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.

Figure 1.

Meta-analytic findings for withdrawal and tonic cravings by menstrual phase. MNWS = Minnesota Nicotine Withdrawal Scale; QSU = questionnaire of smoking urges; SJWSQ = Shiffman-Jarvik Withdrawal Symptom Questionnaire; VAS = visual analog scale; B = between subject comparison; F = follicular; L = luteal; LL = late luteal; W = within subject comparison. When deprivation = yes, estimates were calculated during a nicotine deprivation condition of the study. Weighted Hedge’s G for withdrawal calculated using a random-effects model (significant heterogeneity); for craving calculated using a fixed-effects only model (non-significant heterogeneity). Allen et al., 2009a is reference Allen, Allen, Widenmeir, et al. and Allen et al., 2009b is reference Allen, Allen, Pomerleau.