Sex Hormones and Appetite in Women: A Focus on Bulimia Nervosa

  • Sabine Naessén
  • Angelica Lindén Hirschberg


Sex hormones play an important role in the regulation of appetite and energy metabolism. Estrogen is known to inhibit feeding, whereas progesterone and testosterone may stimulate appetite. There is increasing knowledge about the role of sex hormones in disturbed eating behavior. Bulimia nervosa is frequently associated with sex hormone disturbances, which may be secondary or primary to abnormal eating. Menstrual disorders and low estradiol levels are common although most bulimic women are of normal weight. Furthermore, polymorphisms in the estrogen receptor b gene have been associated with bulimic behavior. Increased androgens and clinical features of hyperandrogenism like acne, hirsutism, and polycystic ovary syndrome (PCO) are also frequent among bulimics. High testosterone levels in women have been associated with a greater craving for sweets, impaired impulse control, irritability, and depression. It has therefore been suggested that androgens may promote bulimic behavior. In support of this hypothesis, antiandrogenic treatment has been demonstrated to improve bulimic behavior. Oral contraceptives (OCs) with antiandrogenic properties reduce symptoms in bulimic patients in relation to decreased testosterone levels. The findings support that androgens could play a significant role in bulimic behavior. Antiandrogenic treatment may therefore develop into a new therapeutic approach in women with bulimia nervosa, especially in those bulimics with hyperandrogenic symptoms.


Bulimia Nervosa Polycystic Ovary Abnormal Eating Menstrual Disturbance Bulimic Behavior 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





