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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Ade Akindipe, DNP, APRN (00:26)
If you're on a GLP-1 medication and hormone therapy right now, there's something your doctor probably hasn't mentioned to you. And honestly, it's not because they don't care, it's because the research is moving so fast that most providers simply haven't caught up yet.
Jillian Woodruff MD (00:42)
That's right, we're talking about a real safety gap, one that affects how well your medications actually work inside your body. One of those medications may be quietly undermining the other one, and today we're going to break the whole thing down for you.
Ade Akindipe, DNP, APRN (00:55)
So if you're a woman in midlife taking ⁓ semaglutide, terizepatide, or some more familiar brands you may have heard of like Ozempic, Wacovi, Monjaro, ZepBound, any of those, and you're also on hormone replacement therapy, this episode is essentially listening, so don't go anywhere.
Jillian Woodruff MD (01:12)
Welcome back to the Modern Midlife Collective.
Ade Akindipe, DNP, APRN (01:15)
Okay, so I have to say, Dr. Jill, I've been waiting to record this for a while now because this too brings together two of the biggest conversations in women's health right now.
Jillian Woodruff MD (01:26)
Yeah, it really does. On one hand, we've got millions of women on GLP-1 receptor agonist medications for weight management, and the numbers are, they're just, they're only growing. On the other hand, we've got millions more on hormone replacement therapy as they navigate perimenopause and menopause, and increasingly, women are ending up on both of those at the same time, but almost nobody, and I mean, almost nobody.
is talking about how these two classes of medication interact with each other.
Ade Akindipe, DNP, APRN (01:56)
Yeah, and that gap in that conversation is exactly why we're here today. So we're going to talk about the exciting synergy between GLP-1s and hormone replacement, because yes, there's genuinely exciting data that we're going to share here. The real risks, we're going to talk about the risks that are flying under the radar. And we're going to give practical, specific steps for every woman that they should be taking at the next appointment. Sound good?
Jillian Woodruff MD (02:19)
Yeah, let's get into it.
Okay, so let's set the stage because I context really matters. So, Dr. Adai, when we talk about midlife women and weight, this is absolutely not just a vanity conversation. It's not a vanity conversation. It's really metabolic health. It's a metabolic health conversation, and I want listeners to hear that really clearly.
Ade Akindipe, DNP, APRN (02:41)
Absolutely. ⁓ During the menopausal transition, up to 70 % of women experience clinically meaningful weight gain. And it's not just any weight, it's the fat around the belly, which we call visceral fat. It wraps around your liver, your heart, your intestines. And as you lose estrogen, your ⁓ body fundamentally shifts where it stores fat. So you go from a pear-shaped distribution
to more of an apple-shaped distribution and that fat around the belly is metabolically dangerous. It's inflammatory. It drives insulin resistance. It raises your heart disease risk and in ways that subcutaneous fat simply does not.
Jillian Woodruff MD (03:25)
Right, it's really different than subcutaneous fat that's just, you know, being overweight, having excess fat externally, I guess you would say. Yeah, you're absolutely right. And we really need to say this and be very clear about it because I think it surprises a lot of people. Cardiovascular disease is the number one cause of death in women. And I know we've said that and...
There's a lot of information about it, but there's a lot more, I think, scare tactics about other disease processes. So people don't really think about it in the same way, not the way they should. So it's not breast cancer. It's heart disease. That is the number one cause of death in women and in men, actually. So menopause is an independent risk factor for cardiovascular disease. And that's probably pretty surprising. Estrogen deficiency.
deficiency directly affects lipid metabolism such as cholesterol metabolism, increasing cardiometabolic risk across the board. Beyond that, the menopausal transition is associated with reduction in our lean body mass, that's meaning muscle, and changes in both resting and total
energy expenditure. So the energy that your body uses while at rest or while sleeping and the energy your body uses in its active state changes. So the metabolic engine is literally slowing down while your body is storing fuel in all the wrong places. It's a double hit.
