Sleep and wellbeing | 6 min read

Menopause Brain Fog: Causes, What Helps, and When to Worry

Editorial draft — clinical review pending.

Short answer: Many women notice forgetfulness, trouble finding words or difficulty concentrating around menopause. It’s common, it’s real, and for most women it improves after the transition. Brain fog in midlife is not usually a sign of dementia. Poor sleep and hot flashes are major contributors, so treating those often helps. [1,2]

Key takeaways

• Memory and concentration problems are recognized symptoms around menopause. [1]
• Research links hot flashes and sleep disruption with changes in memory and brain function. [2]
• Hormone therapy is not recommended for brain fog alone. [1]
• Sudden confusion or trouble speaking is an emergency. Call 911.

What brain fog feels like

• Walking into a room and forgetting why.
• Losing a word mid-sentence.
• Rereading an email several times.
• Struggling to juggle several tasks that used to feel easy.
• Feeling mentally slower or less sharp.

What’s behind it

Hormone changes. Estrogen influences brain areas involved in memory and attention, and fluctuating levels may affect them during the transition.

Poor sleep. Night sweats, insomnia and sleep apnea all impair concentration and memory the next day.

Hot flashes. Research suggests frequent hot flashes, especially at night, are linked with memory changes. [2]

Mood. Anxiety and depression, which can increase during perimenopause, affect thinking.

Other causes. Thyroid problems, low iron or B12, some medicines, alcohol and stress can all contribute. These are worth ruling out.

What helps

• Treat sleep problems. This is often the most effective step. See our article on sleep apnea.
• Treat bothersome hot flashes. Fewer night sweats can mean better sleep and clearer thinking.
• Exercise regularly. Aerobic activity supports brain health and mood.
• Reduce load. Lists, calendars and doing one thing at a time are not signs of weakness. They work.
• Limit alcohol, which disrupts sleep and memory.
• Address mood. Treatment for anxiety or depression can lift thinking too.

Hormone therapy and the brain

Hormone therapy treats menopause symptoms like hot flashes, which may indirectly improve sleep and focus. But it is not recommended specifically to treat brain fog or to prevent dementia. [1]

When to get checked

Book an appointment if:

• Memory problems are getting steadily worse.
• Others are noticing and worried.
• You’re getting lost in familiar places or struggling with tasks you’ve done for years.
• It’s affecting your work or safety.

Call 911 immediately for sudden confusion, trouble speaking or understanding, drooping on one side of the face, weakness or numbness on one side, sudden vision loss or a sudden severe headache. These can be signs of stroke. [3]

Preparing for your appointment

Note two or three specific examples, when they started, how you’re sleeping, your mood, and all your medicines and supplements. Specific examples help more than "I feel foggy."

Frequently asked questions

Is menopause brain fog a sign of early dementia?

Usually not. It’s common during the transition and typically improves afterwards. Worsening or severe symptoms should be checked.

How long does menopause brain fog last?

It’s most common during perimenopause and early postmenopause and often eases after that.

Will HRT fix brain fog?

It may help indirectly by improving hot flashes and sleep, but it isn’t recommended for brain fog alone. [1]

Next step

A HerScripts clinician can look at sleep, hormones, mood and other causes together to find what’s driving the fog. Learn about brain fog in women.

Sources

[1] Office on Women's Health, Menopause symptoms and relief

[2] NIH, Menopause research overview

[3] CDC, Signs and symptoms of stroke

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

Explore related care

Hormones and menopause | 5 min read

Heavy Periods and Fatigue: When to Check for Anemia

Editorial draft — clinical review pending.

Short answer: Heavy periods are one of the most common causes of iron deficiency and anemia in women, and anemia is a common cause of exhaustion. If your periods are heavier than usual and you feel unusually tired, weak or breathless, mention both together. A clinician can check for anemia and look for the cause of the bleeding. [1,2]

Key takeaways

• Bleeding is considered heavy if it lasts more than 7 days, needs a new pad or tampon in under 2 hours, or involves large clots. [2]
• Heavy bleeding has many causes, including perimenopause, fibroids, polyps, bleeding disorders and some medicines. [1]
• Iron supplements can treat low iron, but they don’t fix the cause of the bleeding.

