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. 2015 Mar 10;17(4):407–421. doi: 10.1093/ntr/ntu249

Table 4.

Studies of Withdrawal/Cravings and Menstrual Cycle Phase/Ovarian Hormones

Reference Included in meta-analysis? Treatment study? Type of treatment Number of menstrual phases assessed Menstrual cycle phases assessed Measure of withdrawal Measure of cravings Assessment setting Primary findings
Allen et al. 31 W No – 2 Follicular, luteal MNWS BQSU Outpatient research clinic/lab No significant differences in withdrawal by menstrual cycle phase during ad lib smoking. Greater withdrawal symptoms reported during luteal phase compared to the follicular phase during smoking abstinence. No significant differences in craving by menstrual cycle phase.
DeVito et al. 38 W, C No – 2 Follicular, luteal MNWS BQSU Outpatient research clinic/lab No significant differences in withdrawal or cravings by menstrual cycle phase.
Sakai et al. 40 C No – 3 Follicular, luteal, menstrual – VAS scale (0–100) Diaries completed at home Greater cravings to smoke during menstrual phase compared to follicular or luteal phases
Sofuoglu et al. 43 – No – See notea See notea – BQSU Outpatient research clinic/lab Lower BQSU Factor 1 score for 400mg progesterone compared to placebo and 200mg progesterone
Sofuoglu et al. 50 – No – See notea See notea MNWS (modified, 0–100 scale) BQSU Outpatient research clinic/lab No significant main effects of progesterone vs. placebo for withdrawal lower BQSU total score for 200mg progesterone compared to placebo.
Allen et al. 44 W, C Yes Counseling 2 Follicular, luteal MNWS QSU Outpatient research clinic/lab No significant differences in total withdrawal or cravings by menstrual cycle phase. Significantly greater report of increased appetite/weight gain (withdrawal symptom) for participants who quit during follicular phase compared to the luteal phase. Participants assigned to quit smoking during the follicular phase who reported higher anger and craving withdrawal symptoms were more likely to relapse to smoking at 14 days compared to those with lower anger and craving
Allen, Allen, Widenmier, et al. 48 C Yes Counseling 2 Follicular, luteal – 8-point scale (0 = not at all, 7 = very strong) Outpatient research clinic/lab Participants in follicular phase reported greater cravings to smoke at wake-up compared to participants in luteal phase. Difference was no longer significant after controlling for level of nicotine dependence.
Allen, Allen, and Pomerleau 49 W, C Yes Counseling 2 Follicular, luteal MNWS MNSW- craving item Diaries completed at home Greater withdrawal reported during the luteal phase than the follicular phase. No significant differences in cravings by menstrual cycle phase.
Allen et al. 51 – Yes Counseling 2 Follicular, luteal MNWS MNSW- craving item, QSU Outpatient research clinic/lab No significant differences in withdrawal or cravings by menstrual cycle phase.
Carpenter et al. 52 – Yes TNP, Counseling 2 Follicular, luteal MNWS MNSW- Craving item Outpatient research clinic/lab Greater total withdrawal, cravings, and fatigue reported by participants assigned to quit in the follicular phase compared to participants assigned to quit in the luteal phase.
Sofuoglu et al. 55 – No – See notea See notea NWSC NWSC- craving item Outpatient research clinic/lab No significant difference in overall withdrawal for progesterone vs. placebo. Lower cravings to smoke on progesterone condition before participants smoked a cigarette.
Allen et al. 32 W, C No TNP b 2 Follicular, late luteal MNWS MNSW- craving item, QSU Outpatient research clinic/lab Greater withdrawal reported in late luteal phase compared to follicular phase. No significant main effect of menstrual cycle phase on cravings (MNWS-craving item; QSU). TNP reduced cravings to a greater degree in the late luteal phase compared to the follicular phase (MNWS-craving item).