Ade Akindipe, DNP, APRN (04:51)
⁓ And that's why so many women are turning towards GLP medications. I mean all the medications we talked about like your terezapetide and semaglutide. So these medications work really well by mimicking a hormone that we already make in our bodies called glucagon like peptide 1 or GLP 1. And in simple terms, they basically reduce your appetite and help you feel full sooner and for longer time. But what's really exciting is that they go way beyond.
appetite. We're finding more that they provide significant anti-inflammatory benefit. They can help shrink visceral fat specifically. They decrease inflammatory cytokines, are basically, I call them alarm bells that are going off in the body all the time that slowly drive chronic, you know, they signal that there's something going on underneath, which is called chronic inflammation. So they're going really deep and really helping the metabolic
issue. I tell people all the time that weight loss, metabolic health is like the new weight loss. It's important for us to look at just not the number on the scale, but how is your body doing metabolically.
Jillian Woodruff MD (05:58)
Right. I still need to get into your office to do that, that scale, the one that tells you, right, it gives you all of the data. So maybe I am procrastinating a bit because maybe I don't want to know all of those answers about myself.
Ade Akindipe, DNP, APRN (06:10)
Thank
Jillian Woodruff MD (06:13)
So there you go, it's important, right?
Ade Akindipe, DNP, APRN (06:15)
time to come get it done.
Jillian Woodruff MD (06:16)
What does it tell you? Like you're ⁓
Ade Akindipe, DNP, APRN (06:19)
It tells you your body fat, your percent
body fat, your fat mass, visceral fat, your muscle, skeletal muscle mass, which are really important for us. Yeah. Yeah.
Jillian Woodruff MD (06:26)
Cool.
Yep,
that's the one I'm nervous about, the muscle mass. And I think we'll talk about that more. So then back to our subject on the hormone side, we have this huge change. And ⁓ late last year, the FDA removed the black box warning from hormone replacement therapy. So this was found on any estrogen-containing product, whether it was systemic or local or a cream or a pill.
they all have the same black box warning. So after literally decades of fear that was driven largely by the misinterpretation of the Women's Health Initiative study in the early 2000s, we're now finally seeing HRT recognized, or I should say just estrogen-containing products recognized for what the evidence actually shows it can do. Estrogen therapy can attenuate your visceral fat gain by up to 60%.
It improves insulin sensitivity and for the right candidates, it's literally a game changer.
Ade Akindipe, DNP, APRN (07:24)
Mm.
Yeah, and when you put those two together, HRT and a GLP, a GLP-1 that's attacking visceral fat and reducing systemic inflammation, and estrogen that's improving insulin sensitivity, helping fat to storage away from the organs, it starts to make a lot more sense that more and more women are ending up on both medications at the same time. The question becomes though, what happens when these two work together? Is it just additive or is something
more interesting going on.
Jillian Woodruff MD (07:55)
Yes, this is the part I'm genuinely excited about. And there's real data now, not just theory, and not just speculation showing that these medications don't just coexist peacefully, they actually appear to amplify each other.
Ade Akindipe, DNP, APRN (08:09)
Yeah, it sounds like they do. So some of the studies we're looking at, like Mayo Clinic study published in January of this year, found that post-menopausal women using hormone replacement therapy alongside terepidipide lost 35 % more weight than women on terepidipide alone.
Let that sink in, that's quite a bit. 35 % more weight loss, that's not just a marginal difference, this is a clinically significant benefit. So very important to note.
Jillian Woodruff MD (08:39)
Yeah, that's huge. And you shared another study with me from Mayo Clinic data that built on an earlier study published in the journal Menopause that looked at semaglutides specifically. Postmenopausal women on semaglutide plus HRT or hormone therapy experience approximately 30 % more total body weight loss than semaglutide alone.
Jillian Woodruff MD (09:02)
And another study
And even more impressive, that...
30 % advantage held true at every single checkpoint they measured. So three months, six months, nine months, and at one year. The women on the hormone therapy were also significantly more likely to hit those clinically meaningful milestones that we care about. 5 % total body weight loss and 10 % total body weight loss. Critically, this association persisted even after the researchers adjusted for semiglutide dose intensity.
Ade Akindipe, DNP, APRN (09:32)
Wow, that last point really is important. That means it wasn't just that the HR group, the hormone replacement group happened to be on a higher dose of semaglutide, and that's why they lost weight. Something else was going on, something about the combination, it sounds like. So the preclinical data gives us some fascinating clues about what might be going on. Estrogen appears to be directly enhancing the appetite suppression of the GLP-1.