Is my period heavy?

You may have heavy menstrual bleeding if you: [2]

• Soak through one or more pads or tampons every hour for several hours in a row.
• Need to change products in less than 2 hours.
• Need to change during the night or double up on protection.
• Pass large clots.
• Bleed for more than 7 days.
• Plan your life around your period or miss work or activities because of it.

Common causes in your 40s

Perimenopause. Cycles without ovulation can cause the uterine lining to build up and shed heavily.

Fibroids and polyps. These noncancerous growths are common in midlife and can cause heavy or prolonged bleeding.

Adenomyosis. Tissue from the uterine lining grows into the muscle wall.

Bleeding disorders, such as von Willebrand disease, are more common than many people realize.

Medicines, including blood thinners, can increase bleeding.

Less commonly, changes in the uterine lining that need investigation, especially with bleeding between periods. [1]

Don’t assume heavy bleeding is just perimenopause. A new or changing pattern deserves a check.

Signs of anemia

• Fatigue that doesn’t improve with rest.
• Shortness of breath with activities that used to be easy.
• Feeling dizzy or lightheaded.
• Pale skin, headaches or cold hands and feet.
• Fast heartbeat.
• Restless legs or craving ice.

A simple blood test can check hemoglobin and iron stores (ferritin).

What to tell your clinician

• How many days you bleed and how often you change products on the heaviest days.
• Whether you have clots, bleeding between periods or after sex.
• How tiredness affects stairs, work and exercise.
• Any medicines and supplements you take.

You don’t need to measure blood loss exactly. Practical details are enough.

Treatment options

Treatment depends on the cause and whether you want to preserve fertility. Options include a hormonal IUD, hormonal birth control, tranexamic acid, anti-inflammatory medicines during periods, and procedures for fibroids or polyps. Iron is often given at the same time to rebuild stores. [1]

When to get urgent help

Call 911 or go to an emergency department if bleeding is very heavy and you feel faint, have chest pain, a racing heart or trouble breathing.

Frequently asked questions

Can heavy periods cause anemia?

Yes. Heavy menstrual bleeding is a common cause of iron-deficiency anemia. [2]

Should I just take iron?

Talk to a clinician first. Iron can treat low iron, but the cause of the bleeding still needs to be found.

Are heavy periods normal in perimenopause?

They’re common, but not something you have to live with, and other causes should be ruled out.

Next step

Bring both symptoms to one HerScripts conversation and get a plan that looks at the cause and the effects. Learn about changing periods.

Sources

[1] ACOG, Heavy Menstrual Bleeding

[2] CDC, About Heavy Menstrual Bleeding

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

Explore related care

Skin and hair | 6 min read

Female Hair Thinning: Causes and Treatments That Work

Editorial draft — clinical review pending.

Short answer: The right treatment depends on the cause. For female pattern hair loss, the most common cause of gradual thinning, topical minoxidil is the only FDA-approved medicine and the standard first treatment. Spironolactone and low-dose oral minoxidil are widely used off label. Sudden shedding often has a different cause, such as stress, illness or low iron, and may need a different approach. [1,2,3]

Key takeaways

• Gradual thinning at the part or crown is usually female pattern hair loss. [2]
• Heavy shedding 2 to 3 months after illness, surgery, childbirth or major stress is often telogen effluvium, which usually recovers. [1]
• Treatments take about 6 months to judge and must be continued to keep results. [2]

Common types of hair loss in women

Female pattern hair loss. A widening part and thinning on top, with the hairline usually intact. It runs in families and becomes more common after menopause. [2]

Telogen effluvium. Sudden diffuse shedding a few months after a trigger like illness, surgery, crash dieting, childbirth or stress.

