GLP-1 Medications and Pelvic Physical Therapy: What You Need to Know

GLP-1s (like semaglutide/Ozempic/Wegovy and tirzepatide/Zepbound/Mounjaro) are quite the hot topic right now. These medications have been around for decades, have well-established data and are transforming how we approach metabolic health, obesity, and chronic diseases in healthcare.

But what often gets left out of the conversation is how GLP-1s intersect with movement, the musculoskeletal system and pelvic health. So we’re here to answer the question – WHY (pelvic) physical therapy should be a critical part of care for people using these medications.

How GLP-1 Medications Work

In simple terms, GLP-1s act through two primary pathways:

  1. The brain: They reduce “food noise” and
  2. The gastrointestinal tract: They slow gastric emptying and GI motility – helping people feel fuller longer.

They also appear to positively influence insulin secretion and glycemic control to benefit multiple systems including reproductive, renal, cognitive, psychological, immune and inflammatory pathways.

Importantly: GLP-1s work very well for some people and not for others – and medication alone is never the whole story.

Weight Loss, Muscle, and Why Physical Therapy Matters

One of the biggest concerns with GLP-1 medications is loss of lean muscle mass.

Research shows that ~25% of weight loss with Tirzepatide and up to ~40% of weight loss with Semaglutide may come from lean muscle mass not just fat. This matters because muscles don’t just help you move they are part of the endocrine system and play a key role in helping to regulate your health. 

Muscles release helpful chemical messengers that reduce inflammation, support metabolism and protect your body as a whole. When weight is lost too quickly without strength training, the body may lose muscle along with fat. 

How to protect muscle during GLP-1 Treatment

  • Resistance training
  • Sufficient protein
  • Screen for sarcopenia before and after
  • Pelvic health screen to indicate symptoms that will interfere with activity

This is where physical therapy (and pelvic PT specifically) plays a critical role in GLP-1 use.

Pelvic Health Considerations on GLP-1 Medications

Special Considerations for Folks in Perimenopause & Menopause

Cisgender-women ages 50-64 are currently the fastest-growing group using GLP-1 medications. This matters because:

  • Estrogen fluctuations affect tendons, muscle, bone, and pelvic tissues
  • Tendons love estrogen and hate change… Rapid shifts in hormone levels increase the risk of injury 
  • Menopause already accelerates bone loss and muscle decline.

People in peri- or post-menopause may need:

  • Slower ramp-up of GLP-1 in combination with resistance training
  • Longer recovery windows
  • Close monitoring for tendinopathy, joint pain or pelvic symptoms.

The good news? When paired with appropriate exercise, GLP-1s may actually improve tissue quality, reduce inflammation, and support joint health for some people.

Bowel Function

During the early dose-increase phase of GLP-1 medications common side effects include constipation, diarrhea, nausea and bloating. From a pelvic health perspective, these changes in digestion and bowel habits can place extra strain on the pelvic floor muscles and may contribute to pelvic pain or tightness, hemorrhoids or fissures, difficulty fully emptying the bowels and even leakage of stool.

Pelvic physical therapy can help by retraining and coordinating the pelvic floor muscles, teaching proper toileting positions and techniques and guiding safe increases in fiber and hydration so symptoms don’t worsen.

Bladder Function

Changes in body weight can also affect bladder function. Many people notice less pressure on the bladder and pelvic floor as weight decreases which may improve stress urinary incontinence and overactive bladder symptoms. However, fear of leakage or prolapse can still make people hesitant to exercise which is why pelvic health screening is important before starting or increasing activity.

Sexual Health

Sexual health and intimacy can also change while taking GLP-1 medications. These drugs may affect blood flow to the genitals and brain chemistry involved in pleasure and motivation and some people report lower libido, erectile dysfunction or difficulty reaching orgasm. 

At the same time, weight loss can improve comfort, confidence and mobility. Though experiences vary widely. Some individuals also notice vaginal dryness or changes in labial tissue (“Ozempic vulva”) which may be related to fat loss, circulation changes or hormone shifts around perimenopause rather than the medication alone.

Pelvic physical therapy provides a supportive space to address pelvic muscle function and blood flow, work toward comfortable/enjoyable movement and intimacy, and encourages open communication between partners.

Why Pelvic Physical Therapy Belongs in The GLP-1 Conversation

GLP-1 medications can be powerful by helping with inflammation, creating more comfortable movement and allowing folks to re-engage with their bodies. But lasting impact happens when medication is integrated with movement, strength, pelvic health, nutrition and behavior change.

GLP-1s aren’t “cheating,” a cure-all or a shortcut – they’re a tool and part of a lifestyle change. GLP-1s paired with pelvic physical therapy can help you build a foundation for long-term, sustainable well-being rather than short-term goals. 

If you’re starting, currently using or considering coming off a GLP-1 medication, KPP can help you navigate the process by keeping you strong, informed and supported every step of the way.

Citations & Links

This article was informed by clinical insights from Michelle Lyons, GLP-1 Receptor Agonists and Physical Therapy.

Jensen SBK, Sørensen V, Sandsdal RM, et al. Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment: A Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open. 2024 Jun 3;7(6):e2416775. doi: 10.1001/jamanetworkopen.2024.16775. PMID: 38916894. Available at: https://pubmed.ncbi.nlm.nih.gov/38916894/

Gatto A, Liu K, Milan N, Wong S. The Effects of GLP-1 Agonists on Musculoskeletal Health and Orthopedic Care. Curr Rev Musculoskelet Med. 2025 Oct;18(10):469-480. doi: 10.1007/s12178-025-09978-3. PMID: 40372699. Available at: https://pubmed.ncbi.nlm.nih.gov/40372699/

Mulcahy J, DeLaRosby A, Norwood T. Transforming Care: Implications of Glucagon Like Peptide-1 Receptor Agonists on Physical Therapist Practice. Phys Ther. 2025 Apr 30;105(6):pzaf061. doi: 10.1093/ptj/pzaf061. PMCID: PMC12203058; PMID: 40305684. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12203058/