GLP-1s and Perimenopause: What Women Need to Know, with Dr Jana Pittman

There’s a moment many women describe during perimenopause that feels both confusing and confronting.

“I’ve never struggled with my weight before … and now nothing seems to work.”

Not the gym.
Not cutting calories.
Not reducing carbs.
Not the routines that once felt reliable.

In this podcast episode, women’s health doctor and former Olympian Dr Jana Pittman sits down with Dr Angela Kwong, GP and Founder of Enlighten Me, to unpack what’s really happening beneath the surface and why conversations around GLP-1 medications, metabolic health and perimenopause need far more nuance than social media soundbites often allow.

Why Perimenopause Can Feel Like a Metabolic Turning Point

Perimenopause isn’t just about hot flushes, disrupted sleep or mood changes although those experiences are very real.

It’s also a time of significant metabolic change.

As oestrogen levels begin to fluctuate and decline, many women move into a phase of increasing insulin resistance. This often occurs well before someone meets the diagnostic criteria for type 2 diabetes, yet it can profoundly affect how the body stores fat, responds to food, and regulates energy.

This is why women often notice:

• weight gain despite unchanged habits
  
  
• more fat accumulating around the waist
  
  
• changes in body shape that feel unfamiliar
  
  
• blood sugar markers creeping up over time
  
  

For many, it’s the first time their body stops responding the way it always has and that can be deeply unsettling.

BMI Isn’t the Whole Story

One of the most important themes in this conversation is the reminder that BMI is not a moral judgement and it often doesn’t reflect the full picture.

Dr Jana shares her own experience of reaching a BMI of 28 alongside a raised HbA1c, a combination that signalled increasing metabolic risk even though she remained active and health-literate.

As Dr Angela explains, two people with the same BMI can have very different health trajectories.

What matters more is the whole context:

• blood results
  
  
• medical and hormonal history
  
  
• family risk factors
  
  
• symptoms and quality of life
  
  
• where health is likely to head next
  
  

The goal isn’t a perfect number on a scale. It’s long-term health, function and wellbeing.

What Are GLP-1s, Really?

GLP-1 medications were originally developed for type 2 diabetes, but their role has expanded as our understanding of insulin resistance has evolved.

In the podcast, Dr Angela explains that GLP-1s work across multiple systems in the body.. not just appetite.

At the level of the brain

GLP-1s can reduce appetite and, importantly, quiet “food noise” - the constant mental pull towards food that many people experience.

For many patients, this is the most profound change: not a loss of willpower, but a sense of mental relief.

In the stomach and gut

GLP-1s slow digestion and delay gastric emptying, meaning food stays in the stomach longer. This can increase fullness, but may also cause side effects like nausea, reflux or bloating in some people.

In the pancreas

They improve insulin secretion in response to glucose, which helps regulate blood sugar levels - particularly relevant for people with insulin resistance, pre-diabetes, PCOS or perimenopause-related metabolic change.

A key message from Dr Angela is that more is not always better.
The aim is the right dose, for the right person, at the right time.

Can GLP-1s Be Used Short Term?

In Dr Angela’s clinical experience, many patients don’t need a GLP-1 indefinitely.

For a proportion of people, they may be used as a kickstart - a way to reduce food noise, improve metabolic markers, and create space to address the underlying drivers of weight gain.

Those drivers might include:

• untreated thyroid or autoimmune conditions
  
  
• insulin resistance or pre-diabetes
  
  
• nutritional deficiencies
  
  
• disrupted sleep or stress physiology
  
  
• a difficult or restrictive relationship with food
  
  

When those factors are addressed alongside lifestyle support, many people are able to step away from medication over time.

Intermittent Fasting: Helpful - But Not for Everyone

Intermittent fasting often comes up in weight conversations, and this episode offers a refreshingly balanced view.

For some people, particularly those experiencing reduced food noise on GLP-1s, fasting can feel empowering. It allows for deliberate, calm decision-making around meals rather than reactive eating.

For others, however, the combination of fasting and appetite suppression can lead to under-fuelling.

Signs this may be happening include:

• constipation or digestive issues
  
  
• hair thinning or shedding
  
  
• low energy or dizziness
  
  
• loss of muscle mass
  
  
• feeling flat or depleted
  
  

Weight loss that comes at the cost of health is never the goal.

Protein as a Non-Negotiable

One of the most practical takeaways from this conversation is Dr Angela’s simple approach to nutrition - designed for real life, not perfection.

Rather than tracking apps or weighing food, she encourages patients to use hand portions as a guide.

A balanced plate generally includes:

• a palm-sized serve of protein
  
  
• a fist-sized (or smaller) serve of complex carbohydrates
  
  
• half a plate of colourful salad or non-starchy vegetables
  
  
• a thumb-sized serve of healthy fats
  
  

This approach supports muscle mass, metabolic health and satiety - particularly important during perimenopause and when using GLP-1s.

Measuring Progress Beyond the Scales

Another important discussion point is how to track progress without becoming overly fixated on weight.

Options include:

• weighing no more than every three to four weeks
  
  
• measuring waist circumference
  
  
• tracking body composition where appropriate
  
  
• using visual tools or photos over time
  
  

Consistency matters more than the method. Choose an approach that informs rather than undermines your wellbeing.

Our Takeaway

If there’s one message that stands out from this conversation, it’s this:

Perimenopausal weight gain is not a personal failure.
It’s often a physiological shift.

When we understand what’s happening hormonally and metabolically - and approach it with compassion rather than blame - sustainable change becomes far more achievable.

Watch the Podcast Episode

Medical disclaimer
This article is general information only and is not intended as personal medical advice. Please speak with your GP or healthcare team for individual guidance.