Alcohol use, negative mood states, and menstrual cycle phases

Good sleep is a mood buffer for young women during menses

STUDY OBJECTIVES

We sought to elucidate the interaction between sleep and mood considering menstrual cycle phase (menses and non-menses portions of the cycle) in 72 healthy young women (18-33 years) with natural, regular menstrual cycles and without menstrual-associated disorders. This work fills a gap in literature of examining mood in context of sleep and menstrual cycle jointly, rather than individually.

METHODS

Daily subjective measures of sleep and mood, and date of menses were remotely, digitally collected over a 2-month period. Each morning, participants rated their sleep on the previous night, and each evening participants rated the extent of positive and negative mood for that day. Objective sleep was tracked with a wearable (ŌURA ring) during month 2 of the study. Time-lag cross-correlation and mixed linear models were used to analyze the significance and directionality of the sleep-mood relationship, and how the interaction between menstrual cycle status and sleep impacted mood levels.

RESULTS

We found that menstrual status alone did not impact mood. However, subjective sleep quality and menstrual status interacted to impact positive mood (p < .05). After a night of perceived poor sleep quality, participants reported lower positive mood during menses compared to non-menses portions of the cycle, while after a night of perceived good sleep quality participants reported equivalent levels of positive mood across the cycle.

CONCLUSIONS

We suggest that the perception of good sleep quality acts as a mood equalizer, with good sleep providing a protective buffer to positive mood across the menstrual cycle.

Positive but not negative affect is associated with increased daily drinking likelihood in non-clinical populations: systematic review and meta-analyses

Background: Recent meta-analytical findings indicate that affect regulation plays an important role in alcohol craving, consumption volume, and substance use. However, in view of mixed findings, the affect and drinking likelihood literature remains in need of clarification and consolidation.Objectives: This systematic review with meta-analyses interrogated the results from peer-reviewed studies among non-clinical populations that examined the relationship between daily affective states and intraday likelihood of alcohol consumption.Method: A PRISMA guided search of PsychINFO, PsycARTICLES, Science Direct, Wiley Online Library, PubMed, SCOPUS, and JSTOR databases was conducted. Multilevel meta-analyses yielded 11 eligible negative affect studies (2751 participants, 23 effect sizes) and nine studies on positive affect (2244 participants, 14 effect sizes).Results: The pooled associations between intra-day affect and alcohol consumption likelihood revealed no significant association between negative affective state and drinking likelihood (OR = .90, 95% CI [.73, 1.12]) and that positive affect was associated with increased drinking likelihood (OR = 1.17, 95% CI [1.09, 1.27]). Egger's test, P-curve, fail-safe N, and selection models analyses suggested that the obtained results were unlikely to be the product of publication bias and p-hacking alone.Conclusions: Results converge to suggest that, independent of age, affect measure used, and study design, a significant albeit modest relationship between positive affect and alcohol consumption likelihood exists, which does not appear to be the case for negative affect. In conjunction with other recent meta-analyses, current findings help map out a more nuanced understanding of the affect-alcohol/substance use relationship, with potential implications for interventions.

Discontinuation of hormonal contraception due to changes in mood and decreases in sexual desire: the role of adverse childhood experiences

PURPOSE

To evaluate if adverse childhood experiences are associated with hormonal contraception discontinuation due to mood and sexual side effects.

MATERIALS AND METHODS

Women, ages 18-40 (N = 826), with current and/or previous hormonal contraceptive use completed surveys on demographics, contraceptive history, and the Adverse Childhood Experiences Questionnaire. We characterised women into high (≥2 adverse experiences) and low (0 or 1) adverse childhood experience groups. We calculated risk ratios for associations between adverse childhood experiences and outcomes of interest using log binomial generalised linear models, and adjusted for relevant demographic variables.

RESULTS

Women in the high adverse childhood experiences group (n = 355) were more likely to report having discontinued hormonal contraception due to decreases in sexual desire (adjusted risk ratio 1.44, 1.03-2.00, p = .030). Covariates included age, current hormonal contraception use, and various demographic variables associated with discontinuation. Adverse childhood experiences were not associated with mood or sexual side effects among current (n = 541) hormonal contraceptive users.

