Hormones and menopause | 5 min read

Can a Home Test Tell You If You’re in Perimenopause?

Editorial draft — clinical review pending.

Short answer: Not reliably. Home menopause tests measure follicle-stimulating hormone (FSH) in urine. A positive result means FSH is high on that day, but FSH rises and falls a lot during perimenopause, so a single result can’t confirm or rule it out. Doctors usually diagnose perimenopause from your age, symptoms and period changes, not a hormone test. [1,2]

Key takeaways

• Home tests show whether FSH is raised at one moment. They do not diagnose perimenopause or menopause. [1]
• Never use a home test to decide whether to stop contraception. [1]
• Blood hormone tests are also usually unnecessary for typical perimenopause, but can help in specific situations, such as symptoms before age 45. [2]

How the tests work

FSH signals the ovaries to develop eggs. As the ovaries respond less, FSH tends to rise. Home kits detect FSH in urine above a set level. The FDA notes that the tests can suggest you may be in menopause, but cannot tell you for certain, and that hormonal birth control and some other medicines can affect results. [1]

The problem is timing. In perimenopause, FSH can be high one week and normal the next. One test, or even a few, gives a snapshot of a moving target.

When testing is useful

ACOG says hormone testing is generally not needed to diagnose perimenopause in women over 45 with typical symptoms. Testing can help when: [2]

• You’re under 45 and your periods have changed or stopped.
• Early or premature menopause is a concern.
• Symptoms could have another cause, such as a thyroid problem, which needs its own tests.

Signs that point to perimenopause

• Periods that become irregular, often closer together at first and then further apart.
• Hot flashes or night sweats.
• Disrupted sleep.
• Mood changes, irritability or anxiety.
• Vaginal dryness.
• Brain fog or trouble concentrating.

A timeline of these changes usually tells a clinician more than a test strip.

What to bring to an appointment

• When your periods started changing and how.
• Which symptoms you have and how they affect your day.
• Any medicines, supplements and contraception.
• Any home test results, with the brand and dates, not just a screenshot.

Be careful with large hormone panels

Some online services sell broad hormone panels with dozens of markers. More numbers do not mean clearer answers, and abnormal-looking results can lead to unnecessary worry or treatment. Ask what each test will help decide before paying for it.

Frequently asked questions

Are home menopause tests accurate?

They detect FSH accurately, but a single FSH result doesn’t reliably show where you are in the transition. [1]

Should I get my hormones checked?

Usually not if you’re over 45 with typical symptoms. Testing can help if you’re younger or the picture is unclear. [2]

Can a negative test mean I’m not in perimenopause?

No. FSH can be normal on the day you test even if you are in perimenopause.

Next step

Your symptoms are reason enough to get help, with or without a test result. A HerScripts clinician can review your history and decide whether any testing would change your care. Explore hormone care.

Sources

[1] FDA, Menopause home-use tests

[2] ACOG, Do I need testing of my hormone levels during perimenopause?

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Hormones and menopause | 5 min read

Do You Still Need Birth Control in Perimenopause?

Editorial draft — clinical review pending.

Short answer: Yes, if you don’t want to get pregnant. Ovulation becomes less predictable during perimenopause, but it doesn’t stop until menopause. Menopause is confirmed after 12 months in a row without a period, and contraception is recommended until then. Menopause hormone therapy is not a form of birth control. [1]

Key takeaways

• Irregular or skipped periods do not mean you can’t get pregnant.
• Hormone therapy for hot flashes does not prevent pregnancy. [1]
• Some contraceptives also help perimenopause symptoms such as heavy or irregular bleeding.

Why pregnancy is still possible

During perimenopause, some cycles release an egg and some don’t. You can go months without a period and then ovulate. Unplanned pregnancy rates in women in their forties are higher than many people expect, partly because people stop contraception too early.

Hormonal contraception can also hide the signs of menopause. If you use the pill, a hormonal IUD or an implant, your periods may be light or absent regardless, so you can’t count 12 months the usual way. Your clinician can advise when it’s reasonable to stop based on your age and method.

