Menstrual phase effects on smoking relapse

Abstract

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.

Menstrual Phase and Depressive Symptoms Differences in Physiological Response to Nicotine Following Acute Smoking Abstinence

“…The higher levels of nicotine absorption during follicular phase in women without depressive symptoms may offer additional evidence to explain the seemingly conflicting results of the studies that have assessed smoking cessation outcomes by menstrual phase (Allen et al, 2008;Allen et al, 2009b;Carpenter et al, 2008;Franklin et al, 2008;Mazure et al, 2011). The effectiveness of the nicotine patch may vary by menstrual phase given the differences in nicotine absorption, with higher nicotine levels attained in the follicular phase.…”

“…The 6-day testing week started on the day after the onset of menses for F phase, to time the nicotine laboratory session in early F phase (day 7) and started 2 days after ovulation (determined with urine luteinizing hormone tests as previously described; Allen et al, 2008) to time the nicotine laboratory session in L phase (8 days after ovulation). If schedule conflicts occurred, the entire testing week was shifted 1 day earlier or 1 day later.…”

“…Women who attempted to quit smoking during the luteal phase (the last 14 days of the menstrual cycle with relatively high levels of progesterone and low levels of estrogen) had improved smoking cessation outcomes compared with those who quit during the early follicular phase (begins after menses with relatively low levels of both progesterone and estrogen) in the absence of nicotine replacement therapy (NRT) (Allen et al, 2008;Allen et al, 2009b;Mazure et al, 2011). However, other studies that used NRT observed improved smoking cessation outcomes in the follicular phase compared with the luteal phase (Carpenter et al, 2008;Franklin et al, 2008).…”

“…In women who are attempting to quit smoking, menstrual phase, perhaps via sex hormones (specifically progesterone and estradiol), appears to be associated with risk for smoking relapse (Allen, Bade, Center, Finstad, & Hatsukami, 2008;Allen S.S, Allen A.M, Lunos, & Hatsukami, 2009b;Carpenter, Saladin, Leinbach, Larowe, & Upadhyaya, 2008;Franklin et al, 2008;Mazure, Toll, McKee, Wu, & O'Malley, 2011). Women who attempted to quit smoking during the luteal phase (the last 14 days of the menstrual cycle with relatively high levels of progesterone and low levels of estrogen) had improved smoking cessation outcomes compared with those who quit during the early follicular phase (begins after menses with relatively low levels of both progesterone and estrogen) in the absence of nicotine replacement therapy (NRT) (Allen et al, 2008;Allen et al, 2009b;Mazure et al, 2011).…”

Sustained Reduction of Nicotine Craving With Real-Time Neurofeedback: Exploring the Role of Severity of Dependence

“…Cigarette craving is a key factor contributing to relapse among smokers attempting abstinence (Allen, Bade, Hatsukami, & Center, 2008;Ferguson & Shiffman, 2009;Killen & Fortmann, 1997), and therapies that help smokers control their craving may facilitate smoking cessation. Neurofeedback, delivered via real-time functional magnetic resonance imaging (rtfMRI), can facilitate self-regulation of internal states by providing feedback from localized regions of interest (ROIs) to individuals while performing a task Weiskopf, 2012).…”