Other causes include thyroid disease, iron deficiency, certain medicines, tight hairstyles, and autoimmune or scarring conditions that need a dermatologist. [1]

Treatments for female pattern hair loss

Topical minoxidil (2% solution or 5% foam) is FDA approved for women. Some women notice extra shedding for the first few weeks, which usually settles. Results take 6 months or more, and hair loss resumes if you stop. [2]

Spironolactone is a tablet that blocks androgen effects. It’s used off label and a small randomized trial found adding it to topical minoxidil improved hair density in premenopausal women. [3] It isn’t safe in pregnancy, so reliable contraception is needed for women who could conceive, and blood potassium or blood pressure may need checking.

Low-dose oral minoxidil is increasingly prescribed off label for people who can’t use the topical form. Side effects can include unwanted facial or body hair, ankle swelling and dizziness, so it needs medical supervision. [1]

Other approaches include treating low iron or thyroid problems, and procedures such as platelet-rich plasma or hair transplants for some people.

Before you start any treatment

Ask:

• What type of hair loss do you think this is, and why?
• Is an exam or blood test needed first?
• Is this treatment FDA approved for this use, or off label?
• What side effects and monitoring should I expect?
• When should I expect results, and what if it doesn’t work?

Mention any pregnancy plans and list all medicines and supplements, including biotin, which can interfere with some lab tests.

When to see someone in person

Get an in-person exam if hair loss is patchy, the scalp is red, scaly, itchy or painful, the hairline is receding, or you’re losing eyebrow or body hair. Photos and questionnaires have limits for these patterns.

Track progress fairly

Take photos in the same light and position every 3 months. Daily mirror checks can make changes hard to see.

Frequently asked questions

What is the best treatment for female hair thinning?

For female pattern hair loss, topical minoxidil is the first-line, FDA-approved option. Others may be added depending on your situation. [2]

Does biotin help hair loss?

Only if you’re deficient, which is rare. Biotin can also distort some blood test results.

Is hair loss reversible?

Telogen effluvium usually recovers. Female pattern hair loss can often be slowed or partly reversed with ongoing treatment.

Next step

Start with the pattern you’ve noticed. A HerScripts clinician can help work out the likely cause and the treatment that fits it. Learn about hair thinning in women.

Sources

[1] American Academy of Dermatology, Hair loss diagnosis and treatment

[2] British Association of Dermatologists, Female pattern hair loss

[3] Randomized trial of oral spironolactone for female pattern hair loss

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

Explore related care

Weight care | 6 min read

What to Eat on a GLP-1: Protein, Nutrients, and Managing a Smaller Appetite

Editorial draft — clinical review pending.

Short answer: When a GLP-1 cuts your appetite, focus on quality: protein at every meal, plenty of vegetables, fruit, whole grains and healthy fats, and enough fluids. A 2025 joint advisory from four nutrition and obesity medicine organizations names adequate protein, preventing nutrient deficiencies, managing digestive side effects and strength training as key priorities. [1]

Key takeaways

• The advisory lists eight priorities, including baseline nutrition assessment, nutrient-dense minimally processed food, adequate protein and strength training. [1]
• Most people on GLP-1s eat far less, which raises the risk of falling short on protein, fiber, iron, calcium, vitamin D and B12.
• Your protein target should be personalized. The basic adult minimum is 0.8 g per kilogram of body weight a day, and many clinicians aim higher during weight loss.

Put protein first

Protein helps protect muscle while you lose weight. Because you’ll feel full sooner, eat the protein part of the meal first. Good sources:

• Eggs, Greek yogurt, cottage cheese and milk.
• Fish, chicken, turkey and lean meat.
• Tofu, tempeh, edamame, beans and lentils.
• Protein-fortified foods or shakes if solid food is hard.

Ask your clinician or a dietitian for a daily target based on your weight, kidney function and activity. Don’t borrow a number from social media.

Avoid nutrient gaps

Eating smaller portions makes variety more important. Aim for colorful vegetables and fruit, whole grains, and dairy or calcium-fortified alternatives. The advisory recommends checking for deficiencies and considering a multivitamin where intake falls short. [1] Ask before taking high-dose supplements.

