenopause — where oestrogen and progesterone levels fluctuate significantly from week to week — may notice that their weight loss on Wegovy is less linear than the trial averages suggest. Periods of hormonal shift can temporarily affect fluid retention, appetite signalling and fat mobilisation, producing apparent plateaus that do not reflect a failure of treatment. Understanding this hormonal variability helps patients stay committed through the fluctuations rather than interpreting them as evidence that Wegovy is not working.
The Importance of Lifestyle Support
Wegovy produces its best results when used alongside a supportive lifestyle approach. For menopausal women, the most important adjunctive strategies are resistance exercise (to preserve and rebuild lean muscle mass), adequate protein intake (at least 1.2 g per kilogram of body weight daily), sleep hygiene measures to reduce the impact of menopausal sleep disruption, and stress management practices to mitigate cortisol-driven appetite. These are not prerequisites for Wegovy to work — but they substantially amplify its effect and improve the quality of weight lost.
| Timepoint | Expected Weight Loss | What You May Notice |
|---|---|---|
| Weeks 1–4 | 1–3 kg | Reduced appetite and food cravings; less preoccupation with food between meals |
| Month 3 | 5–7% | Noticeable weight reduction; clothing size beginning to change; improved energy |
| Month 6 | ~10% | Visible abdominal changes; improved metabolic markers; better sleep in many patients |
| Month 12 | ~14–15% | Full treatment effect; sustained weight loss; significant cardiovascular and metabolic improvements |
| Month 12+ | Stabilises | Weight maintained with continued treatment; ongoing metabolic benefits |
Maximising Wegovy Results During Menopause
- Prioritise protein — aim for 1.2–1.5 g per kg of body weight daily to preserve muscle mass
- Incorporate resistance training 2–3 times per week to counteract sarcopenia
- Address sleep disruption — discuss HRT, sleep hygiene or other strategies with your GP
- Minimise alcohol — it impairs sleep, elevates cortisol and adds empty calories
- Manage stress actively — chronic cortisol elevation partially counteracts appetite suppression
- Stay consistent with weekly injections — essential for sustained appetite control
- Review HRT status with your GP — combined HRT and Wegovy can be complementary strategies
Wegovy & HRT
Wegovy and HRT: The Oral Progesterone Consideration
There is no known pharmacokinetic interaction between semaglutide and HRT. However, an important practical consideration applies to women taking oral progesterone tablets (such as Utrogestan, norethisterone or medroxyprogesterone acetate) as part of their HRT regimen.
Because semaglutide slows gastric emptying, it may reduce the absorption of oral progesterone, potentially leading to irregular bleeding and reduced womb lining protection — which over time could increase the risk of endometrial cancer. This concern does not apply to non-oral forms of progesterone delivery.
Women taking oral progesterone as part of HRT should discuss their options with their prescribing clinician before starting Wegovy. Options include:
- Mirena coil (IUS) — considered the ideal option in most cases; provides progestogenic womb protection for up to 5 years and is also contraceptive
- Combined HRT patch — delivers both oestrogen and progestogen transdermally, bypassing the gut entirely
- Increased oral progesterone dose — a higher dose may be recommended for at least 4 weeks after starting or increasing Wegovy
- Vaginal progesterone — not formally licensed for this purpose but commonly used in practice
Key Questions
Key Questions Answered
Does Wegovy help menopause weight gain?
Yes. Wegovy addresses several of the biological mechanisms that drive menopausal weight gain. It restores appetite control in women whose natural satiety signalling has been disrupted by declining GLP-1 responsiveness and hormonal changes; it improves insulin sensitivity to counteract the metabolic consequences of falling oestrogen; and it produces significant reductions in visceral adiposity — the abdominal fat that accumulates most aggressively after menopause. Clinical trial data shows average weight loss of approximately 21% of body weight over 72 weeks in a population representative of perimenopausal and post-menopausal women. It does not reverse the hormonal changes of menopause but effectively addresses their downstream effects on weight and metabolic health.
Why does menopause cause weight gain?
Menopause causes weight gain through several interacting mechanisms. Declining oestrogen drives fat redistribution from the hips and thighs to the abdomen, increasing visceral fat accumulation even without changes in overall body weight. Falling oestrogen also reduces insulin sensitivity, promoting fat storage and making weight loss harder. Declining muscle mass (sarcopenia) reduces resting metabolic rate, meaning fewer calories are needed to maintain weight than before. Disrupted sleep — driven by hot flushes, night sweats and declining progesterone — raises cortisol and hunger hormones while reducing leptin (the fullness signal). And declining progesterone removes a natural appetite buffer, intensifying food cravings. The convergence of these changes creates a biological environment in which weight gain is almost inevitable without deliberate intervention.