Choosing a method in your forties

There is no single best method. CDC’s Medical Eligibility Criteria rate each method’s safety based on health factors such as smoking, migraine with aura, high blood pressure, blood clots and heart disease. Age alone doesn’t rule out most methods, but those factors become more common in midlife. [2]

Common options and what they may offer:

• Hormonal IUD: very effective, often makes periods lighter, and can provide the progestogen part of hormone therapy if you later start estrogen.
• Copper IUD: hormone free and lasts for years. It may make heavy periods heavier.
• Implant: very effective, but bleeding can be unpredictable.
• Combined pill, patch or ring: may regulate cycles and ease hot flashes, but not suitable for smokers over 35 or people with certain risks. [2]
• Progestin-only pill: an option when estrogen isn’t suitable.
• Barrier methods and sterilization remain options.

Contraception and symptom treatment together

Many women want both: protection from pregnancy and relief from hot flashes or heavy bleeding. Sometimes one plan handles both, such as a hormonal IUD plus low-dose estrogen. Sometimes they need separate treatments. Ask your clinician to name what each part of your plan is for.

What to bring to an appointment

• Your current contraceptive and how you use it.
• Your bleeding pattern over the past 6 to 12 months.
• Your symptoms and which ones bother you most.
• Health history, including smoking, migraines, blood pressure and blood clots.

Frequently asked questions

At what age can I stop birth control?

It depends on your age, method and periods. Many clinicians use 12 months without a period as the guide, with adjustments for hormonal methods. Ask yours.

Does HRT prevent pregnancy?

No. Hormone therapy for menopause symptoms uses lower doses and is not a contraceptive. [1]

Can a home test tell me I’m done?

No. Home FSH tests cannot confirm menopause or tell you when to stop contraception. See our article on home hormone tests.

Next step

Bring both questions, symptoms and contraception, to one HerScripts conversation. Learn about changing periods.

Sources

[1] The Menopause Society, Perimenopause

[2] CDC, U.S. Medical Eligibility Criteria for Contraceptive Use, 2024

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 5 min read

Does Tirzepatide Affect Birth Control Pills? What the Zepbound Label Says

Editorial draft — clinical review pending.

Short answer: Yes, it can. Tirzepatide slows stomach emptying, which may reduce how well oral contraceptives are absorbed. Zepbound’s label advises people using birth control pills to switch to a non-oral method, or add a barrier method such as condoms, for 4 weeks after starting and for 4 weeks after each dose increase. [1]

Key takeaways

• The warning applies to oral hormonal contraceptives: the combined pill and progestin-only pill.
• It does not apply to IUDs, implants, injections, patches or vaginal rings, which do not depend on stomach absorption.
• The extra protection is needed at the start and after every dose increase, not just once. [1]

Why it happens

Tirzepatide slows how quickly food and medicines move from the stomach into the intestine. That effect is strongest when treatment begins and right after each step up in dose. During those windows, hormone levels from a pill may be lower than expected, so the pill may not prevent pregnancy as reliably. [1]

Tirzepatide is also sold as Mounjaro for type 2 diabetes. Ask your pharmacist about the label for whichever product you’re prescribed. This specific advice should not be assumed to apply to every weight-loss medicine.

What a typical schedule looks like

Standard tirzepatide dosing increases every 4 weeks or more. If you follow that schedule and use the pill, you could need backup contraception for most of the first several months. For many people, that is a good reason to consider a long-acting method instead.

Ask your prescriber:

• When exactly does each backup window start and end?
• If my dose is held at the same level, do I still need backup?
• Would an IUD, implant, ring or patch suit me better?

Why pregnancy planning matters on GLP-1s

GLP-1 medicines are not recommended during pregnancy, and weight loss itself can improve fertility. Some women find they ovulate more regularly as they lose weight. Contraception is worth taking seriously even if you’ve had trouble conceiving before. If you’re planning a pregnancy, tell your prescriber early, because some labels advise stopping weeks before trying.

If you’re in perimenopause

Irregular periods do not mean pregnancy is impossible. The Menopause Society advises continuing contraception until menopause is confirmed. [2] The tirzepatide precaution still applies if your contraceptive is a pill.

