Estrogens And Other Hormone Derivatives

In earlier reports weight increases have been described in relation to older high dose hormonal contraceptives and weight gain is still one of the most prevalent complaints of women using oral hormonal contraceptives. However, the typical present day combination therapy contains only small doses of estrogen and progesterone and these compounds have not been associated with excessive weight gain apart from cyclic periods of moderate water retention in some individuals (91,92).

In postmenopausal women, several studies (93,94) have also demonstrated that hormone replacement therapy if anything may lead to a small weight reduction. This effect is not fully understood, but increased lipid oxidation seems to be of importance, whereas circulating leptin is not affected (95,96).

In contrast to these findings high to moderate doses of megestrol acetate have been shown to increase appetite and body weight in women with advanced cancer disease (97,98). Tamoxifen, a partial oestrogen receptor antagonist used in post-menopausal women with breast cancer, also promotes weight gain (99-101), but to a lesser extent when used as monotherapy (102).

These compounds, especially megestrol acetate, have therefore been suggested as adjuvant treatment in patients with cancer-induced cachexia (98). Other non-hormone antineoplastic agents such as cyclophosphamide and fluorouracil have also been associated with weight gain exceeding the pre-ill-ness body weight in patients with early stage cancer disease (103). The mechanisms have not been elucidated and very few data are available.

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