First: What is a GLP-1, in plain English?
GLP-1 is a hormone your body naturally makes. It helps:- Increase fullness
- Reduce hunger
- Slow down stomach emptying
- Support insulin release after meals (especially helpful in type 2 diabetes)
Which oral GLP-1 drugs are available?
Right now, this category includes only oral semaglutide.Rybelsus (oral semaglutide for type 2 diabetes)
Rybelsus is an oral version of semaglutide approved for blood sugar control in adults with type 2 diabetes. It is taken once daily. There is a very specific way you have to take it for absorption to work well. That’s not “extra.” That’s the difference between it working and it barely absorbing.Wegovy tablet (oral semaglutide for chronic weight management)
This is newer and important: there is now an oral semaglutide product labeled for chronic weight management, used with a reduced-calorie diet and increased physical activity. It contains an agent that improves absorption, but still has “rules”. So yes, oral therapy is no longer only in the “diabetes” lane.How oral GLP-1s compare to Rybelsus
A lot of people ask this in a way that sounds like: “Is the new pill the same as Rybelsus?” They are both oral semaglutide, but they are not the same product, the same dose, or the same indication. Here’s a simple way to think about it:- If the main goal is type 2 diabetes control, Rybelsus is typically the oral option people mean.
- If the main goal is weight management, the oral weight-loss option uses different dosing and is studied specifically for that purpose.
How oral GLP-1s compare to injectable GLP-1s
1) Convenience is different than it sounds
At first glance, a pill seems easier than a shot. But oral semaglutide has strict timing rules. Typically, it must be taken:- On an empty stomach
- With a small amount of water
- Then you wait before eating, drinking, or taking other oral medications
2) Efficacy: what the data shows
This is where people get surprised. In major clinical trials:- Weekly injectable semaglutide for weight management produced average weight loss around the mid-teens percentage range over about 68 weeks.
- Oral semaglutide at higher doses studied for weight management produced very similar average weight loss over about 64 weeks.
- Tirzepatide (a dual GIP/GLP-1 medication, injected weekly) has produced higher average weight loss in trials, often near or above 20% depending on the dose and study.
Side effects: what to expect (and what to watch for)
Most side effects are gastrointestinal, especially during dose increases:- Nausea
- Vomiting
- Diarrhea
- Constipation
- Stomach pain or bloating
- Reflux in some people
Side effects are often dose and food-related
High-fat meals and large portions tend to make nausea worse. Many people do better with smaller meals, slower eating, and more protein-focused choices.Slower dose escalation can help
If side effects are rough, a slower titration schedule can sometimes improve tolerance. This is very different than “microdosing,” which we’ll talk about later.Red flags are not the same as common nausea
If you have severe or persistent abdominal pain, repeated vomiting, signs of dehydration, or symptoms that feel scary, do not “push through.” Call your clinician. Also, GLP-1 drugs are not appropriate for everyone. For example, they are not recommended in people with a personal or family history of certain rare thyroid tumors (that warning is in the prescribing information).Who is oral GLP-1 best for?
Oral GLP-1 therapy may be a good fit if you:- Strongly prefer to avoid injections
- Can reliably follow the dosing routine
- Want a daily habit you can anchor to mornings
- Are consistent, and you don’t want weekly injections
- Struggle with daily timing rules
- Take multiple morning medications
- Prefer weekly convenience
- Want the option of medications with the strongest long-term evidence and broader dosing flexibility
Want to create a custom longevity health plan?
You’re in the right place.
I can help you with a functional approach to midlife women’s health including hormone balance, gut health, autoimmune issues, bone health, heart health and more!
Cost: what patients need to know
Here’s the honest truth: cost can be the deciding factor, and it often has nothing to do with what’s medically ideal.
List prices (before insurance discounts or rebates) are high. As examples:
- Wegovy has been listed around $1,349 per package.
- Rybelsus has been listed around $997 per package.
What you actually pay depends on:
- Insurance coverage (and whether your plan covers weight-loss medications)
- Copay cards or manufacturer savings programs (if eligible)
- Pharmacy channel (some programs use direct-to-consumer pharmacies)
My advice:
- Ask your insurance: “Is this covered for my diagnosis?”
- Ask the pharmacy: “What is the cash price today?”
- Ask your prescriber: “If this isn’t covered, what are my realistic alternatives?” There are many online telehealth platforms that will prescribe GLP-1s, but many of them use a compounded form.
And please do not get pulled into risky options because you feel desperate. Safety matters.
What happens when you stop GLP-1 drugs?
This part needs to be discussed BEFORE you start.
In studies, many participants regained a significant portion of lost weight after stopping GLP-1 therapy. That’s not because they “failed.” It’s because hunger signaling often returns when the medication is removed, and the body tends to defend its prior weight.
This is why I want you asking:
- Is this intended as a long-term medication for me?
- If not, what is the maintenance plan?
- What skills, routines, and supports are we building while I’m on it?
If your plan is “I’ll take it for 3 months and then white-knuckle it,” I want a better plan for you.
Muscle loss: the hidden risk (and how to prevent it)
Here’s the part that matters a lot in midlife: rapid weight loss can come with loss of lean mass, which includes muscle.
In research using DEXA scans, people losing weight on GLP-1 therapy lost a large amount of fat, but lean mass also decreased.
Muscle is not just for looks. It is:
- Your metabolic engine
- Your joint support
- A major driver of insulin sensitivity
- A predictor of healthy aging, fall risk, and long-term independence
How to protect muscle while on a GLP-1
1) Strength train at least 2 days per week
You do not need to become a bodybuilder. You need consistent resistance training that challenges your muscles.