Is Wegovy suitable during menopause?
Yes. Wegovy is suitable for menopausal women who meet the standard clinical eligibility criteria: a BMI of 30 or above, or 27 or above with at least one weight-related comorbidity. Menopause itself is not a contraindication. Women taking HRT can take Wegovy concurrently — there is no known pharmacokinetic interaction between semaglutide and HRT (though women on oral progesterone should discuss this with their clinician — see above). Some safety considerations specific to this life stage — including bone density monitoring, cardiovascular health and thyroid history — should be discussed during the clinical assessment.
FAQs
Frequently Asked Questions: Wegovy and Menopause Weight Gain
Yes. Wegovy addresses several of the key biological mechanisms that drive menopausal weight gain — particularly disrupted satiety signalling, worsening insulin resistance and visceral fat accumulation. Clinical trial data from STEP UP shows average weight loss of approximately 21% of body weight over 72 weeks in a population representative of menopausal women.
Yes. Perimenopause is not a contraindication to Wegovy. Women in the perimenopausal transition who meet the BMI eligibility criteria and have no clinical contraindications may be prescribed Wegovy following assessment. Active hormonal fluctuation may produce a less linear weight loss trajectory but does not prevent the treatment from working.
For most HRT formulations, yes. However, women taking oral progesterone tablets (Utrogestan, norethisterone or medroxyprogesterone acetate) should discuss alternatives with their prescribing clinician before starting Wegovy, as semaglutide's slowing of gastric emptying may reduce oral progesterone absorption. Options include the Mirena coil, a combined transdermal HRT patch, or increased oral progesterone dose. Non-oral forms of progesterone are not affected.
Yes. Weight loss on Wegovy includes a clinically significant reduction in visceral abdominal fat. STEP 1 trial participants experienced average waist circumference reductions of 13.54 cm. Visible abdominal changes are frequently among the first physical results patients notice, often before total scale weight reflects the full extent of visceral fat loss.
Wegovy works through a fundamentally different mechanism than dietary restriction. Rather than requiring conscious calorie counting, it restores physiological appetite regulation — reducing hunger and cravings at a neurobiological level. This is particularly significant for menopausal women whose natural satiety signals have been disrupted by hormonal changes. It also avoids the pronounced adaptive thermogenesis (metabolic slowdown) that sabotages conventional dieting.
Wegovy reduces cravings for high-calorie comfort foods by acting on GLP-1 receptors in the brain's reward pathways. Many patients describe a significant reduction in the psychological pull of food — less intrusive food thoughts, reduced craving intensity and improved ability to stop eating when comfortable. This is beneficial for women whose eating patterns are driven by progesterone-related mood changes or cortisol-driven stress responses.
The SELECT trial (2023) demonstrated a 20% reduction in major cardiovascular events in overweight adults on semaglutide — making it the first weight loss medication to show such a benefit. For post-menopausal women with elevated cardiovascular risk, Wegovy may therefore offer additional benefits beyond weight loss. Specific cardiovascular risk factors should be disclosed and assessed during the clinical prescribing process.
Weight loss can affect the distribution and metabolism of oestrogen in the body. Women taking HRT who lose significant weight on Wegovy should inform their GP or menopause specialist, as an HRT dose review may be appropriate. This is a routine clinical consideration rather than a contraindication. Women on oral progesterone should be particularly vigilant — see the oral progesterone note above.
Wegovy is intended as a long-term treatment for chronic weight management. The STEP 4 trial showed patients regained approximately two-thirds of lost weight within 12 months of stopping. For menopausal women who face ongoing hormonal drivers of weight gain, maintaining treatment as long as it remains clinically appropriate is generally recommended.
Wegovy does not treat hot flushes, night sweats or other primary menopausal symptoms directly — HRT remains the most effective treatment for these. However, as weight decreases on Wegovy, some associated symptoms may improve: sleep apnoea, joint pain, fatigue and the mood effects linked to poor sleep quality often reduce alongside weight loss. Women with significant menopausal symptoms should discuss HRT with their GP.
The standard clinical eligibility criteria apply regardless of menopausal status: a BMI of 30 or above, or 27 or above in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes, sleep apnoea or dyslipidaemia. Happy Pharmacy's free online assessment will confirm eligibility based on your individual circumstances.
Yes. Post-menopausal women who meet the eligibility criteria can be prescribed Wegovy. The absence of ongoing hormonal fluctuation in post-menopause often means that weight loss trajectory is more consistent than during active perimenopause. Bone density considerations and cardiovascular risk factors should be discussed as part of the assessment for post-menopausal patients.
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