Manage nausea and other side effects

• Eat small meals slowly and stop at the first sign of fullness.
• Avoid very fatty, fried or spicy foods if they make you queasy.
• Sip fluids through the day rather than drinking a lot with meals.
• Increase fiber and water gradually if you’re constipated.
• Don’t lie down right after eating.

A sample day

• Breakfast: Greek yogurt with berries and a spoon of nuts.
• Lunch: Lentil soup with a slice of whole-grain bread.
• Snack: Cottage cheese or a hard-boiled egg.
• Dinner: Salmon, roasted vegetables and a small portion of quinoa.

Adjust portions to your appetite. If you can only manage part of a meal, eat the protein first.

Be careful with supplements

Many products promise to protect muscle or boost metabolism. Quality and evidence vary widely, and supplements are not a substitute for food. [2] Bring any product to your care team before buying.

When to call your care team

Contact your prescriber if you:

• Can’t keep food or fluids down.
• Feel dizzy, weak or very tired most days.
• Have severe or ongoing stomach pain.
• Are eating very little most days.
• Notice hair shedding, which can happen with rapid weight loss or low protein.

Frequently asked questions

How much protein should I eat on a GLP-1?

It depends on your size, health and activity. The basic minimum for adults is 0.8 g/kg a day, and many clinicians recommend more during weight loss. Ask for your own target.

Do I need vitamins on a GLP-1?

Possibly, if your intake is low. The advisory recommends checking for and preventing deficiencies. [1]

What foods make GLP-1 nausea worse?

Large, greasy, fried or very sweet meals are common triggers.

Next step

Bring your typical day of eating to your HerScripts follow-up, and your care team can help make it work with your treatment. See weight care support.

Sources

[1] Joint advisory, Nutritional Priorities to Support GLP-1 Therapy for Obesity, 2025

[2] NIH Office of Dietary Supplements, Exercise and athletic performance

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

Explore related care

Hormones and menopause | 5 min read

Bone Density Screening After Menopause: When Do You Need a DXA Scan?

Editorial draft — clinical review pending.

Short answer: The U.S. Preventive Services Task Force recommends osteoporosis screening, usually with a DXA bone density scan, for all women 65 and older. It also recommends screening postmenopausal women under 65 who have a higher risk of fracture, based on a risk assessment. Bone loss speeds up after menopause, so your forties and fifties are the time to understand your risk. [1,2]

Key takeaways

• Screening is recommended at 65 for all women and earlier for postmenopausal women with risk factors. [1]
• Bone loss accelerates in the years after menopause. [2]
• Calcium, vitamin D, strength and balance exercise, and avoiding smoking all help protect bone.

Why menopause affects bone

Estrogen helps keep bone breakdown and rebuilding in balance. When it falls, bone breaks down faster than it’s replaced. Bone loss is fastest in the first several years after menopause, which raises the risk of osteoporosis and fractures later. [2]

Risk factors that may mean earlier screening

• A previous fracture from a minor fall after age 50.
• A parent who broke a hip.
• Low body weight.
• Smoking or heavy drinking.
• Long-term steroid use or certain other medicines.
• Early menopause, before 45.
• Conditions such as rheumatoid arthritis.

Clinicians often use a tool such as FRAX to estimate your 10-year fracture risk and decide whether a scan is useful before 65. [1]

What a DXA scan involves

A DXA scan is a quick, painless, low-radiation X-ray of the hip and spine. Results are given as a T-score:

• −1.0 or higher: normal.
• Between −1.0 and −2.5: low bone mass (osteopenia).
• −2.5 or lower: osteoporosis.

The result is combined with your other risk factors to decide whether treatment is needed.

Protecting your bones now

• Calcium: women 51 and older need about 1,200 mg a day from food and supplements combined. [3] Food first.
• Vitamin D: 600 IU a day up to age 70 and 800 IU after. [3]
• Exercise: weight-bearing activity like walking, plus strength training and balance work.
• Avoid smoking and limit alcohol.
• Reduce fall risk: good lighting, sturdy shoes and fixing trip hazards.

Check whether your multivitamin already contains calcium or vitamin D before adding more.