CONCLUSIONS

Self-reported adverse childhood experiences were associated with greater likelihood of discontinuing hormonal contraception due to behavioural side effects, particularly decreases in sexual desire. Identification of risk factors for behavioural side effects can assist patients and clinicians in making informed choices on contraception that minimise risk of early discontinuation.

Towards an affect intensity regulation hypothesis: Systematic review and meta-analyses of the relationship between affective states and alcohol consumption

While self-medication and positive and negative reinforcement models of alcohol use suggest that there is an association between daily affect and alcohol consumption, findings within the academic literature have been inconsistent. This pre-registered systematic review meta-analytically interrogated the results from studies amongst non-clinical populations that examine the relationship between daily affective states and alcohol consumption volume. PRISMA guided searches of PsychINFO, PsycARTICLES, Science Direct, PubMed, SCOPUS, and JSTOR databases were conducted. When both laboratory and field studies were included, meta-analyses with robust variance estimation yielded 53 eligible studies on negative affect (8355 participants, 127 effect sizes) and 35 studies for positive affect (6384 participants, 50 effect sizes). The significant pooled associations between intra-day affect and alcohol consumption were r = .09, [.03, .14] for negative affect, and r = .17, [.04, .30] for positive affect. A small-to-medium sized effect (d = .275, [.11, .44]) of negative affect on daily alcohol consumption volume was found in laboratory studies (14 studies, 1100 participants). While publication bias was suspected, P-curve analyses suggested that the results were unlikely to be the product of publication bias and p-hacking alone, and selection model analysis revealed no significant differences in results when publication bias was accounted for. For negative affect, using number of drinks as the measure of alcohol consumption was associated with lower effect sizes. For positive affect, the results demonstrated a decline of this observed effect over time. Overall, findings point towards the possibility of developing an affect intensity regulation theory of alcohol use. Conceptualizing the mood-alcohol nexus in terms of affect intensity regulation may afford a more parsimonious explanation of alcohol consumption rather than viewing the behavior as being shaped by either positive or negative affective states.

Addictive behaviors across the menstrual cycle: a systematic review

Research examining relations between menstrual cycle phase and female addictive behaviors is accumulating. Theories suggest addictive behaviors may increase during specific phases of the menstrual cycle resulting from cyclical fluctuations in hormones and affect. In line with self-medication theory, we predicted that addictive behaviors would increase premenstrually and menstrually, phases marked by elevations in negative affect, relative to the follicular and luteal phases. We also hypothesized, coinciding with reward-sensitivity theory, that addictive behaviors may increase during ovulation, a phase characterized by increased positive affect, compared to the same phases. This systematic review summarizes extant literature examining the menstrual cycle phase-addictive behavior relationship and underlying motivations. Articles pertaining to menstrual cycle phase and addictive behaviors within the PsycINFO, CINAL, and PubMED databases were screened to determine eligibility following PRISMA guidelines (n = 1568). Thirty-four articles examining alcohol use, cannabis use, nicotine use, caffeine use, and gambling behavior across menstrual cycle phase met inclusion criteria. Consistent with self-medication theory, strong evidence indicated that nicotine use increased premenstrually and menstrually. Other factors increasing both nicotine and alcohol use premenstrually and menstrually include having a premenstrual dysphoric disorder diagnosis or having premenstrual syndrome. Motivations for using alcohol and nicotine may too vary by menstrual cycle phase. Results were less consistent or understudied for other addictive behaviors and thus conclusions cannot be drawn. Menstrual cycle phase appears to be a female-specific factor affecting some addictive behaviors, particularly nicotine use, and should be considered when conducting addictive behavior research or clinical interventions for reproductive-aged females with addictive disorders.

Hormonal responses in gambling versus alcohol abuse: A review of human studies

The endocrine system plays an essential role in communication between various organs of the body to maintain homeostasis. Both substance use disorders (SUDs) and non-substance abuse disrupt this system and lead to hormonal dysregulations. Here, we focus on the comparison between the function of the endocrine system in gambling disorders and alcohol addiction to understand the commonalities and differences in their neurobiological and psychological underpinnings. We review human research to compare findings on gambling addiction and alcohol dependence pertaining to the dynamic interplay between testosterone and cortisol. Understanding and classifying similarities in hormonal responses between behavioural addiction and SUDs may facilitate development of treatments and therapeutic interventions across different types of addictive disorders, while describing differences may shed light on therapeutic interventions for specific disorders. Although research on gambling addiction is in its infancy, such evaluation may still have a positive effect for addiction research, thereby stimulating discovery of "crossover" pharmacotherapies with benefits for both SUDs and nonsubstance addictions.