Estrogen and GLPs act on receptors in the brain in the place called the hypothalamus the brain's control center for appetite and metabolism So they're hitting, you know converging signaling pathways that regulate your cholesterol's your glucose metabolism So there may be a true
what we call neurobiologically synergy thing happening by being on a GLP one that we make in our bodies and estrogen that you lose with when you get to menopause.
Jillian Woodruff MD (10:28)
That's such a good point and interesting. I had an interesting conversation with a patient this week and I don't know if you've experienced this or heard this from your patients, but this woman actually did not have hot flashes or night sweats even when she transitioned into menopause, but wanted to start ⁓ estrogen therapy because she's noticed a change in her appetite.
just from estrogen, so she's not on GOPs or anything, it wasn't for weight loss. She just transitioned from the beginning and never went without, but there was a period of time where she couldn't get her estrogen and that's when she recognized that when she wasn't on her estrogen, her appetite changed. Have you seen that with other people that are just doing estrogen?
Ade Akindipe, DNP, APRN (11:12)
Yes,
yes, yes, absolutely. I mean, it makes sense, right? When you lose your estrogen, it's important how that still links to our metabolism and why it makes sense that we almost automatically become insulin sensitive or insulin sensitivity.
Jillian Woodruff MD (11:28)
Insensitive.
Insensitive, yes.
Ade Akindipe, DNP, APRN (11:31)
Not as sensitive. So your blood sugar rises, but then you're not necessarily getting the energy that you need. So you crave more sugar. You have more cravings here, especially for carbs. I find that it's more carbs that they're craving.
Jillian Woodruff MD (11:43)
She said that. She said that exactly, that it was the carbs. she actually is a very healthy eater, a very active person, and it just didn't... it wasn't like her. She said she did not feel like herself. And that was the reason, is because she was just feeling always so hungry. Yeah. So, it really affects some people much more than others and everyone in different ways, but estrogen is just so important to us for so many reasons.
Ade Akindipe, DNP, APRN (12:01)
Wow.
Yeah.
a lot of different reasons. Imagine that for your appetite.
Jillian Woodruff MD (12:13)
Yes. Yeah. Yeah.
And of course, there's some practical downstream mechanisms that we can't ignore. When a woman starts hormone therapy, her sleep often improves dramatically. Her mood is better. Hot flashes, if she was having those, they were waking her up several times a night or she was having night sweats and then not sleeping. And then, of course, you're feeling miserable during the day. And then, of course, your mood is not going to be great, right?
So when a woman feels better, she's sleeping better, she has more stable energy, then she's more likely to exercise. If you have no energy, if there's nothing in the tank, you're not going to be exercising, Unless that's your love language. I know some people, that's what they do, and that's what makes them, yay, feel great. But yeah, you're more likely to be active throughout the day. You're more likely to stay consistent with your good habits. And all of those things feed directly into sustainable weight loss.
So this energy might be partly biological and partly behavioral, which honestly makes it even more compelling.
Ade Akindipe, DNP, APRN (13:14)
Yeah, I agree with you. I think it definitely could be behavioral as well, too. We do lose our GLP-1s, what we normally make in our body. But I wonder, too, if you had the kind of lifestyle, maybe you ate a certain way before you hit perimenopause, if that might, I don't know, impact the way you respond to estrogen loss. But of course, lifestyle is always ⁓ something you have to take into account. But
What I find more interesting too, with all the data that we looked at, was the SIRMOUT trial, which is basically the landmark trials in the terzepatide before it became, of course, FDA approved. It showed that across all reproductive stages, premenopausal women saw 26 % weight loss, perimenopause women saw 23%, postmenopause women, 23%. So we're seeing approximately
20 % weight reduction regardless of what decade of life you're in. So the medication works no matter where you are in the menopause transition. And a data we just discussed suggests that layering hormone replacement therapy on top may make it work even better.
Jillian Woodruff MD (14:26)
I wish more women knew this, that this combination isn't just safe. The early data suggests it may actually be optimal. And that's what we talk all the time about, is really optimization of our health. And, you know, this is big, but here's what we need to pivot to, because there's a critical piece of this puzzle that most prescribers are missing entirely. Like, this is the piece. This is what's missing.
Ade Akindipe, DNP, APRN (14:49)
Yeah, this is
exactly what concerns me because this is the reason we made this episode. If you remember nothing else, remember this segment right here.
Jillian Woodruff MD (14:52)
Hmm.
