Influence of Premenstrual Syndrome on Relapse in Nicotine Abuse a Case Report

Case Report

Austin J Drug Abuse and Addict. 2015; 2(1): 1005.

Influence of Premenstrual Syndrome on Relapse in Nicotine Abuse a Case Report

Rouhollah Qurishi²*, Marieke Arts-de Jong³, Ernst J Franzek², Linda Hartman² and Cornelis AJ De Jong¹

¹Nijmegen Institute for Scientist-Practitioners in Addiction, Netherlands

²Novadic-Kentron Addiction Care network, Netherlands

³Department of Obstetrics and Gynaecology, Radboud University Medical Center, Netherlands

*Corresponding author: Rouhollah Qurishi, Schijndelseweg 46, 5491 TB Sint-Oedenrode, Novadic- Kentron Addiction Care Network, Netherlands

Received: June 18, 2015; Accepted: September 24, 2015 Published: October 03, 2015


Premenstrual Syndrome (PMS) is characterized by the occurrence of physical and psychological symptoms during the luteal phase of almost every menstrual cycle. These symptoms disappear at the beginning of menstruation, and a symptom-free period of at least a week ensues. Importantly, the severity or impact of symptoms must cause a significant impairment in woman’s life. This case presents a nicotine dependent woman who loses control on nicotine use during the luteal phase. The nicotine use increases during this phase, and it decreases at the start of the menstruation.

It is important that doctors of addiction and family doctors are aware of the increase of nicotine desire in the luteal phase of women suffering from PMS.

Keywords: Nicotine; Premenstrual syndrome; Premenstrual dysphoric disorder


Approximately, one fifth of all Dutch adults reported smoking on regular basis, of which less than half were female [1]. In general, gender-specific differences exist in addiction. A growing number of adolescent women abuse nicotine. Among women aged 14 to 24, nicotine dependence lies at 18.5%, which is comparable to 19.1% among men who are diagnosed as nicotine dependent. Women smoke fewer cigarettes and more “light” products. Metabolism of nicotine is faster in women than in men. Cotinine (a metabolite of nicotine) levels are lower in women. A special issue for women is the regulation of their weight via smoking [2]. Women are more likely to rely on cigarettes to cope with stress and negative emotions [3,4]. They tend to relapse in situation involving negative emotions, conflicts and stress, while men tend to relapse in positive situations, such as social events [5].

Whether Premenstrual Syndrome (PMS) could trigger nicotine abuse or relapse has been inadequately described in the literature. In this case study we present a patient with PMS and difficulties quitting smoking.

Case Report

Patient F, a female of forty years old, has been smoking more than half of her life, experiencing increased craving for cigarettes during her premenstrual period.

Her childhood was characterized by a lack of boundaries and clear rules after her parents divorced when she was six years old. She and her sister were raised by their father. He suddenly died from heart problems when she was 21 years. After his death, she started to experience feelings of anxiety and panic attacks for which she eventually got ‘citalopram’. In this period she felt very vulnerable and found it difficult to keep upright in a social society. Therefore, she also used ‘alprazolam’ for a long period of time to regulate her panic attacks. During many years she had contact with different counsellors, and at this moment she has been stable for six years. Currently, she is using a daily dose of 40 mg ‘citalopram’ mainly to stabilize her mood variations.

She started smoking around the age of thirteen. In the first three years she only sporadically smoked cigarettes. Afterwards, she smoked on average five cigarettes per day until the age of 37 years. In this period, she attempted to quit smoking several times being successful three years ago. During these last three years she did not smoke cigarettes at all. However, a couple of months ago she started again smoking four to five cigarettes a day on average. A week before her menstruation the patient experiences considerably more craving for cigarettes. During this period she smokes on average seven to ten cigarettes a day.

Her menarche was at the age of eleven. She always has had a regular cycle. In the week before her menstruation, she complains about a bloated feeling in her abdomen and tender breasts. Furthermore, she reports feelings of being very irritable, moody, emotional, labile, lacking energy, and rapid tantrums and crying. Her period generally takes five days with normal blood loss. During the first days she experiences many complaints, like pain in back and belly, tender breasts, mood swings and energy loss. She is never been pregnant. She is sexual active, and she is not using contraception, her husband is sterilized.


PMS has been defined in many ways. The International Society of Premenstrual Disorders intended to develop a broad excepted, but well-described definition [6]. The definition enables better understanding of this very common, but poorly understood disease. Because of its chronic character the impact of PMS on psychosocial and social functioning is comparable with the impact of a depressive disorder [7]. PMS is a relative frequent occurring syndrome. In recent national population research, 12% of the women reported premenstrual complaints that displayed a negative effect on their daily functioning [8]. In the Netherlands, PMS is reported in 3-5% of all fertile aged women [7]. Since the definition of PMS describes a cyclic complaint pattern, one should assure the patient maintains a daily complaint diary during two menstruation cycles to be able to diagnose. Although the diagnostic procedure is intensive, it is worth the effort.

The etiology of PMS and Premenstrual Dysphoric Disorders (PMDD) is unknown, but most likely there is an abnormal, intensified reaction on physiological hormonal fluctuations. A strong genetic predisposition for PMS is demonstrated in a large twin cohort [9].

In the eighties the diagnostic criteria for PMS where incorporated in the Diagnostic and Statistical Manual III (DSM III). In the DSMIV the PMDD is also described [10].

The criteria for the diagnosis PMDD are mentioned in the DSMIV R. The DSM-5 has a trial period of two years in Holland. No main changes were made about PMDD in the DSM-5.

The criteria for the diagnosis PMDD are presented in (Table 1). In most menstruation cycles during the last year, at least five of the following symptoms have to be present during the major part of the week of the luteal phase which persists during the start of the menstruation.

Citation: Qurishi R, Arts-de Jong M, Franzek EJ, Hartman L and De Jong CAJ. Influence of Premenstrual Syndrome on Relapse in Nicotine Abuse a Case Report . Austin J Drug Abuse and Addict. 2015; 2(1): 1005.