Practical tips

• Write the dates of each dose increase and the 4-week backup window on your calendar.
• Keep condoms on hand before you start.
• If you vomit within a few hours of taking a pill, follow your pill’s missed-dose instructions.
• Take a pregnancy test and contact your prescriber if you miss a period or think you might be pregnant.

Frequently asked questions

Does semaglutide affect birth control?

Semaglutide’s label does not carry the same specific advice. Ask your clinician about the medicine you’re prescribed.

Do I need backup if I have an IUD?

No. IUDs and implants are not affected by stomach emptying.

How long do I need backup after a dose increase?

Four weeks after each increase, according to the Zepbound label. [1]

Next step

Mention your contraception at the start of a HerScripts weight care assessment so it’s built into your plan from day one. Start weight care.

Sources

[1] Zepbound prescribing information, DailyMed

[2] The Menopause Society, Perimenopause

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 6 min read

What Happens When You Stop a GLP-1? Weight Regain and How to Plan

Editorial draft — clinical review pending.

Short answer: When people stop a GLP-1 medicine, appetite usually returns and weight often comes back. In the STEP 1 extension, people who stopped semaglutide regained about two thirds of the weight they had lost within a year. In SURMOUNT-4, people switched from tirzepatide to placebo regained a substantial amount, while those who continued kept losing. Planning before you stop makes a real difference. [1,2]

Key takeaways

• STEP 1: average loss of about 17% on semaglutide; after stopping, people regained roughly two thirds of it over the next year. [1]
• SURMOUNT-4: after 36 weeks on tirzepatide, those switched to placebo regained about 14% of body weight, while those who continued lost about 5.5% more. [2]
• These are averages. Some people keep most of their loss, and a planned approach can help.

Why weight comes back

Obesity is a chronic condition. GLP-1 medicines work by changing appetite signals, and when the medicine stops, those signals return toward where they were. The body also adapts to weight loss by increasing hunger and using slightly less energy. This is biology, not a lack of willpower.

What the trials showed

In STEP 1, participants who stopped both semaglutide and the structured lifestyle program regained about 11.6 percentage points of their 17.3% average loss within a year, ending around 5.6% below where they started. Blood pressure, blood sugar and other improvements also partly reversed. [1]

SURMOUNT-4 gave everyone tirzepatide for 36 weeks, then randomly switched some to placebo. Over the next year, the placebo group regained much of their loss, while the group that stayed on tirzepatide lost more. [2] The two trials studied different drugs and designs, but both point in the same direction.

Common reasons people stop, and what to ask

Cost. Bring your actual charges. Ask whether a different product, dose or plan could make continuing affordable.

Side effects. Describe timing and severity. A slower increase or a dose change may help.

Pregnancy plans. Some GLP-1 labels advise stopping well before trying to conceive. Ask for the guidance that applies to your medicine.

Reaching a goal. Ask whether a maintenance dose is an option instead of stopping completely.

If you do stop: a plan

• Agree on the plan with your prescriber rather than stopping suddenly or stretching doses on your own.
• Keep strength training. Muscle helps maintain weight and energy use.
• Keep protein and fiber high to help with fullness.
• Decide how you’ll monitor. Weekly weigh-ins work for some people; others prefer how clothes fit.
• Agree in advance what amount of regain would prompt a check-in.
• Know how to restart if you need to. After a gap, you usually need to start again at a lower dose rather than your old one.

Frequently asked questions

Do you have to take a GLP-1 forever?

Not necessarily, but trial evidence shows most people regain weight after stopping. Many need some form of long-term treatment, as with blood pressure or cholesterol.

Can I taper off slowly?

Tapering has not been well studied. Talk with your prescriber about a plan rather than reducing doses on your own.

What if I regain weight after stopping?

That is common and treatable. Contact your care team to discuss options, including restarting.

Next step

Ask about the maintenance plan before your first prescription, not after your last. HerScripts weight care includes follow-up for the long term. See how it works.

