Systematic and Meta-Analytic Review of Research Examining the Impact of Menstrual Cycle Phase and Ovarian Hormones on Smoking and Cessation

Abstract

Introduction: To determine the effect of ovarian hormones on smoking, we conducted a systematic review of menstrual cycle effects on smoking (i.e., ad lib smoking, smoking topography, and subjective effects) and cessation-related behaviors (i.e., cessation, withdrawal, tonic craving, and cue-induced craving). Methods: Thirty-six papers were identified on MEDLINE that included a menstrual-related search term (e.g., menstrual cycle, ovarian hormones), a smoking-related search term (e.g., smoking, nicotine), and met all inclusion criteria. Thirty-two studies examined menstrual phase, 1 study measured hormone levels, and 3 studies administered progesterone. Results: Sufficient data were available to conduct meta-analyses for only 2 of the 7 variables: withdrawal and tonic craving. Women reported greater withdrawal during the luteal phase than during the follicular phase, and there was a nonsignificant trend for greater tonic craving in the luteal phase. Progesterone administration was associated with decreased positive and increased negative subjective effects of nicotine. Studies of menstrual phase effects on the other outcome variables were either small in number or yielded mixed outcomes. Conclusions: The impact of menstrual cycle phase on smoking behavior and cessation is complicated, and insufficient research is available upon which to conduct meta-analyses on most smoking outcomes. Future progress will require collecting ovarian hormone levels to more precisely quantify the impact of dynamic changes in hormone levels through the cycle on smoking behavior. Clarifying the relationship between hormones and smoking-particularly related to quitting, relapse, and medication response-could determine the best type and timing of interventions to improve quit rates for women.

Gender differences in self-reported withdrawal symptoms and reducing or quitting smoking three years later: A prospective, longitudinal examination of U.S. adults

“…Further, while the analyses were adjusted for mood disorders, premenstrual dysphoric disorder (PMDD) was not assessed by the AUDADIS-IV. Withdrawal symptoms overlap with premenstrual symptoms (Allen et al, 2000) and changes in ovarian hormones are associated with differences in a range of smoking behaviors including withdrawal (see Weinberger et al, 2015 for a review). Additional research is needed to understand the role of PMDD in the relationship between withdrawal symptoms and smoking cessation for women.…”

Blood Levels of Monoamine Precursors and Smoking in Patients with Schizophrenia

“…We also have not accounted for menstrual status and menstrual cycle phase, which might alter smoking habits and relapses after abstinence (56, 57). …”

Sex Differences in Animal Models: Focus on Addiction

“…For smoking cessation, greater withdrawal has been observed in human females during the luteal phase (O'Hara et al, 1989). In a recent meta-analysis of smoking cessation studies, greater withdrawal was found during the luteal phase compared with the follicular phase (Weinberger et al, 2015). Thus, the reduced subjective effect of nicotine during the luteal phase may contribute to less saliency of nicotine-related cues, but that does not necessarily correspond to reduced withdrawal symptoms.…”