So the issue, one of the core mechanisms of how GLP-1 medications work is that they slow gastric emptying. That's actually part of their therapeutic effect. They delay how fast your stomach empties its contents into the small intestine and they slow small intestinal motility too. So food sits in your stomach longer and this gives you that feeling of feeling full because there's food sitting there. And so that helps with appetite and portion control. That's great.
But it's not just food that sits in your stomach longer, it's everything else you swallow, including your oral medications.
Ade Akindipe, DNP, APRN (15:33)
and so another study in the, well, the British Menopause Society issued formal guidance specifically addressing this issue. They stated that GLP-1 agonist may reduce the absorption and bioavailability of oral progesterone. So I wanna be very clear though about why that is a safety issue, not just an inconvenience. So let's break it down.
Jillian Woodruff MD (15:54)
Okay, going back to the uterus, so we know we had that whole progesterone, progestogen study. If a woman has an intact uterus and she is on estrogen therapy, we have to protect the uterus from being stimulated with estrogen because this will lead to growth of the uterine lining. If you're not having your period, then that can lead to an increased risk of the thickness of the lining, increased risk of uterine cancer. So you need that.
progesterone component of hormone therapy if you have a uterus. So if you do not have adequate progesterone or progestogen, the estrogen will stimulate that lining, grows over time, unopposed, and can lead to what we said. So this is a known issue and progesterone decreases that risk. It's a safety mechanism.
Ade Akindipe, DNP, APRN (16:45)
So now imagine this scenario where a woman is taking oral estrogen and oral progesterone, swallowing both pills at the same time. She starts a GLP medication. The GLP slows her gut down significantly. The oral progesterone pill is now sitting in a sluggish stomach, not being absorbed the way it might be designed to be. She may not be reaching therapeutic levels of the progesterone in her bloodstream. So she thinks she's protected.
Her doctor thinks she's protected, but the endometrial safety net may have a hole in it, so she may not be getting the right amounts of progesterone to counter the estrogen that she's getting.
Jillian Woodruff MD (17:24)
Yeah, there's concrete data about this. Teresepatide has been specifically shown to reduce combined oral contraceptive availability, so oral birth control pills that you've taken. Peak concentration of it in the bloodstream, the C max, they call it, was reduced by 55 to 60%. And then the overall drug exposure, which they call the AUC, was reduced by 16 to
23%, I believe, those are substantial reductions. So, this was studied with oral birth control specifically. The mechanism is the same for oral progesterones used in hormone therapy or hormone replacement therapy. So, if the gut is moving slower, anything you're taking in orally, the absorption drops. So, let's say you're taking estrogen topically, but systemic estrogen topically, and then you're taking your oral progesterone.
your systemic estrogen may be going up because nothing's slowing that down and then you don't have enough progesterone to protect the uterus.
Ade Akindipe, DNP, APRN (18:27)
Yeah, I actually had a patient example. She had called and she currently is on a GLP, specifically the terizepatide. And she'd been stable, you she'd been doing well. She takes the oral estrogen progesterone, you know, no issues. Of course, when she started the terizepatide, she started to have irregular, unscheduled bleeding. So while we investigated, you know, make sure that it's, you know, nothing else going on, make sure that she's got the imaging to check that. It simply was the oral estrogen.
progesterone that was the problem. She just wasn't getting enough of it to provide the endometrial protection that she needed.
Jillian Woodruff MD (19:03)
Yeah, that's exactly the scenario the British Menopause Society is talking about. But there's solutions, so this is very manageable once you know about it, and the recommendations are pretty clear. So if a woman is starting a GLP-1 medication, strongly consider switching from oral products, right, to topical products, transdermal products, creams, patches, anything that is just not going through your mouth. So transdermal...
delivery bypasses the gut entirely, so completely unaffected by gastric emptying speed. And as a bonus, transdermal estrogen is also associated with lower blood clotting risks, so blood clots in your legs or blood clots in your lungs or stroke, you know. This is really relevant in women with obesity because they have higher risks of blood clots.
Ade Akindipe, DNP, APRN (19:49)
Absolutely, that's a great point. And then for the progesterone component, the preferred option is levonorgestrel releasing IUD, which is the Marena being the most well known. Marena delivers progesterone directly to the uterus. It's completely unaffected by what's happening in the gut because it never passes through the gut at all. It provides excellent, reliable endometrial protection. And for perimenopausal women who still need contraception,
Jillian Woodruff MD (19:58)
Mm-hmm.
