Weight is one of the most medically misunderstood parts of women’s health. For generations, women have been told, in effect, to eat less and try harder — without anyone asking why the body is holding on to weight in the first place. In my clinic I meet women who have done everything they were told to do, for years, and still feel their own body is working against them. Usually, it is. Hormones, insulin, thyroid function and the shifts of perimenopause all shape how you store and burn energy, and until someone looks properly, the real reason stays hidden. That is where I start.
Why weight can be a medical problem, not a willpower problem
For many women, weight that will not shift is a sign that something in the body’s metabolism is working against them. Insulin resistance — where the cells respond poorly to insulin, so the pancreas produces more of it — makes weight easier to gain and harder to lose. It is common, and it is central to conditions such as polycystic ovary syndrome. Thyroid problems, chronic stress, broken sleep and the hormonal changes of perimenopause all shift how the body handles energy, often quietly and over years.
None of this means your weight is out of your hands. It means the sensible starting point is understanding what is actually happening, rather than repeating the same effort and blaming yourself when it does not work. A proper assessment is what turns a frustrating, personal struggle into a medical problem with a plan.
Who this service is for
I see women who are struggling with weight despite genuine effort, who have gained weight around perimenopause or menopause, or who have a condition such as PCOS or insulin resistance affecting their metabolism. Some come because their weight is affecting their health — blood pressure, blood sugar, joints, fertility — and some simply because they want to understand their own body and have a plan they can trust.
Assessment follows the clinical standards used across the NHS and in NICE guidance, taking into account your body mass index, any weight-related health conditions, and your overall health. But whether any particular treatment is right for you is always an individual clinical decision, made together at your consultation. Some approaches are not suitable for everyone, and part of a careful assessment is being honest about that. This is not an online prescription service, and it is not a shortcut. If you are pregnant, trying to conceive, or breastfeeding, that changes what is appropriate, and we would talk it through.
What your assessment involves
Your consultation is thorough and unhurried. I take a full history — your weight over time, what you have already tried, your menstrual and hormonal health, family history of diabetes and heart disease, your sleep, your stress and your own goals for treatment.
Investigations usually include a full metabolic screen — fasting glucose, insulin, HbA1c and a lipid profile — alongside thyroid function and the hormone tests relevant to you. I perform a pelvic ultrasound. Then I explain what I have found in plain language, and we agree a plan together — one you understand and feel comfortable with, with follow-up to review your progress and adjust as your body responds.
The foundation: nutrition, movement and lifestyle
For every woman I see, the foundation of the plan is the same: a way of eating that keeps blood sugar steady, movement that is realistic and sustainable, and proper attention to sleep and stress. Even a modest, sustained change in weight can improve insulin sensitivity, energy, cycles and long-term health.
I take a supportive, non-judgemental approach to this. Losing weight is genuinely harder when your metabolism is working against you, and a plan that ignores that tends to fail. For some women, a functional-medicine approach to nutrition, gut health and hormones is a useful part of the picture.
Where medication may fit in
For some women, after a full assessment, medication can form part of a broader plan where it is clinically appropriate. This is a decision we make together, based on your health and your goals — never a default, and never a standalone quick fix.
One group of prescription-only medicines sometimes used in weight management is the GLP-1 receptor agonists, which act on the gut hormones that regulate appetite and how the body handles insulin. National guidance from NICE supports their use for weight management only within defined eligibility criteria and as part of a supervised programme, not in isolation. They are not suitable for everyone, they carry side effects, and they are only ever prescribed after individual assessment. Because I am a gynaecologist, I pay particular attention to what any such medicine means for your wider health — your contraception, your cycle, and any plans for pregnancy — and any prescribing is always accompanied by proper monitoring and follow-up.
Contraception, fertility and pregnancy
This is where a gynaecologist’s oversight genuinely matters, and it is often overlooked when weight medicines are prescribed elsewhere.
- Contraception. Some medicines used in weight management can make the oral contraceptive pill less reliable. Non-oral methods — such as the coil, implant or injection — are not affected in the same way, and I review your contraception as a matter of routine.
- Pregnancy. The MHRA advises that GLP-1 medicines should not be used in pregnancy, just before trying to conceive, or while breastfeeding, because there is not yet enough safety data. There are recommended gaps to leave after stopping certain medicines before trying for a baby.
- Fertility. Improving weight and insulin resistance can restore more regular ovulation, particularly in PCOS — which is why some women conceive unexpectedly. If you hope to conceive, we plan the timing carefully together.
You can read more in my article on GLP-1 medications and women’s reproductive health.
Monitoring, safety and realistic results
Any medical weight management I oversee comes with proper follow-up: reviewing your response, your blood results and your wellbeing, and adjusting the plan as needed. If an approach is not working for you, we change it.
I am honest about what to expect. Results vary from woman to woman, progress is usually gradual, and the aim is lasting metabolic health rather than a number reached quickly and lost again. Where national guidance sets a point to review progress, we follow it — and we keep the focus on your health, not just the scale.
“For most of the women I see, weight isn’t a failure of willpower — it’s a medical problem that has never been properly investigated. That is where we start.”
When to seek specialist input
- Your weight has stopped responding despite genuine, sustained effort with diet and exercise
- You have gained weight around your waistline during perimenopause or menopause
- You have PCOS, insulin resistance, or a family history of type 2 diabetes and want to understand your risk
- Your weight is affecting your blood pressure, blood sugar, joints, or fertility
- You are planning a pregnancy and want to optimise your metabolic health first
- You have seen weight-management treatment offered online and want a proper medical assessment before going near it
You do not need a diagnosis to come and see me — many women simply want to understand what is happening and leave with a plan they trust. If you have felt dismissed, or told your results are “normal” so there is nothing to be done, I would welcome the chance to take a proper, thorough look. Let us find a way forward together.
Clinical Guidelines & Further Resources
The care I provide is grounded in national and international clinical guidance. The following resources may be useful for further reading:
- NICE TA875 — Managing overweight and obesity (technology appraisal)
- NICE TA1026 — Managing overweight and obesity (technology appraisal)
- MHRA — UK medicines regulator, including safety advice on weight-management medicines
- NHS: Obesity — NHS information on the causes, health effects, and treatment of obesity