Sources

[1] STEP 1 semaglutide withdrawal extension, 2022

[2] SURMOUNT-4 randomized withdrawal trial, JAMA 2024

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 5 min read

What Is Food Noise? What GLP-1 Research Actually Shows

Editorial draft — clinical review pending.

Short answer: Food noise is an informal term for persistent, intrusive thoughts about food: what to eat next, cravings, or planning and judging meals so much that it crowds out other thinking. It is not a medical diagnosis. Trials of semaglutide have found reductions in hunger, cravings and food preoccupation, which helps explain why many people on GLP-1 medicines describe their food noise going quiet. [1,2]

Key takeaways

• Researchers do not measure "food noise" directly. They measure hunger, cravings, food preoccupation and control of eating.
• In the STEP 5 trial, semaglutide improved control of eating and reduced cravings compared with placebo over two years. [2]
• A 2026 randomized trial over 60 weeks found semaglutide changed appetite and reduced food preoccupation. [1]

Where the term comes from

The phrase spread through social media as people on GLP-1 medicines described a sudden quiet where constant food thoughts used to be. It caught on because it named something many people had felt but struggled to explain. That is useful. The risk is that a catch-all phrase can blur very different experiences, from ordinary hunger to binge eating to anxiety about food.

What the studies measured

In STEP 5, adults with obesity completed a validated questionnaire about their eating over two years. People on semaglutide reported better control of eating and fewer cravings for sweet and savory foods than people on placebo. [2] The 2026 trial looked at appetite and food reward in more detail and found reductions in hunger and in how much people thought about food. [1]

These results come from specific populations using specific approved doses. They support the experience many patients describe, but they cannot promise that any GLP-1 product at any dose will have the same effect for you.

How to describe it at an appointment

Instead of trying to fit the label, give examples:

• "I think about my next meal within an hour of eating."
• "Cravings interrupt my work most afternoons."
• "I spend a lot of time planning food and then feel guilty about it."
• "If I skip a meal, I can’t stop eating later."

Say when it began, whether it changed with stress, sleep, medication or your cycle, and how much it affects your day. That gives a clinician real information to work with.

When it might be something else

Food preoccupation can overlap with binge eating disorder, other eating disorders, depression or anxiety. If you regularly eat large amounts while feeling out of control, make yourself sick, restrict severely, or feel intense guilt and distress around food, say so. Those patterns need a different kind of care, and a weight-loss medicine alone may not be right.

What good treatment looks like

If a medicine is considered, your care team should check whether you are still eating enough, how you feel emotionally, and whether side effects are manageable. Quieter food thoughts are a welcome change. Not wanting to eat at all is not the goal.

Frequently asked questions

Is food noise a real medical condition?

It is not a diagnosis, but the experiences behind it, such as cravings and food preoccupation, are real and measurable.

Do GLP-1s reduce food noise?

Trials show semaglutide reduces cravings and food preoccupation on average. [1,2] Individual responses vary.

Does food noise come back after stopping?

Appetite often returns after stopping a GLP-1. Plan for that before you stop. See our article on stopping GLP-1s.

Next step

Describe the experience in your own words during a HerScripts assessment, and a clinician will help work out what’s behind it and what might help. Start weight care.

Sources

[1] Randomized 60-week semaglutide appetite and food reward trial, 2026

[2] STEP 5 control of eating analysis, 2023

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 6 min read

How to Protect Muscle and Strength While Losing Weight on a GLP-1

Editorial draft — clinical review pending.

Short answer: Any significant weight loss includes some lean mass, and GLP-1 medicines are no exception. In a body scan substudy of tirzepatide, about three quarters of the weight lost was fat and one quarter was lean mass. You can limit muscle loss by doing strength training at least twice a week, eating enough protein, and telling your care team if you feel weaker. [1,2]

Key takeaways

• In the SURMOUNT-1 DXA substudy of 160 people, roughly 75% of weight lost was fat and 25% was lean mass. [1]
• Lean mass includes water, organs and connective tissue, not only muscle, so "25% muscle loss" overstates it.
• Federal guidelines call for muscle-strengthening activity at least two days a week plus regular aerobic activity. [2]

What the numbers actually say

DXA scans estimate fat, lean tissue and bone. In the SURMOUNT-1 substudy, people taking tirzepatide lost substantially more fat than lean mass, and the ratio was similar to what is seen with diet-based weight loss. [1] That is reassuring, but it is still an average. Women over 50, people who were already inactive, and anyone losing weight quickly may lose more muscle and should pay closer attention.