Ade Akindipe, DNP, APRN (20:16)
it's double duty. So other non-oral progesterone progesterone options include the combined estrogen progesterone patch or vaginal progesterone.
Jillian Woodruff MD (20:26)
Yeah, I love those. I love doing the IUD because it's so easy to do, right? You just put it on. It's a little bit of a conversation, you know, when you're talking to, let's say, a 60-year-old woman, you're like, let's give you a IUD, some birth control, and they think you're nuts, right? But they love it because you have, you know, 20 seconds of discomfort and then years of uterine protection and not worrying. Important to mention, though, we did that whole
Ade Akindipe, DNP, APRN (20:31)
Yes.
Jillian Woodruff MD (20:54)
about progesterone, so if you haven't watched it, go back and do so, because we did talk about a lot of the benefits. There are other, you know, benefits to oral that you may not get in other forms, but this is... if we're talking specifically about uterine protection, excellent. And also those other benefits you may be getting with that use of the GLP-1s with the progesterone, right? I also love vaginal progesterone.
just the same little pill you put in your mouth, you can stick it up in the vagina. And I actually like that better for, not better than the IUD, I love the IUD, but better for my ⁓ obese ladies using, because sometimes with just obesity in general, they're not on any other medications, their uptake of progesterone or their absorption is not as good. And so it really helps with that.
Ade Akindipe, DNP, APRN (21:41)
Yeah.
And it probably also bypasses the whole, if you're not looking to improve your sleep and you want that calming effect, right? You just bypass the oral gut part. So that's good.
Jillian Woodruff MD (21:52)
Right?
Yeah, yeah. So, if a woman stays on oral progesterone, maybe she doesn't want an IUD, maybe she's tried... because there are transdermal progesterone products that you can have compounded and made, but, you know, maybe they... she didn't tolerate that very well either. So, the British Menopause Society does have guidance for this as well. And they say to temporarily increase the progesterone dose by 4 weeks.
after initiating... for four weeks after you start the GLP-1. And again, each time you increase the dosage of your GLP-1. So, that accounts for the period when the gastric slowing effect is going to be most pronounced. Because you remember, you have side effects from these medications, and they usually... the GI side effects are at the beginning, and they usually decrease significantly. So, each dose, you may have those side effects, and then over time...
that decreases. So they're saying to increase the dosage for a few weeks, four weeks, every time you increase the dose of the GLP-1. So your body does adapt somewhat over time, but those initial weeks after each dose change are the highest risk window.
Ade Akindipe, DNP, APRN (23:01)
That's pretty interesting to know that, you know, to see that as some guidance. Also, one absolutely critical point, ⁓ unscheduled bleeding should always be investigated. If you're on HRT and in GLP and you start experiencing unexpected bleeding, do not chalk it up to the medication change and move on. First of all, the other thing that could happen if you're on a GLP and you had some hormonal imbalance, I've seen pregnancies happen while people are on GLP. ⁓
Jillian Woodruff MD (23:28)
Right?
Ade Akindipe, DNP, APRN (23:29)
Very possible, so don't just say, whoop, it's just the HRT. Talk to your doctor, get it properly evaluated. That bleeding may be your body telling you that there's something going on. You could be pregnant, or maybe you just need some endometrial protection like we just talked about.
Jillian Woodruff MD (23:43)
I agree. I agree. Should we shift gears and talk about body composition? Okay, let's do it. This is also a conversation that should be happening more. And when women are losing weight on their GLP-1 medications, it's not all fat, right? That distinction matters enormously.
Ade Akindipe, DNP, APRN (23:48)
Do it.
matters a lot, I've been preaching about this so much that stop looking at that number on the scale. It's where we really need to look at the data because not all GLP medications are created equal when it comes to what kind of weight you are losing. If go back to those, the initial trials, the SIRMT1 trials, they included a DEXA sub-study. DEXA is the goal standard for measuring body composition. So if you're interested in getting one, there's lots of places you can get that done.
Jillian Woodruff MD (24:14)
Mm.
Ade Akindipe, DNP, APRN (24:29)
It basically tells you how much body fat you have, muscle and bone. What tears up a tide, approximately 75 % of the weight loss was fat mass and about 20 % was lean mass, 25 % rather. So 25 is a lot. That's actually a pretty favorable ratio. You're losing mostly fat, but you're still at risk for losing muscle.
