The short answer
GLP-1 medicines like Ozempic, Wegovy, Mounjaro, and Zepbound are not approved to treat menopause symptoms, and hot flashes are not listed as a side effect. But many women on them still wake up hot at night, because perimenopause and menopause do not stop while you lose weight.
Two Mayo Clinic studies found that women on menopause hormone therapy lost more weight on a GLP-1 than women who were not.1,2 These were small, early studies. A cool bedroom, a steady routine, and a talk with your doctor about hormone therapy are the best next steps.
"I wake up so hot"
In my experience, most women in perimenopause or menopause who are on a GLP-1 tell me the same thing: they wake up in the night very hot.
When we look closer, there is often a reason. Some take a hot shower right before bed. Some wear pajamas that are too warm, or sleep under blankets that are too heavy. Some also have a racing mind, which may have nothing to do with the GLP-1 at all.
What GLP-1s can and cannot do in menopause
What they can do
- Help with weight loss, including the weight gain many women notice in midlife.
- Treat moderate to severe sleep apnea in adults with obesity. Zepbound is FDA approved for this.3
What they cannot do
- Treat hot flashes or night sweats. They are not approved for menopause symptoms.
- Replace hormone therapy.
- Quiet a racing mind at night.
GLP-1s and hormone therapy (HRT)
Hormone therapy is the most effective treatment for hot flashes and night sweats, according to The Menopause Society.4 Two studies looked at what happens when women take it alongside a GLP-1.
| Study | With HRT | Without HRT |
|---|---|---|
| Semaglutide (Ozempic, Wegovy), 106 women, 12 months1 | 16% weight loss | 12% weight loss |
| Tirzepatide (Mounjaro, Zepbound), 120 women, 12 months or more2 | About 35% more weight loss | Compared group |
Both studies looked back at medical records. They cannot prove hormone therapy caused the extra weight loss. The researchers noted that women on hormone therapy may have had better sleep and fewer hot flashes, which could make healthy habits easier.1,2
Should you think about HRT on a GLP-1?
When a woman on a GLP-1 asks me if she should think about hormone therapy for her night sweats, I tell her it is very important to speak to her family doctor, her gynecologist, or a menopause specialist, so they can give her a firm medical opinion.
What I have seen in women who use HRT and a GLP-1 together is that many still have sleep disruptions, still have hot flashes, have a lack of energy, and lose weight. There are a multitude of factors, so it is hard to say either one is the direct cause. HRT might not be right for everyone. Talk to your doctor to find out if it is the right choice for you, and if it is, whether a pill, a patch, or a gel works best while taking your GLP-1.
Can you take Ozempic or Mounjaro with HRT?
The women in these studies did. The GLP-1 labels give advice about birth control pills, but they do not address menopause hormone therapy directly.3,5 Ask your doctor whether the form of HRT you use, such as a pill, patch, or gel, matters with your GLP-1.
Why you wake up hot, and what to change
- A hot shower right before bed. Take it 1 to 2 hours before bed instead. Your body cools down afterward, which can help you fall asleep faster.6
- Pajamas that are too warm. Choose light, breathable fabrics.
- Blankets that are too heavy. Use layers you can kick off.
- A warm room. Run a fan at night. It cools you down, and its steady sound works like white noise.
- A racing mind. Keep a notepad by the bed. Write your thoughts down and deal with them in the morning.
A cool, calm bedtime routine
I tell women to keep a regular routine and a regular bedtime. No electronics at night. Put the phone away, with no blue light and no TV. Try to relax, and remember that everyone is different.
- Warm shower 1 to 2 hours before bed, not right before.
- Cool the room. Turn on a fan and dim the lights.
- Screens off. Phone out of reach, TV off.
- Wind down at the same time every night. If you use a supplement, take it at least 30 minutes before bed. I suggest a low dose of melatonin with calming botanicals like valerian, lavender, and chamomile.
- Notepad by the bed for racing thoughts.
- Same bedtime and wake time, even on weekends.
