title: Systematic and meta-analytic review of research examining the impact of menstrual cycle phase and ovarian hormones on smoking and cessation.
abstract: BACKGROUND
  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.
authors.affiliation: andrea.weinberger@einstein.yu.edu.
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Weinberger
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
authors.forename: Philip H
authors.initials: PH
authors.lastname: Smith
authors.affiliation: Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT;
authors.forename: Sharon S
authors.initials: SS
authors.lastname: Allen
authors.affiliation: Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN;
authors.forename: Kelly P
authors.initials: KP
authors.lastname: Cosgrove
authors.affiliation: Departments of Psychiatry, Diagnostic Radiology, and Neurobiology, Yale University School of Medicine, New Haven, CT;
authors.forename: Michael E
authors.initials: ME
authors.lastname: Saladin
authors.affiliation: Departments of Health Sciences and Research and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC;
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Gray
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT;
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Mazure
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC;
authors.forename: Cora Lee
authors.initials: CL
authors.lastname: Wetherington
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
authors.forename: Sherry A
authors.initials: SA
authors.lastname: McKee
mesh_terms: D000328:Adult; D005260:Female; D005498:Follicular Phase; D005783:Gender Identity; D006801:Humans; D008183:Luteal Phase; D008597:Menstrual Cycle; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D016387:Women's Health