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Effects of menstrual phase on intake of nicotine, caffeine, and alcohol and nonprescribed drugs in women with late luteal phase dysphoric disorder

https://doi.org/10.1016/S0899-3289(94)90265-8Get rights and content

To investigate the possibility that cigarette smoking and other drug use are affected by menstrual phase in smokers with Late Luteal Phase Dysphoric Disorder (LLPDD), we examined daily diaries rating menstrual symptomatology, smoking, alcohol and nonprescription drug use, and caffeine intake in nine female smokers meeting criteria for LLPDD. Menstrual symptomatology peaked during the premenstrual phase. Smoking, alcohol, and nonprescription drug intake were increased during menses; caffeine intake was unaffected by phase. No systematic intrasubject correlation between symptomatology and smoking was detected. It was concluded that in women with LLPDD, smoking and alcohol and nonprescription drug intake appear to vary as a function of menstrual phase. The lack of intrasubject correlations between symptomatology and intake, and the failure of peak intake to coincide with peak symptomatology, however, indicate that these effects cannot be explained simply as “self-medication” of acute episodes of dysphoric mood.

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    Moreover, assessment of between-person differences is not suitable for revealing processes within persons. While several studies have used univariate repeated measures analysis to explore within-person variation in symptom levels across the various menstrual phases and across multiple cycles (Berger and Presser, 1994; Bloch et al., 1998, 1997; Eriksson et al., 2006; Marks et al., 1994; Marr et al., 2011a; Pearlstein et al., 2005c; Rapkin et al., 1998; Seippel and Bäckström, 1998; Sundblad et al., 1993; Wang et al., 1996), these studies only reveal mean symptom patterns within-persons, rather than individual patterns of symptom change across time. This is problematic, because results found at group level can only be generalised to the individual level under very strict conditions (Molenaar, 2004; Molenaar and Campbell, 2009), which are rarely met.

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    Women are reported to have more difficulty quitting smoking than men, whether quitting without assistance (Kabat and Wynder, 1987; Ward et al., 1997) or with behavioral interventions or nicotine replacement therapy (Bjornson et al., 1995; Bohadana et al., 2003; Perkins, 2001; Perkins and Scott, 2008; Royce et al., 1997; Swan et al., 1997; Wetter et al., 1999). The contributing role of the menstrual cycle to the apparent reduced rate of smoking cessation for women has been supported by investigations showing higher rates of smoking during menses (DeBon et al., 1995; Marks et al., 1994; Steinberg and Cherek, 1989) and the luteal phase (DeBon et al., 1995; Mello et al., 1987; Snively et al., 2000), greater desire to smoke and reduce negative affect in luteal versus follicular phases (Allen et al., 1999), and more intense cue-induced craving in luteal versus follicular phases or compared to males (Franklin et al., 2004). Although some reports have not shown menstrual cycle phase effects on smoking withdrawal symptoms (Allen et al., 1999; Pomerleau et al., 2000), others have shown increased withdrawal symptoms and craving in the luteal phase (Allen et al., 2009; Carpenter et al., 2006; DeBon et al., 1995; O’Hara et al., 1989; Perkins et al., 2000; Pomerleau et al., 1992) as well as increases in self-reported depressive symptoms (Perkins et al., 2000).

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    Despite inconsistencies in the literature, due in part to differences in methodology and difficulty separating premenstrual from withdrawal symptomatology, there is considerable support for the role of cycle-related hormonal changes in making quitting more difficult for women (see Carpenter, Upadhyaya, LaRowe, Saladin, & Brady, 2006 for a review). Attempts to assess the effects of menstrual cycle phase on ability to abstain from smoking have typically relied on either collection of data during ad libitum smoking followed by a time-limited period of attempted smoking abstinence (e.g., Allen, Hatsukami, Christianson, & Brown, 2000; Craig, Parrot, & Coomber, 1992; DeBon, Klesges, & Kleges, 1995; Franklin et al., 2004; Marks, Hair, Klock, Ginburg, & Pomerleau, 1994; Pomerleau, Garcia, Pomerleau, & Cameron, 1992) or on assessments collected in the context of a trial (e.g., O'Hara, Portser, & Anderson, 1989; Perkins et al., 2000). By contrast, the possible influence of individual differences in phase-related measures of premenstrual symptomatology, mood, and smoking withdrawal during ad libitum smoking upon smoking cessation outcome has been underexplored.

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Data were collected by the first author as part of her doctoral dissertation at the University of Connecticut; the work was supported by a grant from the University of Connecticut Foundation to the fourth author and a grant from the University of Connecticut Health Center to the second author. Preparation of the article was supported Grant CA 42730 to Ovide F. Pomerleau by the National Cancer Institute. The authors wish to thank Nancy Reame for her helpful comments on an earlier draft of this manuscript.

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