Estrogen receptor


Hypothalamic–pituitary–gonadal axis


Oral contraceptive


Polycystic ovary syndrome


Premenstrual syndrome


  1. Abraham S. J Psychosom Res. 1998;44:491–502.PubMedCrossRefGoogle Scholar
  2. Andersen AE. J Gend Spec Med. 1999;2:47–54.Google Scholar
  3. Asarian L, Geary N. Phil Trans R Soc B. 2006;361:1251–63.PubMedCrossRefGoogle Scholar
  4. Bergman L, Eriksson E. Acta Psychiatr Scand. 1996;94:137–9.PubMedCrossRefGoogle Scholar
  5. Brown C, Ling F, Wan J. J Reprod Med. 2002;47:14–22.PubMedGoogle Scholar
  6. Bryant M, Truesdale KP, Dye L. Br J Nutr. 2006;96:888–94.PubMedCrossRefGoogle Scholar
  7. Cantopher T, Evans C, Lacey JH, Pearce JM. Br Med J. 1988;297:836–7.CrossRefGoogle Scholar
  8. Chan, Mantzoros CS. Lancet 2005;366:74–85.PubMedCrossRefGoogle Scholar
  9. Clegg DJ, Brown LM, Zigman JM, Kemp CJ, Strader AD, Benoit SC, Woods SC, Mangiaracina M, Geary N. Diabetes. 2007;56:1051–8.PubMedCrossRefGoogle Scholar
  10. Copeland PM, Sacks NR, Herzog DB. Psychosom Med. 1995;57:121–6.PubMedGoogle Scholar
  11. Cotrufo P, Monteleone P, d’Istria M, Fuschino A, Serino I, Maj M. Neuropsychobiology 2000;42:58–61.PubMedCrossRefGoogle Scholar
  12. Cross GB, Marley J, Miles H, Willson K. Br J Nutr. 2001;85:475–82.PubMedCrossRefGoogle Scholar
  13. Dye L, Blundell JE. Hum Reprod. 1997;12:1142–51.PubMedCrossRefGoogle Scholar
  14. Ehrmann DA. N Engl J Med. 2005;352:1223–36.PubMedCrossRefGoogle Scholar
  15. Eriksson E. In: Steiner M, Yonkers KA, Eriksson E, editors. Mood disorders in women. London: Martin Dunitz; 2000. p. 233–46.Google Scholar
  16. Flöter A. Curr Women’s Health Rev. 2009;5:29–43.CrossRefGoogle Scholar
  17. Fong AK, Kretsch MJ. Am J Clin Nutr. 1993;57:43–6.PubMedGoogle Scholar
  18. Gallo MF, Lopez LM, Grimes DA, Schulz KF, Helmerhorst FM. Cochrane Database Syst Rev. 2008 Oct 8;4:CD003987.Google Scholar
  19. Geary N. Peptides 2001;22:1251–63.PubMedCrossRefGoogle Scholar
  20. Gendall KA, Bulik CM, Joyce PR, McIntosh VV, Carter FA. J Psychosom Res. 2000;49:409–15.PubMedCrossRefGoogle Scholar
  21. Hirschberg AL. In: Becker KL, editor. Principles and practice of endocrinology and metabolism. 3rd ed. Philadelphia: J. B. Lippencott; 2001. p. 1233–9.Google Scholar
  22. Hirschberg AL, Byström B, Carlström K, von Schoultz B. Contraception. 1996;53:109–13.PubMedCrossRefGoogle Scholar
  23. Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holte J. Gynecol Endocrinol. 2004;19:79–87.PubMedCrossRefGoogle Scholar
  24. Jahanfar S, Eden JA, Nguyent TV. Gynecol Endocrinol. 1995;9:113–7.PubMedCrossRefGoogle Scholar
  25. Johnson WG, Corrigan SA, Lemmon CR, Bergeron KB, Crusco AH. Physiol Behav. 1994;56:523–7.PubMedCrossRefGoogle Scholar
  26. Klein DA, Boudreau GS, Devlin MJ, Walsh BT. Int J Eat Disord. 2006;39:341–5.PubMedCrossRefGoogle Scholar
  27. Laflamme N, Nappi RE, Drolet G, Labrie C, Rivest S. J Neurobiol. 1998;36:357–78.PubMedCrossRefGoogle Scholar
  28. Liang YQ, Akishita M, Kim S, Ako J, Hashimoto M, Iijima, Ohike Y, Watanabe T, Sudoh N, Toba K, Yoshizumi M, Ouchi Y. Int J Obes Relat Metab Disord. 2002;26:1103–9.PubMedCrossRefGoogle Scholar
  29. Lidegaard Ø, Løkkegard E, Svendsen AL, Agger C. BMJ. 2009;339:557–60.CrossRefGoogle Scholar
  30. Lindén A, Uvnäs-Moberg K, Forsberg G, Bednar I, Södersten P. J Neuroendocrinol. 1990;2:797–801.PubMedCrossRefGoogle Scholar
  31. Maltoni M, Nanni O, Scarpi E, Rossi D, Serra P, Amadori D. Ann Oncol. 2001;12:289–300.PubMedCrossRefGoogle Scholar
  32. McCluskey SE, Lacey JH, Pearce JM. Lancet. 1992;340:723.PubMedCrossRefGoogle Scholar
  33. Monteleone P, Luisi M, Colurcio B, Casarosa E, Monteleone P, Ioime R, Genazzani AR, Maj M. Psychosom Med. 2001;63:62–8.PubMedGoogle Scholar
  34. Moran L, Norman RJ. Best Pract Res Clin Obstet Gynaecol. 2004;18:719–36.PubMedCrossRefGoogle Scholar
  35. Morgan JF, McCluskey SE, Brunton JN, Lacey JH. Fertil Steril. 2002;77:928–31.PubMedCrossRefGoogle Scholar
  36. Münster K, Helm P, Schmidt L. Br J Obstet Gynecol. 1992;99:430–3.CrossRefGoogle Scholar
  37. Naessén S, Carlström C, Glant R, Jacobsson H, Hirschberg AL. Eur J Endocrinol. 2006a;155:245–51.PubMedCrossRefGoogle Scholar
  38. Naessén S, Garoff L, Carlström K, Glant R, Hirschberg AL. Gynecol Endocrinol. 2006b;22:388–94.PubMedCrossRefGoogle Scholar
  39. Naessén S, Carlström K, Byström B, Pierre Y, Hirschberg AL. Psychoneuroendocrinology. 2007;32:548–54.PubMedCrossRefGoogle Scholar
  40. Nilsson M, Naessén S, Dahlman I, Hirschberg AL, Gustafsson J-Å, Dahlman-Wright K. Mol Psychiatry. 2004;9:28–34.PubMedCrossRefGoogle Scholar
  41. Olmsted MP, Kaplan AS, Rockert W. Int J Eat Disord. 2005;38:1–6.PubMedCrossRefGoogle Scholar
  42. Osculati A, Castiglioni C. Lancet 2006;367:1140–1.PubMedCrossRefGoogle Scholar
  43. Pekhlivanov B, Mitkov M, Ivancheva Kh., Amaliev I. Akush Ginekol. 2006;45:25–9.Google Scholar
  44. Pelletier G, Li S, Luu-The V, Labrie F. J Neuroendocrinol. 2007;19:426–31.PubMedCrossRefGoogle Scholar
  45. Sitruk-Ware R. Hum Reprod Update. 2006;12:169–78.PubMedCrossRefGoogle Scholar
  46. Sundarrajan C, Liao W, Roy AC, Ng SC. J Clin Endocrinol Metab. 2001;86:135–9.PubMedCrossRefGoogle Scholar
  47. Sundblad C, Bergman L, Eriksson E. Acta Psychiatr Scand. 1994;90:397–8.PubMedCrossRefGoogle Scholar
  48. Sundblad C, Landen M, Eriksson T, Bergman L, Eriksson E. J Clin Psychopharmacol. 2005;25:85–8.PubMedCrossRefGoogle Scholar
  49. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJM, Rosendaal FR. BMJ. 2009;339:b2921.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyKarolinska University HospitalStockholmSweden

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