Elsevier

Maturitas

Volume 71, Issue 3, March 2012, Pages 248-256
Maturitas

Review
Sex hormones, appetite and eating behaviour in women

https://doi.org/10.1016/j.maturitas.2011.12.016Get rights and content

Abstract

Sex hormones play essential roles in the regulation of appetite, eating behaviour and energy metabolism and have been implicated in several major clinical disorders in women. Estrogen inhibits food intake, whereas progesterone and testosterone may stimulate appetite. This review describes recent findings concerning interactions between sex hormones and neuroendocrinological mechanisms in the control of appetite and eating in women. Furthermore, we are gaining insights into the roles played by sex hormones in the development of eating disorders and obesity. For instance, androgens may promote bulimia by stimulating appetite and reducing impulse control, a proposal supported by the observation that antiandrogenic treatment attenuates bulimic behaviour. Androgens are also involved in the pathophysiology of abdominal obesity in women. On the other hand, hormone replacement therapy with estrogen counteracts the weight gain and accumulation of abdominal fat associated with the menopausal transition. In conclusion, sex hormones and/or agents that exhibit similar activities may provide novel strategies for the treatment of eating disorders and android obesity, two of the most serious health problems for women today.

Introduction

The sex hormones estrogen, progesterone and androgens are involved in the complex regulation of appetite, eating and energy metabolism. In most species, including man, food intake and reproductive functions are closely linked. Thus, during the different hormonal phases of the menstrual cycle daily food intake varies and, moreover, remarkable physiological adaptations of appetite and body composition occur during pregnancy and lactation. In addition, regulation of eating behaviour and metabolic functions by sex hormones is of considerable general importance for women's health, as indicated by the disturbances in this regulation associated with a number of clinical disorders. In this context eating disorders and obesity, which are becoming more and more widespread and are coupled to severe morbidity and mortality, are of particular concern. Recent research designed to elucidate mechanisms and provide strategies for the prevention and treatment of these major health problems has revealed new insights into the regulation of appetite and eating behaviour by sex hormones.

The present overview of the role of sex hormones in the control of appetite and regulation of normal, as well as pathological eating behaviour in women focuses on recent findings in the following areas:

  • 1.

    Interactions between sex hormones and neuroendocrinological factors

  • 2.

    Regulation of eating behaviour by sex hormones during the different phases of the menstrual cycle, menopause, pregnancy and lactation

  • 3.

    The potential role of sex hormones in eating disorders and obesity

  • 4.

    The effects of treatment with estrogens (i.e., oral contraception and menopausal hormone therapy) on appetite and body weight

Section snippets

Hormonal control of appetite and food intake

In response to hunger or the desire for some specific item of food, we normally eat until satiated. In this connection, various factors such as the size of meals and rate and frequency of food intake may vary greatly in response to various environmental, psychological, social and cultural influences.

During the various phases of the menstrual cycle

In the female of numerous species, eating behaviour is closely linked to the functioning of the hypothalamic–pituitary–gonadal (HPG) axis. For example, both female rodents and primates eat less during the estrus phase prior to and following ovulation, when they are more sexually receptive and active [10]. It has been proposed that specific central neural mechanisms promote either feeding or sexual behaviour at the appropriate times [22].

Similarly in the case of women, food intake during the

Anorexia nervosa

The fact that eating disorders are much more common in women than in men suggests that sex hormone signaling may be involved in their etiologies. Moreover, both anorexia nervosa (AN) and bulimia nervosa (BN) are associated with endocrinological abnormalities that disrupt the menstrual cycle and give rise to metabolic disorders. These alterations may be the cause and/or an effect of the abnormal eating behaviour. We are gaining some insight into the roles played by sex hormones in connection

Oral contraceptives

Oral contraceptives (OCs) containing both estrogen and progestin are used by countless women for birth control, as well as for medical treatment of dysmenorrhea, heavy bleeding, endometriosis and menstrual disorders. Such treatment is generally tolerated well, with few side-effects and only a small risk for thromboembolic events. Nonetheless, many women, especially adolescents, stop taking OCs because of weight gain, mood swings and sexual dissatisfaction [66]. An American survey found that

Conclusions

The present review highlights the complex involvement of sex hormones in the regulation of appetite and eating behaviour in women. In both experimental animals and humans, estrogen reduces food intake; whereas testosterone, as well as progesterone in combination with estrogen, may enhance food intake. Sex hormones modulate appetite and energy expenditure during the menstrual cycle, pregnancy, lactation and menopause. Moreover, alterations in sex hormones may play a role in disturbed eating

Contributors

All authors contributed equally.

Competing interests

None declared.

Provenance and peer review

Commissioned and externally peer reviewed.

Acknowledgement

Financial support by the Swedish Research Council (20324), Karolinska Institutet and the Stockholm County Council.

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