Overview: When a woman’s progesterone levels rise from a low level, the fewer cigarettes she consumes during the day. However, when progesterone levels peak, the benefits drop.
Source: University of South Carolina
Classic characters like Holly Golightly of “Breakfast at Tiffany’s” and Danny Zuko of “Grease” have certainly bolstered the cultural aesthetic of cigarette smoking. But since their time, we have learned a lot about the dangers of smoking and the importance of quitting.
And while we may never know if these characters would have tried to quit, had they existed in real life, we do know that Danny Zuko would have been more likely to succeed than Holly Golightly.
Despite knowledge of the harmful side effects of cigarettes, smoking remains the leading cause of preventable death in the United States. And while men and women try to quit equally often, women are more likely to relapse.
A paper recently published in Research on nicotine and tobacco aimed at addressing this discrepancy, and the results point to a possible cause: progesterone levels.
Progesterone is a steroid hormone, or chemical messenger, that is found in the bodies of both men and women, but it is present in higher levels in women and is released in the second half of the menstrual cycle. Medical University of South Carolina (MUSC) researchers Nathaniel Baker, MS, and Michael Saladin, Ph.D. have been studying the effect of progesterone on women trying to quit for nearly eight years.
In 2015, they published a paper noting the link between the hormone and smoking cessation success, and they found that specifically using a nicotine patch alongside naturally occurring increases in progesterone levels led to an increase over the course of a week. of 37% in the probability of abstinence.
“What we found in that study,” Baker said, “was that it wasn’t high progesterone per se, but it was high and increased abstinence.”
It was the first paper to identify a link between rising progesterone levels and abstinence outcomes in women trying to quit, but it required weekly personal visits by trial participants to measure their serum hormone levels.
Saladin and Baker wanted a more detailed assessment than the weekly data collection could give them, and they also wanted to use a method that was more easily accessible to patients. So they set out to investigate whether hormone levels collected from saliva each day by participants in their own homes could produce equivalent results to the more invasive serum collected.
Saladin said the goal of this study was not to recruit participants who wanted to quit the trial, but to look at their hormone fluctuations, as well as their cigarette smoking fluctuations, and compare those results with what they already knew about serum levels.
“What we found was so interesting,” he said.
“When a woman’s progesterone levels increased from low levels, she smoked fewer cigarettes per day without knowing or trying. But that effect on smoking behavior eventually levels off. When progesterone peaks in a woman’s cycle, it is very high. The benefits plateau.”
He noted that the biggest finding is that quitting successfully comes from the low to high increase, which can help time a woman’s quit attempt with her hormone cycle.
Baker performed the statistical modeling for the study, and by using the data they collected for the 2015 paper and combining it with the results of this study, as well as some known results for tracking ovulation, they found that serum and saliva were comparable progesterone levels throughout the month.
“We found that the saliva data followed a very similar pattern to the serum data,” he said. “It was just a little noisier, but clinically it’s very exciting.”
And by identifying which hormones influence smoking addiction and how, Saladin said women may have an easier time quitting.
“If we can time a quit attempt around a period when women are less likely to experience withdrawal and craving and more likely to abstain, for example,” Baker said, “I think medical utility is incredibly important.”
Timing peak nicotine withdrawal during any given five to seven days of a woman’s monthly hormone cycle could aid her success.
Although Saladin and Baker’s research centers focus on women who are not using oral contraceptives, they agree that there is an avenue for research to look at the effect of those drugs on smoking cessation. The intent of oral contraception is to alter the monthly hormone cycle, so it adds a level of complexity in examining hormonal changes in this context.
Another avenue of research could be to use exogenous progesterone to help both men and women quit. By giving a dose of progesterone at the time of withdrawal, Saladin and Baker hypothesize greater abstinence success for both sexes. The results of this research may also be applied to other substance abuse, such as cocaine or marijuana, in the future.
Baker said this area of research has made great strides over the past decade, and he’s interested to see where it goes. “The effect of progesterone on reducing withdrawal, as well as craving and even reducing cigarettes smoked per day, is valuable for patients trying to quit,” he explained. “And by using a less invasive approach, we improve patient engagement and reduce patient burden. And that helps everyone involved.”
About this news about hormones and quitting smoking
Original research: Closed access.
†Characterization of salivary progesterone in female smokersby Nathaniel L Baker et al. Nicotine and tobacco research
Characterization of salivary progesterone in female smokers
Fluctuations in ovarian hormones have been associated with changes in cigarette smoking behavior, which can be measured through both serum and less invasive salivary procedures. The primary aim of this exploratory study is to characterize the progesterone profiles from salivary progesterone measurements and to compare them with the profiles estimated from a previously measured serum sample.
Objectives and methods
Women who do not seek treatment, women who smoke (n = 82; ages 18-45) provided daily salivary hormone samples every morning for 14 consecutive days. Time-dependent random effects functions were used to approximate daily saliva progesterone levels (ng/ml) over the course of a standardized menstrual cycle. Serum measurements of progesterone from a previous study of female cigarette smokers were examined for consistency with established profiles and compared to the saliva profile using the same methodology.
The fit of the saliva model shows relative stability during the follicular phase and a clear unimodal peak during the luteal phase. Parameter estimates of the nonlinear function show agreement with serum data. Although the profiles estimated from salivary and serum data are consistent in functional form, we observed greater inter-subject heterogeneity both in the follicular level and the peak luteal level in saliva measurements.
The pattern of saliva and serum progesterone measured over the menstrual cycle is similar in shape, which is remarkable considering that the saliva and serum samples are from an independent sample of female smokers. The inter- and intra-individual variation in saliva measurements may be greater than in serum measurements.
Measuring the variation in progesterone level over the menstrual cycle through saliva samples has several advantages over the serum sampling methods, in that they are easy to obtain, non-invasive and inexpensive. The inter- and intra-individual variation in measurements may be greater than that in serum measurements. However, the functional form of the salivary progesterone profile is isomorphic to serum progesterone.