Muscle matters for more than looks. It supports balance, blood sugar control, bone strength and the ability to keep doing everyday tasks as you age.

Build a simple strength routine

The guideline is muscle-strengthening work on two or more days a week covering the major muscle groups, plus about 150 minutes a week of moderate aerobic activity such as brisk walking. [2] If that sounds like a lot, start smaller. Some activity is better than none.

A beginner week might look like this:

• Two 20-minute sessions of squats to a chair, wall push-ups, step-ups and resistance-band rows.
• Two or three brisk walks.
• Add a set or a little weight every week or two as it gets easier.

If you have joint pain, heart disease or another condition, ask your clinician what is safe first. A physical therapist or certified trainer can help you start correctly.

Eat to protect muscle

Reduced appetite makes it easy to fall short on protein. Put a protein source first at each meal, such as eggs, Greek yogurt, fish, chicken, tofu, beans or cottage cheese, and eat it before the rest of the plate. Ask your care team for a protein target based on your size and health. See our nutrition guide for more.

Track strength, not just weight

Signs worth noting:

• Getting up from a chair or the floor is harder.
• Stairs or carrying groceries feel more tiring.
• You can lift less in your usual workout.
• You feel weak, dizzy or exhausted most days.

These are reasons to contact your care team, not badges of fast progress. The plan may need a slower dose increase, more protein, or more support.

Frequently asked questions

Do GLP-1s cause muscle loss?

Weight loss from any cause includes some lean mass. GLP-1 studies show most of the loss is fat, and strength training plus protein can help limit muscle loss. [1]

How many days a week should I strength train?

At least two days a week, working all major muscle groups. [2]

Can I build muscle while losing weight?

Beginners often can, especially with regular resistance training and enough protein.

Next step

HerScripts weight care looks at strength and how you feel day to day, not just the scale. Learn about strength and body changes.

Sources

[1] Look et al., SURMOUNT-1 DXA substudy, 2025

[2] HHS Physical Activity Guidelines, questions and answers

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Hormones and menopause | 6 min read

Why Your Waist Is Changing in Perimenopause (Even When the Scale Isn’t)

Editorial draft — clinical review pending.

Short answer: During the menopause transition, the body tends to gain fat and lose lean mass, and more fat settles around the abdomen. That can happen even when total weight barely moves, which is why jeans fit differently while the scale looks the same. Aging drives much of midlife weight gain; the hormonal shift mainly changes where fat is stored. [1,2]

Key takeaways

• A long-term study of more than 1,200 women found fat gain speeds up and lean mass declines as menopause approaches. [1]
• Menopause is linked to a shift of fat toward the belly. [2]
• Waist size matters for health. In women, a waist over 35 inches is associated with higher risk of heart disease and type 2 diabetes. [3]

What the research found

The Study of Women’s Health Across the Nation (SWAN) followed women for years as they went through menopause. Researchers found that fat mass began rising faster and lean mass started falling about two years before the final period, and those trends continued for roughly two years after. Weight gain didn’t speed up in the same way, so body composition changed more than the scale suggested. [1]

This was an observational study. It shows a pattern across many women, not a guaranteed path for each person, and it does not prove that one hormone causes every change.

Why fat moves to the middle

Estrogen influences where the body stores fat. Before menopause, more fat tends to go to the hips and thighs. As estrogen falls, a larger share goes to the abdomen, including visceral fat around the organs. [2] Visceral fat is the type most closely linked to metabolic and heart risk, which is why waist size is worth knowing.

Other common midlife changes add to this: less muscle, less daily movement, poorer sleep from night sweats, stress, and some medications.

