Subjective response to intranasal nicotine administration in oral contraceptive users and naturally-cycling women

Abstract

Introduction: Approximately half of premenopausal women who smoke cigarettes also use hormonal contraceptives, with most using oral contraceptives (OCs). While research on the effects of endogenous hormones on smoking-related outcomes continues to expand, little is known about the influence of OCs on similar outcomes. We sought to explore differences in the subjective response to nicotine by OC use after stratifying by testing condition (e.g., smoking status).

Methods: Participants were regular (≥5 cigarettes/day) smokers, classified into OC and naturally cycling (NC) groups. All participants completed four total lab sessions by smoking status (ad libitum smoking, acute smoking abstinence) and anticipated progesterone level (low progesterone week (LPW), high progesterone week (HPW)). Each lab session included self-administration of intranasal nicotine (Time 0 min), assessment of subjective response via the Subjective State Scale (-30 and + 5 min).

Results: Compared to the NC group (n = 28), the OC group (n = 14) was younger (26.2 ± 1.1 versus 24.2 ± 1.1; p < 0.001) and had a lower Fagerström Test for Nicotine Dependence score (3.4 ± 0.5 versus 2.6 ± 0.5; p = 0.011). Progesterone-to-estradiol ratios varied significantly by group at three of the four time points (p < 0.05). During ad libitum smoking, the OC group had significantly lower craving after nicotine administration than the NC group (1.93 ± 0.33 versus 2.89 ± 0.23; p = 0.024). No other significant differences in subjective response were identified.

Conclusions: Despite significantly different hormone levels, group differences in subjective response to nicotine were relatively few. Additional research is needed to elucidate the mechanisms involved in these observations, as well as explore how they may influence cessation in women.

Figure 1.. Craving Before and After Use of Nicotine Nasal Spray by Oral Contraceptive Use during Ad Libitum Smoking in anticipated low progesterone week (LPW) and anticipated high progesterone week (HPW).

Nicotine nasal spray reduced self-reported craving by 36-46% in OC users regardless of progesterone levels, but had almost no effect (0-3% change) in naturally-cycling women, again irrespective of progesterone levels. Craving levels are adjusted for FTND and order effects, and after-nasal-spray craving is adjusted for before-nasal-spray craving.