Jillian Woodruff MD (24:48)
And what we've talked about, really, is that with semaglutide, the picture shifts. So, the step one DEXA substudy... yes, substudy showed a different breakdown, about 60 % fat mass loss, 60 %... did I say that right? Yes, 60 % fat mass loss, and 40 % lean mass lost. So, 60 % fat mass, 40 %...
lean mass. So, semaglutide appears to cause proportionally more muscle loss. And for the midlife woman, we're already seeing muscle mass loss as part of the natural aging process. compounded by declining estrogen, declining testosterone levels, that extra muscle loss is a real concern. You're accelerating a process that's already working against you.
Ade Akindipe, DNP, APRN (25:41)
my goodness, it's like accelerated aging. ⁓
Jillian Woodruff MD (25:43)
Exactly.
Ade Akindipe, DNP, APRN (25:44)
Yeah,
the very good news is that visceral fat reduction was dramatic across the board. So with teresepiside, I'm sorry, we saw a 40 % reduction in visceral fat compared to just 7 % with a placebo. So the most metabolically dangerous fat, the fat that's driving inflammation and driving insulin resistance is being targeted very effectively, but we absolutely cannot afford to be
just know cavalier about lean mass loss. We have to be intentional about preserving muscle.
Jillian Woodruff MD (26:18)
And I do talk to all of my patients that are starting a GLP-1 and I tell them, you know, the medication has a job to do and it will reduce your appetite. It is going to burn fat. It's going to improve metabolic health. But your job is to protect your muscle because muscle is your most metabolically active tissue. That's huge. So more muscle means better resting metabolism. So we want our metabolism to be turning away, you know, whether we're active or not.
We have better blood sugar regulation, better bone density with muscle because you're only going to have the amount of muscle that your bones can support. you do better bone density is huge, better balance, better functional capacity as you age. And that's big. Also, I'd say also not being frail. You're not looking as frail as you age. the really critical part, they're all critical parts. They're all critical, but...
More muscle means a significantly better chance of maintaining your weight loss. If you ever decide to stop the GLP one or if you need to come off of it for any reason, muscle, we need that muscle. It's going to maintain that metabolism and do those things I just said, you know?
Ade Akindipe, DNP, APRN (27:27)
Absolutely.
So, you know, what does muscle preservation look like in practice? Three things that I consider non-negotiable for any patient on GLP-1 therapy. Number one is resistance training. This is, you know, two to three structured sessions per week minimum. And, you know, you don't have to start with heavy lifting. You don't even have to start with weights. You can start with body weights, you know, practicing. I know sometimes I'll tell my clients, just sit in the chair and push up on the chair. Sit down again, push up on the
You're working your muscles in your arms. Just keep doing it over and over again. Maybe setting your alarm clock and you know doing it a few times a day or you can use resistance bands if you're working you can take breaks. Even walking can be resistance training. Maybe walking in a very rough terrain where you have to work extra hard to to get going. It's just different ways to kind of tell your body that it needs to be active and that's where you're and then you can just graduate you know and get
better. Start lifting five pounds before you know you're you're lifting heavier. So whatever modality you enjoy and will do consistently is what's going to keep it doable for and sustainable over the long run. So you know it's not optional. We just talked about estrogen is how you lose your your muscle mass and if you're going to be on a GLP for sure that's another double whammy. So it's important when you're injecting yourself with this think about you know the repercussions of that. We just talked about those numbers for
% with semaglutide, I think 20-25 % with teresapatite. So it is a real thing. If you're considering it, make sure that you are doing everything, including eating more protein, keeping the protein on to keep the muscle mass on.
Jillian Woodruff MD (29:04)
Yeah, absolutely. I'd say protein intake, that's the number two. And I do see that a lot in practice is that when you're starting these medications, they suppress your appetite. They're very good at that. So women do end up dramatically under eating. And protein is usually the first thing to drop. It's not like the easiest little snack to get because people don't really think about the protein rich foods as the snacks they prefer.
you know, they may have a few crackers, they may have a small salad, and then that's it. So we do need to be intentional and really deliberate about our protein intake at every meal, whether you're on GLP-1s or not. But, you know, definitely if you're on GLP-1s, this needs to be a huge priority. And so you have to plan for it. You have to prioritize your protein intake, even when you're not hungry. Making, you know, a schedule, I'm going to have something small every three hours or so, because we do want that metabolism to be going.
and protein is the raw material your body needs to maintain and rebuild muscle.