If treatment is suggested

Several medicines lower fracture risk. Hormone therapy is FDA approved to prevent bone loss and may be considered if you also have menopause symptoms. Ask about benefits, side effects, how long you’d take it and how it will be monitored.

Frequently asked questions

At what age should women get a bone density test?

At 65, or earlier after menopause if you have risk factors for fracture. [1]

Can I get a DXA scan in my 40s?

Usually only if you have specific risk factors or conditions. Ask your clinician.

Does hormone therapy protect bones?

Yes, it’s approved to prevent postmenopausal bone loss, but it’s usually chosen when there are also symptoms to treat.

Next step

Add bone health to your next midlife check-in. A HerScripts clinician can review your risk and whether screening makes sense now. Learn about strength and body changes.

Sources

[1] USPSTF, Osteoporosis to Prevent Fractures: Screening, 2025

[2] Office on Women's Health, Menopause and your health

[3] NIH Office of Dietary Supplements, Calcium fact sheet

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

Treatment literacy | 6 min read

Peptide Therapy for Women: How to Tell Evidence From Hype

Editorial draft — clinical review pending.

Short answer: "Peptide" just means a short chain of amino acids. Some peptides are well-tested, FDA-approved medicines. Semaglutide and tirzepatide are examples. Others sold for recovery, anti-aging or "hormone balance," such as BPC-157, have no FDA approval and limited human safety data, and the FDA has raised safety concerns about them. Judge each product on its own evidence, not on the word "peptide." [1,2]

Key takeaways

• Being a peptide says nothing about whether a product is safe or works.
• FDA approval covers a specific product for a specific use, not every product containing a similar ingredient. [1]
• The FDA has flagged BPC-157 and some other peptides for risks such as immune reactions and impurities. [2]
• "Research use only" products are not meant for people.

Approved peptides vs. wellness peptides

Approved peptide medicines have been tested in clinical trials in people, reviewed by the FDA for safety, effectiveness and manufacturing quality, and come with a label describing proper use. Examples include insulin, semaglutide and tirzepatide.

Wellness peptides such as BPC-157, TB-500 and various "anti-aging" blends are often supported mainly by animal studies, small human studies or testimonials. Results in rats do not show that a product is safe or effective in women. [1]

What the FDA has said

The FDA keeps a list of bulk substances that may pose significant safety risks when used in compounding. Its material on BPC-157 notes potential immune reactions, peptide-related impurities and limited information about safety in humans. [2] A substance being studied or discussed online doesn’t make it approved.

Red flags

• One product promising many unrelated benefits: recovery, glow, fat loss, longevity and libido.
• Labels saying "research use only" or "not for human consumption" alongside dosing advice.
• No prescription or medical history required.
• Testimonials and before-and-after photos in place of clinical studies.
• Purity certificates presented as proof the product works. Purity and benefit are different questions.

A five-question checklist

Before paying for any peptide treatment, ask:

1. What is the exact ingredient, dose and form?

2. Is this specific product FDA approved? For what?

3. If not approved, is it compounded, investigational or neither?

4. What human studies support it for my goal?

5. Who prescribes it, who makes it, and who manages side effects?

If you can’t get clear answers, that tells you something.

Why people are interested

Interest in peptides is understandable. Several approved peptide medicines have changed how conditions like diabetes and obesity are treated, and that success has made the word sound like a guarantee. Curiosity is a good starting point. The goal is to turn it into questions that protect your health and your money.

Frequently asked questions

Is BPC-157 safe?

Its safety in people hasn’t been established, and the FDA has listed safety concerns. [2]

Are GLP-1s peptides?

Yes. Semaglutide and tirzepatide are peptide medicines with FDA approval for specific uses.

Can a clinician prescribe wellness peptides?

Regulations limit which substances can be compounded. Ask any prescriber about approval status and evidence before starting.

Next step

Have a question about a peptide or wellness claim you’ve seen? Bring it to a HerScripts clinician for a straight answer. Ask your questions.

Sources

[1] FDA, The drug review process

[2] FDA, Certain bulk drug substances for compounding that may present significant safety risks

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

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.

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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