The Effect of Estrogen on Appetite


Medscape General Medicine. 1998;1(3) 

In This Article

Abstract and Introduction


Such eating disorders as anorexia nervosa, bulimia nervosa, and binge eating disorder are associated with significant morbidity and mortality in women. The etiology of these disorders and the causes of women's increased vulnerability to them remain obscure. The lack of understanding of the biological bases of normal and abnormal human eating behavior impedes development of effective pharmacologic treatment for eating disorders. A review of basic research, implicating estradiol in the physiologic control of eating in laboratory animals, shows potential heuristic and mechanistic significance for normal and disordered eating in women. Furthermore, accumulating evidence indicates that estradiol may decrease meal size by increasing the potency of the satiating actions of some gut peptides, especially cholecystokinin. These findings suggest there may be hope for treatment through manipulation of estradiol's interactions with both peripheral psychological and central neural controls of eating.


Dramatic differences exist between women and men in the prevalence of disordered eating. In fact, more than 90% of patients who meet the American Psychiatric Association's (APA's) DSM-IV criteria for anorexia nervosa or bulimia nervosa are women. In 1 study, the prevalence of moderate obesity, defined as a weight 30% to 50% higher than normal, was 11% for women versus 8% for men, a small but significant difference.[1] Severe obesity (>50% above the recommended weight) affects 4 times as many women (8%) as men (2%). Several studies indicate that the APA's new diagnostic category of binge eating disorder, which includes persons who regularly eat huge meals without purging, occurs in a substantial number of overweight persons; about 60% of binge eaters are women. An even larger percentage of persons whose eating is influenced by the personality construct known as cognitive restraint are women. Furthermore, altered eating may be a part of the symptomatology of other disorders occurring in women, such as premenstrual syndrome. Thus, major clinical challenges confront women who are affected by an eating disorder and their physicians.

Why do these disorders occur more commonly in women? Although there has been rapid progress in the last decade in the analysis of the physiologic controls of eating in animals, the potential contribution of physiologic factors to the etiology and courses of these disorders remains obscure. However, a wealth of data indicates that the hypothalamic-pituitary-ovarian axis has significant effects on eating in animals and that estradiol is a key link in controlling eating in normally cycling adult females. These findings have potential heuristic and mechanistic significance for normal and disordered eating in women, suggesting that manipulation of estradiol's effects on eating may provide an opportunity for the development of pharmacologic treatment.