GLP-1 Microdosing

Weight gain in perimenopause

Many people experience weight gain during perimenopause. This is because the drop in hormone levels can decrease the body’s metabolism leading to a decrease in 250 to 350 calories burned each day. While taking Hormone Replacement Therapy (HRT) can balance the hormonal changes, it does not reverse any gained weight or help with weight loss.

What is a GLP-1 agonist?

A GLP-1 agonist is a medication that can assist with weight loss when combined with healthy lifestyle changes. These medications slow stomach emptying and can lower glucose and cholesterol levels. GLP1 agonists can also help with other perimenopausal symptoms, like sleep, mood, brain fog/trouble concentrating, “food noise,” and cravings related to food and alcohol.

What is microdosing?

Regular doses of GLP-1 agonists can have a lot of side effects and can lead to rapid weight loss. The most commonly seen side effects are nausea, abdominal pain, changes in bowel movements, hair loss, muscle wasting and loose skin. Microdosing, or taking small amounts each week, is a safer and more gentle way of treating perimenopausal symptoms with little to no uncomfortable side effects. Microdosing also makes it easier to stop taking the medication once it is no longer needed. There are currently no national guidelines for microdosing.

We recommend tracking your symptoms to monitor how medications are working. Please share your symptoms and goal weight at the beginning of your treatment. If you are looking to lose some weight, we recommend aiming for no more than 1-2 pounds per week. If you find that you reach a weight loss plateau, (greater than 2-4 weeks of weight stabilization) or if your perimenopausal symptoms have not improved enough, please inform your provider for a personalized approach.

Are GLP-1 agonists right for everyone?

It is recommended that you NOT use this medication if you have the following:

An eating disorder
Active gallbladder disease
Pancreatitis
A personal or family history of medullary thyroid cancer or Multiple endocrine neoplasia type 2 syndrome (MEN-2)
Are pregnant or breastfeeding

Additionally, if you want to lose a significant amount of weight and/or if you have diabetes, we recommend you work with your Primary Care Provider as the standard dosing regimen may be more appropriate.

Be sure to let your provider know if you experience any side effects. For any moderate adverse symptoms, please contact us right away. For severe symptoms or any allergic reactions, please call 911 or go to the nearest emergency room.

What else do I need to know before starting?

Microdosing means taking the medication off-label, or in a different way from how it was originally intended to be prescribed. This approach means you will have more doses in each vial and will need a refill less frequently.

If interested in adding this to your Poppy regimen, your provider will send a prescription for Zepound (tirzepatide) 2.5mg/0.5mL to the LillyDirect Self-Pay Pharmacy (Patient FAQs about LillyDirect® Pharmacy). The self-pay price for the vials is $299/month* and is HSA/FSA eligible depending on your current plan. With our standard microdosing schedule, the vials last 2 months instead of one, so the price is effectively half per month.

The medication lasts for 5 days, so may notice an increase in food noise/cravings the last two days of the week. We recommend weekly dosing for ease of scheduling, and selecting a day of the week when you can anticipate and manage any unwanted changes in appetite or other symptoms. Using a phone app is a great way to monitor the amount of medication in your system and associated symptoms. It will also help you track your injection locations.

It is also important to remember that there is a natural decline in muscle mass and bone density during this stage of life. Please be sure to get adequate protein intake and to incorporating resistance training (eg weight lifting) a few days each week.

*price subject to change

What happens when I reach my goal weight?

It’s time for maintenance! How you approach maintenance is up to you. Some people like to stay on their same dosing schedule, others spread out their injections to every 10 days or twice a month, or go off it completely without issue. It’s important to build healthy habits and address any issues with food prior to going off the medication. Please contact us for customized recommendations if needed.