How to measure it

Stand, breathe out normally, and wrap a tape measure around your bare waist just above your hip bones. Keep the tape snug but not pressing into the skin. Measure the same way each time, no more than monthly. If tracking your body makes you anxious, skip it and let your clinician measure at visits instead.

What actually helps

Strength training is the most direct way to counter lean mass loss. Two or more sessions a week is a common target. Start where you are and build gradually.

Protein at each meal supports muscle, especially when combined with resistance exercise.

Sleep matters more than most people expect. If night sweats wake you, treating them can help with energy, appetite and activity.

Medical treatment may be appropriate. Hormone therapy treats menopause symptoms, but it is not a weight-loss drug. For some women, a weight-care medicine is reasonable when health risks justify it.

Be skeptical of products promising to melt menopause belly fat. No supplement has good evidence for that.

When to talk to a clinician

Book an appointment if your waist is growing quickly, you have other symptoms such as heavy bleeding, fatigue or mood changes, or your blood pressure, blood sugar or cholesterol is rising. Bring your measurements, a note on when you noticed the change, and a list of your medicines.

Frequently asked questions

Is menopause belly inevitable?

No. The tendency is common, but strength training, sleep and nutrition can limit it, and the degree varies widely between women.

Will hormone therapy reduce belly fat?

It is not approved for weight loss. Some studies suggest it may reduce the shift toward abdominal fat, but it should be chosen for symptom relief.

Should I diet harder?

Very low calorie diets can speed up muscle loss. Focus on protein, strength and consistent meals rather than steep restriction.

Next step

HerScripts can look at your symptoms, body changes and health risks together, so you don’t have to choose between a hormone conversation and a weight conversation. Explore weight changes in women.

Sources

[1] Greendale et al., SWAN body composition study, JCI Insight 2019

[2] The Menopause Society, MenoNote: Midlife Weight Gain

[3] NHLBI, Assessing your weight and health risk

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 6 min read

GLP-1 Microdosing: What It Is, What the Evidence Shows, and What to Ask

Editorial draft — clinical review pending.

Short answer: "Microdosing" a GLP-1 usually means taking a semaglutide or tirzepatide dose below the standard starting dose, often for general wellness or gentle weight loss. It is not a defined, studied regimen. No large clinical trial has tested it, and the term means different things to different sellers. Some clinicians do prescribe lower doses for individual reasons, but that should be an explained decision, not a marketing promise.

Key takeaways

• Approved GLP-1 medicines have a set starting dose and a planned increase. Microdosing is a departure from that label. [1]
• Very small doses are often measured from multidose vials, where the FDA has documented serious dosing errors. [2]
• Benefits promised for microdosing, such as less inflammation, longevity or better mood, have not been established for these doses.

How standard dosing works

Take tirzepatide as an example. Zepbound’s label starts at 2.5 mg once weekly for four weeks. That first dose is meant to help the body adjust, not to cause weight loss. The dose then increases in 2.5 mg steps, at least four weeks apart, to a maintenance dose of 5, 10 or 15 mg. [1] Semaglutide for weight management follows a similar stepwise plan.

That structure exists because higher doses cause more gastrointestinal side effects if introduced too quickly. A clinician may slow the increases or stay at a lower dose if someone is responding well or struggling with side effects. That is ordinary clinical judgment. It is different from a program built around staying below the starting dose indefinitely.

Why the evidence gap matters

Clinical trials measured weight loss, side effects and safety at specific doses. Results at those doses cannot be assumed to apply to a much smaller amount. A smaller dose may produce fewer side effects, but it may also produce less benefit, and nobody has carefully measured the trade-off.

Ask any provider offering microdosing: what outcome are we aiming for, how will we measure it, and what evidence supports this dose for that goal?

The measuring problem

Microdoses are often drawn from compounded multidose vials. The FDA has reported patients receiving five to twenty times the intended amount because of confusion between milligrams, milliliters and syringe units. Some were hospitalized with severe nausea, vomiting, dehydration or low blood sugar. [2]

If you are using a vial:

• Ask for the concentration in writing (milligrams per milliliter).
• Ask for your dose in both milligrams and syringe units.
• Use the syringe the pharmacy supplies, not one from another source.
• Call the pharmacy if anything does not match your last prescription.