Menstrual cycle phase, alcohol consumption, alcohol cravings, and mood among women in outpatient treatment for alcohol use disorder

Research shows fluctuations in drinking across the menstrual cycle among women with alcohol use disorder (AUD), but little work has investigated moderators of these fluctuations. This study examined drinking and craving intensity across the menstrual cycle, and the moderating effect of baseline depression and emotional distress during the midlate luteal phase and/or menses, among women receiving AUD treatment. Fifty-nine regularly cycling women reported menstrual history and baseline depression. Over 3 months of treatment, they kept daily logs of drinks, alcohol cravings, and menstruation (yes/no). Emotional distress during the midlate luteal phase and/or menses of their most recent menstrual cycle was also assessed during treatment. Menstrual cycle phase was estimated for each within-treatment day. Mixed model analyses tested main and interactive effects of menstrual cycle phase, baseline depression, and emotional distress during the midlate luteal phase and/or menses on daily drinks and craving intensity. Women drank most during the midlate luteal phase and menses compared with other phases. Among women with lower baseline depression, those with lower distress during the midlate luteal phase and/or menses reported more intense cravings during the midlate luteal phase (ΔM = .77, p = .000) and menses (ΔM = .51, p = .012); those with higher distress reported more intense cravings during menses, compared with all other phases (p < .01). Among women with higher baseline depression, craving intensity remained consistently high. Results document more drinking during the midlate luteal phase and menses and suggest that cycle-related distress and depression moderate the alcohol-menstrual association among women in AUD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fluctuations in progesterone moderate the relationship between daily mood and alcohol use in young adult women

BACKGROUND

Research has demonstrated associations between hormonal fluctuations during the menstrual cycle and women's alcohol use. This association has been explained by mood changes that, for some women, accompany decreasing levels of progesterone during the menstrual cycle, particularly during the late luteal/premenstrual phase. The current study examined whether participants' daily ratings of mood interact with changing levels of progesterone to predict alcohol use.

METHOD

Young adult women attended two sessions scheduled two weeks apart, during which they completed questionnaires and provided salivary samples for the assay of progesterone levels. In the intervening two weeks, participants completed daily logs of their mood, alcohol use, and menses. Ordered Generalized Linear Mixed Models assessed the effects of daily mood (examined as both a within- and between-subject variable) on the likelihood of drinking, as a function of menstrual cycle phase and changes in progesterone across the two weeks.

RESULTS

One standard deviation increase in progesterone corresponded to a 1.61 decrease in the odds of drinking. This main effect was moderated by daily mood. Women were more likely to drink during a decrease in progesterone on days they rated their mood as negative, whereas during an increase in progesterone they were more likely to drink on days they reported a positive mood. Between-subject analyses showed that women who reported lower overall mood during the two-week period were more likely to drink with an increase in progesterone and less likely with a decrease.

CONCLUSIONS

Women's likelihood to drink increased when they experienced negative mood in the context of decreasing levels of progesterone, whereas the negative-mood/drinking association was mitigated among those with increasing levels of progesterone. However, compared to women who on average had an overall more positive mood, women with an overall lower mood (and corresponding higher levels of depression and anxiety at baseline) did not experience the protective effects of rising progesterone levels on drinking.

Chronic ethanol drinking increases during the luteal menstrual cycle phase in rhesus monkeys: implication of progesterone and related neurosteroids

RATIONALE

Sporadic reports of alcohol consumption being linked to menstrual cycle phase highlight the need to consider hormonally characterized menstrual cycle phase in understanding the sex-specific effects of risk for alcohol drinking in women.

OBJECTIVES

We investigated the association between menstrual cycle phase, characterized by circulating progesterone and menses, with accurate daily alcohol intakes in rhesus monkeys, and the contribution of progesterone derived neuroactive steroids to cycle-related alcohol drinking.