Ade Akindipe, DNP, APRN (30:05)
Absolutely. And of course, we talked about DEXA scan before. know, every single woman that comes in, we do a body composition. It's not a DEXA scan, but it does give you some numbers you can start with. But a DEXA scan tells you about how your bones are doing, especially when you start to go towards menopause. But a DEXA scan can tell you more about the fat, especially the ones around your organs in your belly. So know exactly where you're starting from. If you're going to be on a GLP, even if you're not going to be
be
on a GLP and you're looking to just get stronger or you want to change your body composition and reduce belly fat, track your body composition over time. Not just the number on the bathroom scale. There are so many different body compositions now. You can get them online. They're pretty close. Sometimes my patients will monitor it at home and they'll compare it with whatever we have in clinic and they're pretty close. Because when a woman loses 20 pounds and preserves a muscle mass,
and you're in a completely different metabolic position than a woman who loses 20 pounds, but half of it is muscle. You're still unhealthy, even though you're slimmer, but unhealthy. We call that normal weight obesity still. So the scale treats those two outcomes as identical, but they're not. Dexascan can give you a lot more truth.
Jillian Woodruff MD (31:19)
Yeah, it looks different too, right? You know, somebody who's lost a lot of weight with muscle versus someone who's lost a lot of weight, but they don't have that muscle. So if there's people who are losing their weight from exercising, running, lifting, all these things, you know, their body looks different and you know, there's different beauty. There's different beauty.
What is it? Like models that we look at, but it's definitely a change. It will look very different even if the numbers on the scale are the same, the way we look will look different based off of the way, the amount or the type of weight we lose. Yeah.
Ade Akindipe, DNP, APRN (31:49)
Yeah.
Absolutely. Okay,
let's make this concrete and actionable, Dr. Jill. Let's give our listeners five specific questions they can literally write down and bring to their next appointment.
Jillian Woodruff MD (32:02)
Okay. Hmm. Okay. I love it. Let's do it. So, number one, I guess we should ask if we should review our HRT, our hormone therapy delivery method, now that we're on a GLP-1. So, this is about... yeah, right? Changing from oral to something non-oral.
Ade Akindipe, DNP, APRN (32:06)
Thank
That's a good
Jillian Woodruff MD (32:24)
If you're currently swallowing your estrogen pill, which I think if you are, you should be asking what to do anyway. You should be getting on another method because there are just safer methods. So why not choose something that's safer and actually will work better than competing with all the other things in your gut, right? Anyway, I digress. Yes. So that would be the question. we review our HRT delivery method now that we're on a GLP-1?
Ade Akindipe, DNP, APRN (32:44)
system work.
Good one, good one. I think another one is just asking, am I getting enough endometrial protection? Especially if you're an oral progesterone. This is the safety question we spend our entire segment on today. So your doctor should be able to walk you through whether your current setup is still providing endometrial protection when you're on a GLP-1. especially if you're having bleeding or spotting,
there's any signs that you're noticing, definitely talk to your doctor about that.
Jillian Woodruff MD (33:21)
Right. There could be someone listening that's been having bleeding issues on their hormones and didn't know. Like they're thinking, I'm taking the recommended dosage of oral progesterone and they're checking their hormone levels and maybe their estrogen is not high, but they're not making that further connection between, wow, I'm on GLP-1s or even other medications that slow my gastric emptying. And that could be the answer, right?
could be a very simple solution to that. number three. Number three, would say, would be do a DEXA scan. Let's establish your baseline body composition. Yep. Or do one of the, like, use the scale that you have in your office, the body scan. So, that gives you, gives your provider a clear objective picture of where you're starting from and creates a benchmark for tracking whether you're preserving lean mass or as you lose weight.
over the coming months. So I guess this should be a part of your, if you're doing this for weight loss, a part of that weight loss journey so you can make sure that you're preserving muscle and losing visceral fat.
Ade Akindipe, DNP, APRN (34:23)
Yeah.
