Oral Estradiol Appetite & Cravings Changes: What the Evidence Shows

Does oral estradiol change appetite or cravings?

The oral estradiol tablet label is the most specific information on this question. It lists, without frequencies, reactions reported with estrogen therapy. Among them are 'increase or decrease in weight' and 'reduced carbohydrate tolerance,' along with nausea, vomiting, abdominal cramps and bloating [1]. Appetite and food cravings are not named in that list [1].

What the label lists about weight and eating

The same label section also lists gallbladder disease, increased blood pressure, edema, headache, mood changes and changes in vaginal bleeding [1].

Weight is listed in both directions, and the label gives no frequency for either [1]. A change on the scale during oral estradiol therapy is therefore a listed possibility, not proof that appetite changed.

What the large hormone therapy trials measured

The Women's Health Initiative enrolled 16,608 postmenopausal women with a uterus in its estrogen-plus-progestin trial, which used conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg [2]. Its estrogen-alone trial enrolled 10,739 women with a prior hysterectomy and used conjugated equine estrogens 0.625 mg [3]. Both trials were stopped early [2][3].

The outcomes reported were coronary heart disease, invasive breast cancer, stroke, pulmonary embolism, colorectal cancer, hip fracture and death [2][3]. Neither trial tested estradiol, so their results do not answer whether oral estradiol changes appetite or weight. The Climara label notes that only daily oral conjugated estrogens 0.625 mg were studied in the estrogen-alone substudy. It says the relevance of those findings to lower doses, other routes of administration or other estrogen-alone products is not known [4].