Pomerleau et al. 56 – No – 5 Post-menses, ovulation, post-ovulation, premenstrual, menstrual MNWS MNSW- craving item Diaries completed at home No significant differences in withdrawal by menstrual cycle phase. Greater cravings to smoke during post-menses phase compared to the premenstrual phase.
Snively et al. 57 – No – 2 Follicular, luteal SJTWQ SJTWQ Inpatient research clinic/lab No significant differences in withdrawal or cravings by menstrual cycle phase.
Perkins et al. 37 W, C Yes Counseling 2 Follicular, luteal DSM-IV symptoms, 0–100 scale Desire to smoke, 0–100 scale Outpatient research clinic/lab No significant differences in withdrawal by menstrual cycle phase during pre- quit period. Greater increase in total withdrawal and each withdrawal symptom for participants quitting during the luteal phase compared to the follicular phase. No significant differences in cravings by menstrual cycle phase.
Marks et al. 58 – No – 4 Early follicular, mid-to-late follicular, mid- to-late luteal, late luteal MNWS (modified; −50 to +50 scale, recoded to 0–50 for analyses) VAS scale (−50 to +50, recoded to 0–50 for analyses) Outpatient research clinic/lab No significant differences in changes in withdrawal or cravings in response to nicotine by menstrual cycle phase.
Allen et al. 59 – No – 2 Follicular, luteal MNWS QSU Inpatient research clinic/lab No significant differences in withdrawal or cravings by menstrual cycle phase.
Masson and Gilbert 36 – No – 2 Early phase of cycle, menses/ late phase of cycle SJTWQ – Outpatient research clinic/lab No significant main effects of menstrual cycle phase for withdrawal. Oral contraceptive users reported more physical withdrawal than non-oral contraceptive users.
Allen et al. 60 W No – 3 Follicular, luteal, late luteal MNWS MNWS craving item, QSU Diaries completed at home Greater withdrawal during the late luteal phase than the follicular or luteal phases. Greater cravings to smoke during the late luteal phase than the follicular phase on the NWSC Craving item. No differences in cravings to smoke by menstrual phase on the QSU.
DeBon et al. 61 C No – 5 Follicular, ovulation, early luteal, late luteal, menstrual MNWS (modified, added symptoms related to menstrual cycle, e.g., cramping) – Diaries completed at home Greater smoking during menstrual phase compared to ovulation
Pomerleau et al. 64 – No – 3 Early follicular, mid-to-late follicular, late luteal MNWS (modified, −5 to +5 scale) MNWS- craving item Outpatient research clinic/lab Trend (p < .10) toward main effect of phase on withdrawal scores. No significant differences in cravings by menstrual cycle phase.
Craig et al. 65 – No – 2 Midcycle, premenstrual TWQ Frequency of urges to smoke, strength of urges to smoke Diaries completed at home No significant differences in withdrawal by menstrual cycle phase. Greater frequency and strength of urges to smoke for midcycle phase compared to premenstrual phase.
O’Hara et al. 66 W Yes Counseling 2 Follicular, luteal SJTWQ – Outpatient research clinic/lab Greater withdrawal reported by women who quit during the follicular phase compared to the luteal phase 24, 48, and 72hr after quitting.

– = not assessed, not applicable, not reported, or unable to calculate from available data; BQSU/QSU = (brief) questionnaire on smoking urges 70,71 ; C = this study was included in meta-analysis of cravings; MNWS = Minnesota Nicotine Withdrawal Scale (also referred to as Nicotine Withdrawal Symptom Checklist; Hughes and Hatsukami 72 ); SJTWQ = Shiffman–Jarvik Tobacco Withdrawal Questionnaire (also referred to as the Shiffman-Jarvik Withdrawal Questionnaire; Shiffman and Jarvik 73 ); TNP = transdermal nicotine patch; TWQ = the withdrawal questionnaire (no reference provided); VAS = visual analog scale; W = this study was included in meta-analysis of withdrawal.

aStudy of progesterone vs. placebo; all women participated during the early follicular phase.

bParticipants were randomized to receive TNP or placebo patch over a seven day period for each of 2 menstrual cycle phases to assess changes in withdrawal symptoms by menstrual cycle and patch condition.