METHODS

Menses (daily) and progesterone (2-3×/week) were obtained in female monkeys (n = 8, 5 ethanol, 3 control) for 12-18 months. Ethanol monkeys were then induced to drink ethanol (4% w/v; 3 months) and given 22 h/day access to ethanol and water for approximately 1 year. In selected cycles, a panel of neuroactive steroids were assayed during follicular and luteal phases from pre-ethanol and ethanol exposure.

RESULTS

There were minimal to no effects of ethanol on menstrual cycle length, progesterone levels, and follicular or luteal phase length. The monkeys drank more ethanol during the luteal phase, compared to the follicular phase, and ethanol intake was highest in the late luteal phase when progesterone declines rapidly. Two neuroactive steroids were higher during the luteal phase versus the follicular phase, and several neuroactive steroids were higher in the pre- vs. post-ethanol drinking menstrual cycles.

CONCLUSIONS

This is the first study to show that normal menstrual cycle fluctuations in progesterone, particularly during the late luteal phase, can modulate ethanol intake. Two of 11 neuroactive steroids were selectively associated with the effect of cycle progesterone on ethanol drinking, suggesting possible links to CNS mechanisms of ethanol intake control.

Correlations between sex-related hormones, alcohol dependence and alcohol craving

BACKGROUND

Sex-related differences in the susceptibility, progression, and treatment response in alcohol-dependent subjects have been repeatedly reported. In this study, we aimed to investigate the associations of the sex-related hormone/protein levels with alcohol dependence (AD) and alcohol craving in male and female subjects.

METHODS

Plasma sex-related hormones (estradiol, estrone, total testosterone, progesterone, follicle stimulated hormone [FSH], luteinizing hormone), and sex hormone binding globulin were measured by mass spectrometry or automated immunoassays from 44 recently-abstained subjects (29 males and 15 females; mean age = 45.9 ± 15.6) meeting DSM-IV-TR criteria for AD and 44 age-, sex- and race-matched non-AD controls. Conditional logistic regression was conducted to examine the association of sex-related hormone and protein levels with AD risk, accounting for matching variables. Their associations with alcohol craving scales (Penn Alcohol Craving Scale and Inventory of Drug-Taking Situations) were assessed in AD subjects.

RESULTS

Plasma FSH level was significantly higher in AD males (10.3 ± 9.8 IU/L) than control males (8.0 ± 15.9 IU/L; p = 0.005, p_corrected = 0.035). We also found a significant inverse correlation of FSH level with propensity to drink in negative emotional situations (Spearman's rho=-.540; p = 0.021) and positive correlations between progesterone level and craving intensity (Spearman's rho=.464; p = 0.020) and between total testosterone level and propensity to drink under temptations (adjusted for no-drinking days; β=6.496; p = 0.041) in AD males.

CONCLUSIONS

These results suggest that FSH, progesterone, and testosterone levels may be associated with AD and alcohol craving in AD males. Future research is needed to replicate these findings and investigate the underlying biological mechanisms.

Sex hormones in alcohol consumption: a systematic review of evidence

Sex hormones play an important role in establishing sex‐distinctive brain structural and functional variations that could contribute to the sex differences in alcohol consumption behavior. Here, we systematically reviewed articles that studied sex hormone impacts on alcohol consumption and alcohol use disorder (AUD). An extensive literature search conducted in MEDLINE, PubMed, Scopus and CINAHL databases identified 776 articles, which were then evaluated for pre‐specified criteria for relevance and quality assurance. A total of 50 articles, including 19 human studies and 31 animal studies, were selected for this review. Existing evidence supports the association of increased testosterone level and increased risk for alcohol use and AUD in males but results are inconclusive in females. In contrast, the evidence supports the association of increased estrogen level and increased alcohol use in females, with mixed findings reported in males. Much less is known about the impact of progestins on alcohol use and misuse in human subjects. Future observational and experimental studies conducted in both sexes with a comprehensive hormone panel are needed to elucidate the impact of the interplay between various sex hormone levels during various developmental stages on alcohol use‐related phenotypes and AUD.

Effect of menstrual cycle on ethanol drinking in rhesus monkeys

BACKGROUND

Sex differences in the abuse-related effects of alcohol have been demonstrated in the clinic and in preclinical animal models. Less is known about the influence of menstrual cycle phase on drinking.

