Women who want to quit smoking may have better success by
carefully timing their quit date with optimal days within their
menstrual cycle, according to a new study.
Research shows that women have greater difficulty with smoking
cessation than men.
Credit: © Serhiy Kobyakov / Fotolia
Women who want to quit smoking may have better success by carefully
timing their quit date with optimal days within their menstrual cycle,
according to a new study from researchers at the Perelman School of
Medicine at the University of Pennsylvania. The results, published
online this month in Biology of Sex Differences, were also presented
at the annual meeting of the Organization for the Study of Sex
Differences (OSSD), held at Penn.
Cigarette smoking remains the leading cause of preventable death in
the United States, and women experience more severe health
consequences from cigarette smoking than men, including a 25 percent
increased risk of developing coronary heart disease and chronic
obstructive pulmonary disease. Research also shows that women have
greater difficulty with smoking cessation than men.
"Understanding how menstrual cycle phase affects neural processes,
cognition and behavior is a critical step in developing more effective
treatments and in selecting the best, most individualized treatment
options to help each cigarette smoker quit," said the study's lead
author, Reagan Wetherill, PhD, a research assistant professor of
Wetherill and senior author Teresa Franklin, PhD, a research associate
professor of Neuroscience in Psychiatry, have been studying the brains
of premenopausal women who smoke cigarettes for several years in
Penn's Center for the Studies of Addiction. Their work is based on a
significant animal literature showing that the natural sex hormones —
estrogen and progesterone — which fluctuate over the course of the
menstrual cycle modulate addictive behavior. The animal data show that
during the pre-ovulatory, or follicular phase of the menstrual cycle,
when the progesterone-to-estrogen ratio is low, women are more likely
to be spurred toward addictive behaviors. Alternatively, during the
early pre-menstrual or luteal phase of the menstrual cycle, when the
progesterone-to-estrogen ratio is high, addictive behaviors are
thwarted, suggesting that progesterone might protect women from
relapsing to smoking.
In the current study, 38 physically healthy, premenopausal women who
smoke and who were not taking hormonal contraceptives, ranging from 21
to 51 years of age, received a functional MRI scan to examine how
regions of the brain that help control behavior are functionally
connected to regions of the brain that signal reward.
The researchers theorized that the natural fluctuations in ovarian
hormones that occur over the course of the monthly menstrual cycle
affect how women make decisions regarding reward — smoking a
cigarette — and so-called "smoking cues," which are the people,
places and things that they associate with smoking, such as the smell
of a lit cigarette or going on their coffee break. These "appetitive
reminders" to smoke are perceived as pleasant and wanted, and similar
to cigarettes, are also rewarding.
In 2015, the researchers showed that compared to when women are in the
luteal phase of their menstrual cycle, which is the period of time
following ovulation and prior to menstruation, women in the follicular
phase — which begins at menstruation and continues until ovulation —
have enhanced responses to smoking cues in reward-related brain
regions. This finding led them to further test whether groups differed
in the strength of the functional connections that exists between
regions exerting cognitive control and reward-related brain regions.
The weaker the functional connections between cognitive control brain
regions and reward signaling brain regions, the less ability women
have to 'Just Say No' when attempting to quit.
The women in the study were separated into two groups — those in
their follicular phase and those in their luteal phase. Results
revealed that during the follicular phase, there was reduced
functional connectivity between brain regions that helps make good
decisions (cortical control regions) and the brain regions that
contain the reward center (ventral striatum), which could place women
in the follicular phase at greater risk for continued smoking and
relapse. Orienting attention towards smoking cues (pictures of smoking
reminders such as an individual smoking) was also shown to be
associated weaker connections between cognitive control regions in
"These data support existing animal data and an emerging human
literature showing that progesterone may exert protective effects over
addictive behavior and importantly, the findings provide new insights
into sex differences in smoking behavior and relapse," Franklin said.
"Interestingly, the findings may represent a fundamental effect of
menstrual cycle phase on brain connectivity and may be generalizable
to other behaviors, such as responses to other rewarding substances
(i.e., alcohol and foods high in fat and sugar).
"The results from this study become extremely important as we look for
more ways to help the over 40 million individuals in the U.S. alone
addicted to cigarettes," Franklin, continued. "When we learn that
something as simple as timing a quit date may impact a woman's
cessation success, it helps us to provide more individualized
treatment strategies for individuals who are struggling with
The above post is reprinted from materials provided by Perelman School
of Medicine at the University of Pennsylvania. Note: Materials may be
edited for content and length.