Does hormone replacement therapy with progesterone (Progesterone) increase hunger?

Progesterone Hormone Replacement Therapy and Increased Hunger

Yes, progesterone hormone replacement therapy does increase hunger and appetite, which can lead to weight gain primarily through increased fat mass rather than lean body mass. 1

Mechanisms of Progesterone-Related Hunger and Weight Effects

Progesterone affects appetite and weight through several mechanisms:

• Direct appetite stimulation: Progestins (including progesterone) are known to increase appetite and food intake 1, 2
• Fat deposition: Progesterone promotes increased fat mass rather than lean body mass 1
• Fluid retention: Can cause edema contributing to weight changes 1

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines specifically note that progestins increase appetite and body weight but not fat-free mass 3. This effect is so reliable that progestins like megestrol acetate are deliberately used to stimulate appetite in cancer patients with cachexia 3.

Evidence from Clinical Guidelines

The strongest evidence comes from clinical guidelines that recognize progesterone's appetite-stimulating effects:

• ESPEN guidelines (2021) recommend progestins specifically to "increase the appetite of anorectic cancer patients" while noting potential side effects 3
• Earlier ESPEN guidelines (2006) similarly noted that progestins improved "appetite, nutritional intake, body weight and mood" 3
• Praxis Medical Insights summarizes that progestins increase appetite and body weight, primarily through fat mass rather than lean body mass 1

Differences Between Progesterone Types

The impact on hunger and weight may vary by progesterone type:

• Natural micronized progesterone: May have a more favorable metabolic profile with potentially less impact on weight compared to synthetic progestins 3, 4
• Synthetic progestins (medroxyprogesterone acetate, megestrol acetate): More consistently associated with increased appetite and weight gain 3, 1

Clinical Considerations and Monitoring

If you're concerned about hunger and potential weight gain while on progesterone therapy:

• Baseline assessment: Consider your current BMI and history of weight responses to hormonal treatments 1
• Regular monitoring: Track weight changes, especially during the first 6 months of therapy, as early weight gain >5% of baseline predicts continued weight gain 1
• Combination effects: When combined with estrogen (as in typical HRT), the estrogen component may partially counteract some weight effects 4

Common Pitfalls and Caveats

• Misattribution of normal aging effects: Some weight gain may occur with age regardless of HRT; a study showed weight increases in both treatment and control groups of postmenopausal women 5
• Individual variation: Response to progesterone varies between individuals 2, 6
• Therapeutic use: The appetite-stimulating effect that may be unwanted for some patients is actually therapeutic for others (e.g., cancer patients with cachexia) 3

For patients concerned about weight gain with progesterone therapy, discussing alternative formulations (like micronized progesterone) with their healthcare provider may be beneficial, as these may have less impact on appetite and weight compared to synthetic progestins 3, 4.