METHODS

In this study, we examined the relationship between menstrual cycle phase and intake of ethanol (EtOH) in five adult female rhesus monkeys. Subjects consumed a 4% EtOH solution in their home cage 6 h per day, 5 days per week and pressed a lever to receive food pellets during the drinking session. Menstrual cycle was determined with vaginal swabs 5-7 days per week. To facilitate comparison with previous studies, the cycle was divided three different ways for analysis.

RESULTS

First, no significant difference was observed when EtOH intake was compared between phases defined as "follicular" (days 5-10) and "luteal" (19-24). Second, when the cycle was further divided into four phases [early follicular (days 1-7), late follicular (8-14), early luteal (15-21) and late luteal (22-next cycle)], significant differences were detected, with intake highest in phases that bracket menses and lowest in the late follicular phase. Finally, EtOH intake during "mid-cycle" (days 12-16) was significantly lower than during "menses" (days 1-5) and "late luteal" (last 5 days). Effect sizes were small to moderate, although absolute differences in EtOH intake (g/kg) were <15%. Food-maintained responding was not different across phases.

CONCLUSIONS

Menstrual cycle has modest but statistically significant and selective effects on EtOH drinking, with higher EtOH intake observed in the peri-menstrual period compared to the middle of the cycle.

Sex Differences in Animal Models: Focus on Addiction

The purpose of this review is to discuss ways to think about and study sex differences in preclinical animal models. We use the framework of addiction, in which animal models have excellent face and construct validity, to illustrate the importance of considering sex differences. There are four types of sex differences: qualitative, quantitative, population, and mechanistic. A better understanding of the ways males and females can differ will help scientists design experiments to characterize better the presence or absence of sex differences in new phenomena that they are investigating. We have outlined major quantitative, population, and mechanistic sex differences in the addiction domain using a heuristic framework of the three established stages of the addiction cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. Female rats, in general, acquire the self-administration of drugs and alcohol more rapidly, escalate their drug taking with extended access more rapidly, show more motivational withdrawal, and (where tested in animal models of "craving") show greater reinstatement. The one exception is that female rats show less motivational withdrawal to alcohol. The bases for these quantitative sex differences appear to be both organizational, in that estradiol-treated neonatal animals show the male phenotype, and activational, in that the female phenotype depends on the effects of gonadal hormones. In animals, differences within the estrous cycle can be observed but are relatively minor. Such hormonal effects seem to be most prevalent during the acquisition of drug taking and less influential once compulsive drug taking is established and are linked largely to progesterone and estradiol. This review emphasizes not only significant differences in the phenotypes of females and males in the domain of addiction but emphasizes the paucity of data to date in our understanding of those differences.

Toll-like Receptors in the Vascular System: Sensing the Dangers Within

Toll-like receptors (TLRs) are components of the innate immune system that respond to exogenous infectious ligands (pathogen-associated molecular patterns, PAMPs) and endogenous molecules that are released during host tissue injury/death (damage-associated molecular patterns, DAMPs). Interaction of TLRs with their ligands leads to activation of downstream signaling pathways that induce an immune response by producing inflammatory cytokines, type I interferons (IFN), and other inflammatory mediators. TLR activation affects vascular function and remodeling, and these molecular events prime antigen-specific adaptive immune responses. Despite the presence of TLRs in vascular cells, the exact mechanisms whereby TLR signaling affects the function of vascular tissues are largely unknown. Cardiovascular diseases are considered chronic inflammatory conditions, and accumulating data show that TLRs and the innate immune system play a determinant role in the initiation and development of cardiovascular diseases. This evidence unfolds a possibility that targeting TLRs and the innate immune system may be a novel therapeutic goal for these conditions. TLR inhibitors and agonists are already in clinical trials for inflammatory conditions such as asthma, cancer, and autoimmune diseases, but their study in the context of cardiovascular diseases is in its infancy. In this article, we review the current knowledge of TLR signaling in the cardiovascular system with an emphasis on atherosclerosis, hypertension, and cerebrovascular injury. Furthermore, we address the therapeutic potential of TLR as pharmacological targets in cardiovascular disease and consider intriguing research questions for future study.

