Semaglutide in postmenopausal women: Clinical implications for weight loss, muscle health, and sleep-disordered breathing.

Postmenopause is characterized by hormonal changes that predispose women to sleep disturbances, alterations in body composition, and an increased risk of sarcopenia. Current studies indicate that weight reduction induced by glucagon-like peptide-1 receptor agonists is associated with decreases in lean body mass, although the functional consequences of these changes, including their implications for muscle and sleep-disordered breathing, are incompletely understood. Importantly, reductions in lean body mass do not necessarily reflect clinically meaningful skeletal muscle loss or impaired muscle function. This narrative mini-review highlights the clinical challenge of balancing effective pharmacologically induced weight loss with the preservation of muscle health and physical function in postmenopausal women. It reviews the current evidence regarding semaglutide use in this population, with a focus on muscle health and sleep-disordered breathing. In this context, overcoming anabolic resistance through adequate intake of protein and micronutrients, and resistance exercise may help preserve musculoskeletal health, although evidence in semaglutide-treated postmenopausal women remains indirect. Although weight reduction is generally expected to improve obesity-related obstructive sleep apnea, the specific effects of semaglutide on sleep-disordered breathing and long-term sleep-related outcomes in postmenopausal women are insufficiently characterized. A more integrated approach to obesity management, combining pharmacological treatment with targeted nutritional and lifestyle strategies, may help achieve safe and sustainable weight loss while preserving muscle function and optimizing overall metabolic health.