Red flags in an offer

Be cautious when a program promises broad benefits without a medical reason, skips a health history review, offers no follow-up, or uses the same plan for every customer. A responsible offer explains its limits as clearly as its benefits.

Frequently asked questions

Is GLP-1 microdosing safe?

It has not been studied as a defined regimen, so its safety and benefit at very low doses are unknown. Dosing errors from vials are a documented risk. [2]

Can a clinician prescribe a lower dose?

Yes. Clinicians can adjust doses for individual reasons. They should tell you if a plan is off label and why they recommend it.

Will microdosing help me lose weight?

There is no reliable trial evidence on how much weight people lose at doses below the label’s starting dose.

Next step

If you want a gentler start because of side effects or health concerns, raise it during your assessment. A HerScripts clinician can explain the standard plan and whether adjusting it makes sense for you. Learn about weight care.

Sources

[1] Zepbound prescribing information, DailyMed

[2] FDA alert on dosing errors with compounded semaglutide

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

Explore related care

Weight care | 6 min read

Compounded GLP-1s vs. FDA-Approved Semaglutide and Tirzepatide: What’s the Difference?

Editorial draft — clinical review pending.

Short answer: A compounded GLP-1 is a preparation made by a pharmacy for an individual patient. It is not FDA approved, and the FDA does not review it for safety, effectiveness or quality before it is dispensed. An FDA-approved brand or generic has gone through that review. Both can be prescribed, but they are not interchangeable, and you should know which one you are receiving. [1]

Key takeaways

• "Compounded" and "generic" are different legal categories. A generic must show it matches the approved drug; a compounded preparation does not. [1]
• The FDA has documented dosing errors and counterfeit or mislabeled GLP-1 products, mostly from outside licensed pharmacies. [2]
• The right question is not only the price. It is what the product is, who made it, and what support comes with it.

Three categories, three pathways

FDA-approved brands such as Wegovy (semaglutide) and Zepbound (tirzepatide) were tested in large clinical trials, and the FDA reviewed their manufacturing.

FDA-approved generics must show they contain the same active ingredient in the same strength and dosage form and work the same way as the brand.

Compounded preparations are made by state-licensed pharmacies or registered outsourcing facilities. Compounding has a legitimate role, for example when a patient needs a formulation the approved product does not offer. But the finished product is not FDA approved, and calling it a generic is inaccurate. [1]

Why this matters for GLP-1s specifically

Demand for semaglutide and tirzepatide outpaced supply in 2022 to 2024, and compounding expanded quickly. The FDA has since declared both shortages resolved, which narrows when copies of approved drugs can legally be compounded. [2]

The FDA has also received reports of patients hospitalized after measuring the wrong dose from multidose vials, of products with incorrect labels, and of counterfeit products sold online. Many of these issues came from sellers operating outside legitimate pharmacies. [2]

None of this means every compounded prescription is unsafe. It means the source and the instructions matter more than they do with a prefilled brand-name pen.

Questions to ask any provider

• Is this an FDA-approved product or a compounded preparation?
• Which pharmacy makes and dispenses it, and is it state licensed or an FDA-registered outsourcing facility?
• Does it contain anything besides the active ingredient, such as added vitamins? If so, what evidence supports that combination?
• Is it a prefilled pen or a vial I draw up myself? Who will show me how to measure the dose?
• What does the monthly price include: clinician visits, medication, supplies, shipping and follow-up?

A trustworthy service will answer each of these in writing without hesitation.

Safe-use basics

Never convert a dose from one product to another yourself. Milligrams on a brand pen and units on a syringe are not the same measurement. Do not use a friend’s dosing chart. If a package, label or concentration looks different from your last shipment, call the pharmacy before injecting.

Frequently asked questions

Is compounded semaglutide the same as Wegovy?

It contains the same named active ingredient, but it is a different product that has not been FDA approved or tested in the same trials.

Is compounding legal?