Menstrual Cycle Influences on Alcohol Consumption among Blacks

Alcohol consumption patterns among 39 Black men, normally cycling women, and women taking oral contracep tives were examined over a 30-day self-monitoring period to determine the influence of the menstrual cycle on drinking behavior. Previous animal and human data suggest premen strual increases and mid-cycle decreases in alcohol con sumption, but contradictory reports of an absence of men strual cycle effects have emerged more recently. Decreased drinking among women taking oral contraceptives also has been reported. No studies examining Black subject samples could be isolated, and indications of racial differences in metabolic rates suggest that generalizations about Black women from studies using predominantly White subjects may be unjustified. No overall significant differences were found in alcohol consumption patterns or amounts of alcohol consumed for the three groups across the menstrual cycle. The effects of the sex hormones and the possibility of interactions between menstrual cycle symptomatology and drinking patterns are discussed along with implications and recommendations for future research in this area.

Differential associations between ovarian hormones and disordered eating symptoms across the menstrual cycle in women

OBJECTIVE

We examined changes in drive for thinness, body dissatisfaction, and dietary restraint across the menstrual cycle and associations between these symptoms and ovarian hormones in two independent samples of women (N = 10 and 8 women, respectively) drawn from the community.

METHOD

Daily self-report measures of disordered eating and negative affect were completed for 35-65 days. Daily saliva samples were assayed for estradiol and progesterone in Study 2 only.

RESULTS

Levels of body dissatisfaction and drive for thinness were highest during the mid-luteal/pre-menstrual phases in both studies and were negatively associated with estradiol, and positively associated with progesterone. By contrast, dietary restraint showed less variation across the menstrual cycle and weaker associations with ovarian hormones.

DISCUSSION

Differential associations between ovarian hormones and specific disordered eating symptoms point to distinct etiological processes within the broader construct of disordered eating.

Sex hormone activity in alcohol addiction: integrating organizational and activational effects

There are well-known sex differences in the epidemiology and etiopathology of alcohol dependence. Male gender is a crucial risk factor for the onset of alcohol addiction. A directly modifying role of testosterone in alcohol addiction-related behavior is well established. Sex hormones exert both permanent (organizational) and transient (activational) effects on the human brain. The sensitive period for these effects lasts throughout life. In this article, we present a novel early sex hormone activity model of alcohol addiction. We propose that early exposure to sex hormones triggers structural (organizational) neuroadaptations. These neuroadaptations affect cellular and behavioral responses to adult sex hormones, sensitize the brain's reward system to the reinforcing properties of alcohol and modulate alcohol addictive behavior later in life. This review outlines clinical findings related to the early sex hormone activity model of alcohol addiction (handedness, the second-to-fourth-finger length ratio, and the androgen receptor and aromatase) and includes clinical and preclinical literature regarding the activational effects of sex hormones in alcohol drinking behavior. Furthermore, we discuss the role of the hypothalamic-pituitary-adrenal and -gonadal axes and the opioid system in mediating the relationship between sex hormone activity and alcohol dependence. We conclude that a combination of exposure to sex hormones in utero and during early development contributes to the risk of alcohol addiction later in life. The early sex hormone activity model of alcohol addiction may prove to be a valuable tool in the development of preventive and therapeutic strategies.

Do oral contraceptives act as mood stabilizers? Evidence of positive affect stabilization

Previous research has suggested that oral contraceptives (OCs) may provide a stabilizing effect on affect. The present study examined whether OC users and nonusers differ in their affect reactivity in response to four laboratory mood induction procedures. A sample of 107 undergraduate students (40 OC users, 36 nonusers, and 31 men) completed the Positive and Negative Affect Schedule (PANAS) before and after completing a series of four mood-induction procedures (i.e., positive affect, jealousy, social ostracism, and parental feelings affect inductions). OC users experienced a blunted positive affect response to the tasks when compared with nonusers and men. Women who used OCs for less than two years showed the lowest positive affect reactivity. The groups did not differ in terms of negative affect reactivity. The results suggest that hormonal contraceptives may reduce the degree of positive affect change that women experience in response to environmental events. Possible mechanisms for an OC-induced positive affect stabilization effect are discussed.