Ask your pharmacist before adding any supplement to a GLP-1. For more help, read melatonin for perimenopause, why you keep waking up at 3am, and GLP-1s and sleep.
Important for women in perimenopause
- Still on birth control pills? The Zepbound label (Mounjaro is the same medicine) advises a method that is not a pill, or a backup, for 4 weeks after starting and after each dose increase. The Foundayo label says 30 days.3,5
- Bleeding after menopause always needs to be checked by your doctor, whether or not you take a GLP-1.
- Feeling more tired than usual? Fatigue is a listed side effect of these medicines. Read GLP-1 fatigue.
Talk to your doctor if
- Hot flashes or night sweats wake you up most nights.
- You want to know if hormone therapy is right for you.
- You have any bleeding after menopause.
- You snore loudly or stop breathing in your sleep.
- You feel low, anxious, or not yourself.
Where Driffly fits
A low dose for a calm wind down
Driffly is not made for GLP-1 medicines and has not been studied with them, and it does not treat hot flashes. But if you and your pharmacist decide melatonin fits your bedtime routine, this is what I chose: 1 mg of melatonin with valerian root, lavender, chamomile, and hibiscus to support a calm wind down.*
- 1 mg of melatonin, the same in every strip.
- Melts on your tongue. No water and no sugar.
- Take it 30 minutes before bed, at the same time every night.
Every order comes with a 30 night money back guarantee.
Common questions about GLP-1s and menopause
Can a GLP-1 help with menopause symptoms?
GLP-1 medicines are not approved to treat menopause symptoms like hot flashes. They can help with weight, and Zepbound is approved for sleep apnea in adults with obesity.3 Hormone therapy is the most effective treatment for hot flashes.4
Does Ozempic cause hot flashes?
Hot flashes are not listed as a side effect on the label for Wegovy, which is the same medicine as Ozempic.5 Feeling hot at night in midlife is more often from perimenopause or menopause itself.
Can you take Ozempic and HRT together?
Many women do, including the women in the Mayo Clinic study.1 Ask your doctor whether your form of HRT matters with your GLP-1.
Does HRT help you lose more weight on a GLP-1?
Two small studies found more weight loss in women on HRT, but they cannot prove HRT caused it.1,2 Larger trials are planned.
Can Mounjaro make perimenopause worse?
There is no good evidence that it does. But side effects like fatigue and poor sleep can pile on top of perimenopause symptoms. Talk to your doctor if things feel worse.
Is microdosing a GLP-1 safe for menopause?
Microdosing usually means taking much lower doses than the label, often from compounded products. These doses have not been studied in the trials that led to approval. Talk to your doctor before trying it.
Why do I wake up hot at night in menopause?
Night sweats are common in perimenopause and menopause. A hot shower right before bed, warm pajamas, heavy blankets, or a warm room can make it worse.
Sources
- Hurtado MD, Tama E, Fansa S, et al. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause. 2024;31(4):266-274.
- Mayo Clinic News Network. New study links combination of hormone therapy and tirzepatide to greater weight loss after menopause. The Lancet Obstetrics, Gynaecology, & Women's Health. January 2026.
- Zepbound (tirzepatide) injection, prescribing information. US Food and Drug Administration label, 2026.
- The Menopause Society. The 2022 hormone therapy position statement. Menopause. 2022;29(7):767-794.
- Wegovy (semaglutide) injection, prescribing information, 2024; Foundayo (orforglipron) tablets, prescribing information, 2026.
- Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Before bedtime passive body heating by warm shower or bath to improve sleep: a systematic review and meta-analysis. Sleep Medicine Reviews. 2019;46:124-135.
Tyler Smith, RN, BSN, BA is a registered nurse and the founder of Driffly. He writes and reviews the articles in the sleep education hub. About Tyler
The author is the founder of Driffly, which sells the product mentioned in this article. Driffly does not sell GLP-1 medicines, hormone therapy, or any prescription medicine. This article is for education and is not medical advice. Do not start, stop, or change any medicine without talking to your doctor. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.