Yes, under specific federal and state rules. Those rules limit when copies of commercially available approved drugs can be made. [1]

How do I know if a pharmacy is legitimate?

Ask for its name and license, then check it with your state board of pharmacy. Be cautious of sites that sell without a prescription.

Next step

HerScripts clinicians explain exactly which product is being prescribed, where it comes from, and how to use it. See how weight care works.

Sources

[1] FDA, Compounding and the FDA: Questions and Answers

[2] FDA, Concerns with unapproved GLP-1 drugs used for weight loss

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Hormones and menopause | 6 min read

What the FDA’s 2026 Menopause Hormone Therapy Label Changes Mean for You

Editorial draft — clinical review pending.

Short answer: On February 12, 2026, the FDA approved new labels for six menopausal hormone therapy products that removed statements about cardiovascular disease, breast cancer and probable dementia from the boxed warning, the most prominent warning a medicine can carry. The medicines did not become risk free. The change means the most alarming summary on the label now better reflects who was actually studied and when they started treatment. [1]

Key takeaways

• Six products across all four hormone therapy categories got updated labels first, including vaginal estrogen. Others are still in review. [1]
• Risks are still described in the full prescribing information. They are no longer presented as a blanket warning for every woman.
• Age and timing matter. The FDA pointed to evidence that starting within 10 years of menopause, usually before 60, carries a different balance of benefit and risk than starting later. [1]

Why the warning existed in the first place

The boxed warning dates back to the Women’s Health Initiative, a large study published in 2002 that linked combined hormone therapy to higher rates of heart disease, stroke and breast cancer. Prescriptions dropped sharply afterward. The trouble was that many participants were in their sixties and seventies and had started hormones years after menopause. That is a very different group from a 51-year-old woman with disruptive hot flashes.

The FDA started the review in November 2025 and asked manufacturers to submit revised labels. Twenty-nine companies did. The six products approved in February are the first batch, not the full list. [1]

What changed, and what stayed

For most of the updated products, the boxed warning was removed. For systemic estrogen-alone products, a boxed warning about endometrial cancer remains, because unopposed estrogen raises that risk in women who still have a uterus. [3]

Everything else in the label still applies. Blood clots, stroke, gallbladder disease and other risks are still listed in the warnings and precautions sections. The FDA keeps a page listing which products currently have updated labeling, so you can check the exact product you use or are considering. [2]

What it means if you are considering hormone therapy

If you ruled out hormones years ago because of a headline, it is reasonable to revisit the question. The FDA has approved hormone therapies for moderate to severe hot flashes, vaginal dryness and discomfort, and prevention of bone loss. [1] Those are the conditions to discuss, not general anti-aging.

The most useful details to bring to an appointment are your age, how long ago your periods stopped or changed, which symptoms bother you most, and any personal or family history of breast cancer, blood clots, stroke, heart disease or liver disease. Those facts shape whether hormones make sense and which route is better. A patch, gel, pill or vaginal product each has a different profile.

What it means if you already take it

You do not need to change anything because of the label update. Check whether your product is on the FDA’s updated list, and read the new patient information if it is. If you were told to stop at a certain age or after a fixed number of years, ask whether that still applies to you. Current guidance focuses on regular review rather than a single cutoff.

Frequently asked questions

Does this mean hormone therapy is safe for everyone?

No. It means the boxed warning no longer applies one summary of risk to every woman. Individual risk still depends on age, timing, health history and the type of product.

Was vaginal estrogen included?

Yes. Topical vaginal estrogen was one of the four categories in the first group of approved changes. [1]

Will my pharmacy leaflet change?

Over time, yes. Updated labels roll out product by product, so your leaflet may still show the old wording for a while.

Next step

If hot flashes, night sweats, sleep disruption or vaginal symptoms are affecting your life, a HerScripts clinician can review your history and talk through whether hormone therapy, a nonhormonal option or no medication fits you best. Start with hormone care.

Sources

[1] FDA news release, February 12 2026

[2] FDA list of products with updated prescribing information

[3] Public Citizen Health Letter, March 2026

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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