Aims-To examine if menstrual phase affects relapse in women attempting to quit smoking.Design-An intent-to-treat randomized smoking cessation trial where women were assigned to quit smoking in either the follicular (F) or luteal (L) menstrual phase and were followed for up to 26 weeks. They were assessed for relapse by days to relapse and relapse phase to determine if those who begin a quit attempt during the F phase were more successful than those who begin during the L phase.Setting-Tobacco Use Research Center, University of Minnesota, Minneapolis, Minnesota. Participants-A total of 202 women.Measurements-Latency to relapse from continuous and prolonged abstinence, point prevalence, phase of relapse, first slip within the first 3 and 5 days post-quit date, subject completion rates and symptomatology (i.e. withdrawal and craving).Findings-The mean days to relapse from continuous abstinence and relapse from prolonged abstinence for the F group were 13.9 and 20.6 days, respectively, and 21.5 and 39.2 days, respectively, for the L group. Using point prevalence analysis at 14 days, 84% of the F group had relapsed compared with 65% of the L group [χ 2 = 10.024, P = 0.002; odds ratio (OR) = 2.871, 95% confidence interval (CI), 1. 474-5.590]. At 30 days, 86% of the F group relapsed, compared with 66% of the L group (χ 2 = 11.076, P = 0.001; OR = 3.178, 95% CI, 1.594-6.334).Conclusion-Women attempting to quit smoking in the F phase had less favorable outcomes than those attempting to quit in the L phase. This could relate to ovarian hormones, which may play a role in smoking cessation for women.

Rates of smoking relapse remain high, despite the wide availability of cessation aids. Presumably factors such as craving, withdrawal symptoms, and smoking urges are key contributors to relapse, but empirical support for this presumption is not conclusive and is complicated by the high variability in symptoms across individuals and time, as well as by the lack of an absolute symptom threshold for response. Data were analyzed from 137 female smokers, aged 18-40 years, who completed 30 days of a protocol for a longitudinal smoking cessation trial. Subjects were assigned a quit date and followed regardless of subsequent smoking status. At baseline, subjects completed written measures of nicotine craving, withdrawal symptoms, and smoking urges. They also completed these measures daily for 30 days, beginning on their quit date, Scores were standardized within subjects and graphed to identify temporal symptom patterns. A total of 26 women quit smoking and 111 relapsed (at least one cigarette puff). The intensity of subjects' craving, withdrawal, and smoking urges Factors 1 and 2 peaked on the day of relapse by an average of 1.4, 1.1, 1.2, and 1.1 standard deviations, respectively, with symptoms rising during the previous 2-5 days and dropping precipitously over the 2 days subsequent to relapse. Additionally, women who relapsed had higher absolute (unstandardized) symptom scores on their quit day than those who were abstinent for 30 days. These findings imply that escalation of withdrawal symptoms, craving, and smoking urges during a quit attempt may contribute to smoking relapse. Frequent symptom monitoring might be clinically important for relapse prevention.

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This study of postmenopausal female smokers (N = 94) asked: During short-term smoking abstinence, do the beneficial effects of transdermal nicotine replacement therapy (NRT) on acute symptomatology (i.e., withdrawal, cigarette craving, smoking urges, mood, depressive symptoms, motor speed, and reaction time) differ in women who use and do not use hormone replacement therapy (HRT)? Participants were recruited according to HRT and non-HRT use (self-selecting), then randomized within strata to active nicotine or placebo nicotine patch. After 1 baseline week of smoking, participants quit smoking for 2 weeks. Women received cessation counseling and were monitored for abstinence. Dependent measures were collected during five clinic visits. Two-way analysis of covariance (ANCOVA) were run on change scores for dependent variables, with nicotine patch group (active/placebo) and HRT group (HRT/non-HRT) as independent variables and age as a covariate. No interactions were found between HRT and patch condition, but both showed specific effects. During the first abstinent week, women on active nicotine patch (compared with placebo) experienced less severe withdrawal, greater reductions in cigarette cravings, and lower (more favorable) Factor 1 scores on the Questionnaire of Smoking Urges. During the second abstinent week, women using HRT (compared with the non-HRT group) exhibited better mood (Profile of Mood States scores) and less depression (Beck Depression Inventory scores). These results suggest the following: First, the efficacy of transdermal nicotine replacement is not adversely modified by women's HRT use; second, ovarian hormones might influence women's responses to smoking cessation, and thus should be considered in developing effective strategies for women to quit smoking.

Prevention of early weight gain may be critical to avoid relapse among women with a fear of weight gain. Menstrual phase has physiological fluctuation of fluid resulting in short-term weight gain, suggesting menstrual phase of smoking cessation may impact short-term weight gain. This study examined the effect of smoking abstinence and menstrual cycle on short-term weight gain. Women were randomized to quit smoking during the follicular or luteal phase of their cycle and followed for four weeks. Weight, among other measures, was recorded at five post-quit date visits (days 2, 5, 9, 12 and week 4). Participants (n = 152) were grouped based on randomized quit phase and smoking status after assigned quit date: 1) follicular (F), quit < 24 hours, 2) F, quit ≥ five days, 3) luteal (L), quit < 24 hours, and 4) L, quit ≥ five days. Participants who quit smoking experienced significantly more weight gain than those who quit for less than 24 hours. There were no significant increases in short-term weight gain based on menstrual cycle phase during attempted smoking cessation. KeywordsCessation; Menstrual Cycle; Smoking; Weight; Women CORRESPONDING AUTHOR: Sharon S. Allen, MD, PhD, University of Minnesota, Medical School, Department of Family Medicine and Community Health, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, Email: allen001@umn.edu, Phone: 612-624-2446, Fax: 612-625-0916. d Present Address: Carver County Public Health, Government Center, Administration Building, 600 East 4 th Street, Chaska, MN 55318 USA, Email: tbade@co.carver.mn.us Phone: 952-391-1349, Fax: 612-361-1360 Previous Affiliation: University of Minnesota, Medical School, Department of Family Medicine and Community Health, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414 USA Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access IntroductionThe fear of weight gain is a major barrier to quitting smoking among women (Perkins, Levine, Marcus & Schiffman 1997). Weight gain is a common consequence of quitting (Gritz, Berman, Read, Marcus, & Siau, 1990;Hughes, Higgins, & Bickel, 1994), with an average post-cessation weight gain of 8-10 lbs (Kawachi, Troisi, Rotnitzky, Coakley, & Colditz, 1996;Williamson, Madans, Anda, Kleinman, Giovino, & Byers, 1991). Several studies report no significant differences in short-term weight gain over 4-10 days post-cessation (Hatsukami, LaBounty, Hughes, & Laine, 1993;Hellerstein, Benowitz, Neese, Schwartz, Hoh, Jacob, Hsieh, & Faix, 1994;Perkins, Epstein, & Pastor, 1990) while others show a significant gain among abstaining women compared...