Absolutely. if you, and that's a great point, think if you are seeing someone that's managing your GLP and weight loss and remote, sometimes I see people do this a lot where it's remote and you're not able to go to the office, know, ask them for maybe a recommendation or go online and purchase one. The in-body, which is the body composition scale we use, they actually have a way for you to find someone that has a body composition
in their clinic, you can just walk in, you can pay for it, or you can purchase your own, whatever it is, but definitely it's something that should be monitored when you are on a GLP. And another one you should ask for is what is your protein target?
If you're on a GLP one, you should be getting some kind of nutritional advice. I would recommend actually tracking how much protein that you're getting, whether you're tracking, you know, monitoring how much you're eating or you're logging your meals or, you know, a lot of things are labeled right now with 30 grams, 20 grams. If you're on protein meal replacements like protein shakes, usually 20 to 32. I know there's one out there. There's like 32 grams of protein.
in the shake, especially if you are not hungry. You should be hungry. If you're not hungry at all, that's a little concerning. You should have an appetite. Usually some people think, well, I still have an appetite. You don't want to completely remove your appetite. But at least that gives you a benchmark for you to monitor to make sure that you're getting the building blocks for your muscles.
Jillian Woodruff MD (35:52)
Okay, number five. Should we consider adding hormone therapy if I'm not already on it? I would say given the data we discussed today, especially that synergy data showing 30 to 35 % greater weight loss when HRT is combined with GLP-1 therapy, if you're a candidate for a hormone therapy and you're already on a GLP-1, then...
There's a real evidence-based argument for adding HRT to optimize your results. So this isn't going to be the right move for every woman, but it's absolutely a conversation worth having with a knowledgeable provider.
Ade Akindipe, DNP, APRN (36:25)
Absolutely. And I'll add one more thing that's not a question, but a mindset shift. Bring a list to your doctor, print out these questions. Bring this podcast episode if you want.
Jillian Woodruff MD (36:34)
Yeah, yes, yes.
Ade Akindipe, DNP, APRN (36:37)
And share
it with your provider. Your doctor may not have seen the latest research on GLP and HRT interactions yet. So this is a constantly evolving field. And being an informed, proactive patient is one of the most powerful things you can do for your own health. You're not being difficult by asking questions. You're being very smart.
Jillian Woodruff MD (36:55)
Right, mean, and you said something really important is that your doctor may not have seen this latest research on this because, you know, there's no way to see the latest research on everything. And I do have patients that bring me studies and share new findings with me about various topics that I may be interested in. I love it. You know, we're lifelong learners. So, yes, you know, it would be really interesting if your provider is treating you with something and you find something. Sure, share it.
Ade Akindipe, DNP, APRN (37:13)
Yeah.
Absolutely. And actually, this is one of the reasons why we do this. We are also learning along with you.
Jillian Woodruff MD (37:29)
Yeah,
right. Because there's, I mean, this field is huge. There's new medications coming out all the time. There's a new, there's a new GLP that's coming that's in the end of its trials, right? So it's a big field. It's a big field. So our message to you, if you're navigating midlife, managing medications, whether that's GLP-1s, hormone therapy, or both, you deserve a provider who's connecting these dots for you.
Ade Akindipe, DNP, APRN (37:39)
Yes.
Jillian Woodruff MD (37:54)
And if they're not doing that, yep, be the one who starts the conversation. You have every right to advocate for yourself, and you should.
Ade Akindipe, DNP, APRN (38:01)
Absolutely. The research in this space is evolving incredibly fast, but what we know today is already meaningfully different from what we knew even a year ago. And that's exactly why we do this podcast, to keep you informed, empowered, and at the forefront of what's possible for your health and midlife and beyond.
Jillian Woodruff MD (38:17)
If this episode was helpful to you, please follow us, subscribe to the Modern Midlife Collective podcast wherever you listen, share it with a friend, a sister, a colleague, a loved one, someone who needs to hear this information as well. And if you have a moment, leave us a review. It genuinely helps more women find these conversations and helps us make this what you need when we get that feedback. So that's what this is all about.
Ade Akindipe, DNP, APRN (38:42)
yeah, and we also have some incredible episodes coming up that we're really excited about. We'll be diving into the latest on peptide therapies. I'm really excited about that. There are so many things that were taken away but are coming back and metabolic health in general. So you will not want to miss this. Until next time, take care of yourselves.
Jillian Woodruff MD (38:59)
and take care of each other. We will see you next time. Thank you. Bye.