2) Protein is not optional
When appetite drops, protein intake often drops too. That’s when muscle loss risk rises. Many women need to be more intentional about protein at each meal.
3) Don’t undereat by accident
If you’re living on yogurt, half a salad, and coffee, the scale may drop, but your energy, strength, and mood will drop too. That is not the goal.
A helpful checkpoint: if your weight is decreasing and your strength is also decreasing, we need to intervene early.
Microdosing GLP-1s: is there evidence to support it?
“Microdosing” GLP-1s is trending online. The idea is that tiny doses can give benefits with fewer side effects.
Here’s what I want you to know: we do not have strong clinical trial evidence proving that very small doses deliver the big claims being marketed.
There’s another issue too. Microdosing often overlaps with compounded products, vial dosing, and DIY math. That is where things can get dangerous. The FDA has reported dosing errors and adverse events tied to compounded semaglutide products in multi-dose vials.
If your goal is fewer side effects, the safer path is usually:
- A clinician-guided titration plan
- Nutrition and hydration support
- A muscle-protection plan from day one
Not experimenting on yourself.
Benefits beyond weight loss and blood sugar
GLP-1 medications are not only about the scale.
Depending on the medication and the patient population, research and approvals have supported benefits in areas like:
- Cardiovascular risk reduction in adults with established cardiovascular disease and overweight or obesity (for specific products)
- Kidney protection in people with type 2 diabetes and chronic kidney disease (semaglutide showed benefit in a large kidney outcomes trial)
- Obstructive sleep apnea in adults with obesity (tirzepatide has an FDA-approved indication for moderate to severe OSA in this population)
- Fatty liver disease and MASH (semaglutide has shown promising results in phase 3 research)
- Addiction to opioids and alcohol
This is why these medications are now part of bigger medical conversations: heart, kidney, liver, sleep health and substance abuse.
The bottom line
Oral GLP-1s can be a real option, with real efficacy, for the right person.
But the best outcomes come from pairing the medication with:
- A plan you can actually follow
- A strategy for side effects
- A maintenance plan for the long haul
- And a serious commitment to protecting muscle with protein and strength training
If you’re thinking about starting, the most important question is not “Which drug is best?”
It’s: “What is the safest plan that I can sustain, and how are we supporting my future self?”
References (APA)
Aronne, L. J., et al. (2024). Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity or overweight: The SURMOUNT-4 randomized clinical trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2812936
Centers for Disease Control and Prevention. (2023). Physical activity guidelines for adults. https://www.cdc.gov/physical-activity-basics/guidelines/adults.html
Eli Lilly and Company. (2025, December 1). Lilly lowers the price of Zepbound® (tirzepatide) single-dose vials [Press release]. https://investor.lilly.com/news-releases/news-release-details/lilly-lowers-price-zepboundr-tirzepatide-single-dose-vials
Food and Drug Administration. (2024, March 8). FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or
Food and Drug Administration. (2024, December 20). FDA approves first medication for obstructive sleep apnea. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea
Food and Drug Administration. (2024). RYBELSUS (semaglutide) tablets: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/213051s018lbl.pdf
Food and Drug Administration. (2025). WEGOVY tablets (semaglutide): Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/218316Orig1s000lbl.pdf
Food and Drug Administration. (2024, July 26). FDA alerts health care providers, compounders and patients of dosing errors associated with compounded semaglutide injectable products. https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-providers-compounders-and-patients-dosing-errors-associated-compounded
Food and Drug Administration. (2025, September 25). FDA’s concerns with unapproved GLP-1 drugs used for weight loss. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss
Jastreboff, A. M., et al. (2022). Tirzepatide once weekly for the treatment of obesity. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
Nunes, E. A., et al. (2022). Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults. Journal of Cachexia, Sarcopenia and Muscle, 13(2), 795–810. https://pmc.ncbi.nlm.nih.gov/articles/PMC8978023/
NovoCare. (n.d.). What is the list price for Wegovy® and will it impact me? https://www.novocare.com/mash/resources/explaining-list-price.html
NovoCare. (n.d.). Find out the cost for RYBELSUS®. https://www.novocare.com/diabetes/products/rybelsus/explaining-list-price.html
Perkovic, V., et al. (2024). Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. The New England Journal of Medicine. https://www.nejm.org/doi/10.1056/NEJMoa2403347
Sanyal, A. J., et al. (2025). Phase 3 trial of semaglutide in metabolic dysfunction–associated steatohepatitis. The New England Journal of Medicine. https://www.nejm.org/doi/10.1056/NEJMoa2413258
Wharton, S., et al. (2025). Oral semaglutide at a dose of 25 mg in adults with overweight or obesity. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2500969
Wilding, J. P. H., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine, 384, 989–1002. https://pubmed.ncbi.nlm.nih.gov/33567185/
Wilding, J. P. H., et al. (2021). Impact of semaglutide on body composition in adults with overweight or obesity: Exploratory analysis of the STEP 1 study. Journal of the Endocrine Society, 5(Suppl 1). https://pmc.ncbi.nlm.nih.gov/articles/PMC8089287/
Wilding, J. P. H., et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725
STAT News. (2025, November 4). Microdosing GLP-1 drugs: Marketing claims aren’t backed by robust clinical evidence. STAT. https://www.statnews.com/2025/11/04/microdosing-glp-1-drugs-no-clinical-evidence-effective/
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultations. Find out more at www.drannagarrett.com/lets-
