HRT & Weight Loss Injections: What You Need to Know

With the popularity of medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) on the rise—whether for weight management or type 2 diabetes—many women are wondering: how do these injections affect my HRT?

A new clinical guideline from the British Menopause Society (BMS), published in April 2025, helps shed light on exactly that. If you’re on HRT and also using one of these newer weight loss or diabetes medications, read on—because your current hormone therapy might need a tweak.

First, the basics

Semaglutide and tirzepatide belong to a family of medications called incretin-based therapies. They help regulate blood sugar and reduce appetite, making them powerful tools for managing type 2 diabetes and supporting weight loss.

But they also slow down your digestion—which is part of how they work so well.

And that’s where things get interesting for HRT.

The issue with oral progesterone

If you’re on oral progesterone as part of your HRT (for example, Utrogestan), and you’re taking semaglutide or tirzepatide, there’s a potential problem. These injections slow the movement of food (and medication) through your gut, and that could reduce how well your body absorbs oral hormones—particularly progesterone.

Why does this matter? Because if you have a uterus, progesterone is what protects the lining of your womb (the endometrium) when you're on estrogen. If you’re not absorbing enough, you may be at increased risk of endometrial hyperplasia or even cancer over time.

What the BMS recommends

The British Menopause Society now recommends switching to a non-oral form of progesterone if you’re also using semaglutide or tirzepatide.

Your safest options are:

• The Mirena coil (a hormone-releasing intrauterine device) – provides reliable womb lining protection and contraception

• A combined HRT patch – delivers both estrogen and progestogen through the skin

• Oral progesterone – now not preferred alongside these medications

If you already use the Mirena or a patch: good news, no change needed.

What should I do next?

If you're using semaglutide or tirzepatide and taking oral progesterone as part of your HRT, please book a review with your GP or menopause specialist. We'll work together to choose a safer, effective alternative that suits your needs.

It’s important not to stop or change your HRT without advice. Every woman is different, and your treatment should reflect your individual risk factors and health goals.

If you experience any unscheduled bleeding them please do ensure you seek an urgent medical review. I have a blog dedicated to understanding bleeding on HRT.

The bigger picture

This guidance is part of a wider movement in medicine to personalise hormone therapy—especially as more women seek support during midlife while also managing metabolic health concerns like weight and diabetes.

At Sirona Health, we’re here to help you navigate these transitions with evidence-based care, compassion, and clarity.