Puberty, hormones, and sex differences in alcohol abuse and dependence

Sex differences in patterns of drinking and rates of alcohol abuse and dependence begin to emerge during the transition from late puberty to young adulthood. Increases in pubertal hormones, including gonadal and stress hormones, are a prominent developmental feature of adolescence and could contribute to the progression of sex differences in alcohol drinking patterns during puberty. This paper reviews experimental and correlational studies of gonadal and stress-related hormone changes and their effects on alcohol drinking and other associated actions of alcohol. Mechanisms are suggested by which reproductive hormones and stress-related hormones may modulate neural circuits within the brain reward system to produce sex differences in alcohol drinking patterns and vulnerability to alcohol abuse and dependence which become apparent during the late pubertal period.

To what extent do oral contraceptives influence mood and affect?

BACKGROUND

Studies examining the effects of oral contraceptives (OCs) on mood, affect, and affect variability are reviewed.

METHODS

MEDLINE and PsycLIT data bases were examined to identify studies that compared OC users with nonusers using daily ratings of mood, affect, or affect variability.

RESULTS

Compared to non-users, OC users experience less variability in affect across the entire menstrual cycle, and less negative affect during menstruation (i.e. withdrawal bleeding). In women with OC-related negative mood and affect change, potential mediators of the relation between OCs and mood or affect were identified: a history of depression, psychiatric symptoms, dysmenorrhea, and premenstrual mood symptoms prior to OC use; a history of pregnancy-related mood symptoms; a family history of OC-related mood complaints; being in the postpartum period; and age. Furthermore, a lower ratio of progesterone to estrogen is associated with more negative mood change in women with a history of premenstrual emotional symptoms, higher progesterone to estrogen ratios are associated with increased negative mood effects in women without such a history, and monophasic OCs have a greater stabilizing effect on mood than triphasic OCs.

LIMITATIONS

The 'survivor effect', psychological factors, and indirect pharmacological effects (e.g. weight gain) have not yet been systematically investigated. Furthermore, most studies have examined only negative mood or affect, as opposed to both positive and negative affect and affect variability; and few affect studies have assessed potential mediators of OC-related affect change.

CONCLUSIONS

While the only consistent OC-related mood effects experienced by most women are beneficial, a subgroup of women do experience negative mood change. Future research must focus on expounding the individual difference and OC-related risk factors for negative mood change.

Effects of oral contraceptives on daily self-ratings of positive and negative affect

OBJECTIVES

The relationship between affect and duration of oral contraceptive (OC) use was investigated.

METHOD

Ninety-six women (17 first-time OC users, 34 long-time users, and 45 never-users) completed the Positive and Negative Affect Schedule (PANAS) and the Menstrual Distress Questionnaire (MDQ) daily for 35 days. This study was the first to examine positive affect variability; and personal family psychiatric history; and to compare early-, late-, and never-users of OCs.

RESULTS

Triphasic users experienced greater variability in positive affect across the cycle, likely due to the variable hormone levels. Withdrawal of a constant level of hormones (monophasics) during early use was associated with greater variability in positive affect than withdrawal of changing hormonal levels (triphasics). Furthermore, personal and family psychiatric history may mediate an effect of OCs on negative affect variability.

CONCLUSIONS

OCs and, therefore, hormones can alter day-to-day affect variability. Four variables are associated with this effect: duration of use, OC type, personal psychiatric history, and family psychiatric history.

Ethanol-like discriminative stimulus effects of the neurosteroid 3 alpha-hydroxy-5 alpha-pregnan-20-one in female Macaca fascicularis monkeys

The present study was designed to characterize the discriminative stimulus effects of ethanol and the neurosteroid 3 alpha-hydroxy-5 alpha-pregnan-20-one (allopregnanolone) in non-human primates. Female cynomolgus monkeys (Macaca fascicularis) were trained in a two-lever procedure to discriminate 1.0 g/kg ethanol (IG, 30 min pretreatment) from water using food reinforcement. Consistent with previous results in a variety of species, pentobarbital (0.56-17 mg/kg, IG) resulted in a dose-dependent substitution for the discriminative stimulus effects of ethanol, with an average ED50 value of 1.9 mg/kg. Administration of allopregnanolone (0.3-5.6 mg/kg, IV) also produced complete substitution for the discriminative stimulus effects of ethanol, with an ED50 value of 1.0 mg/kg. Plasma allopregnanolone levels 35 min following the administration of 3.0 mg/kg allopregnanolone ranged from 33 to 69 ng/ml. The ethanol-like discriminative stimulus effects of 1.0 mg/kg allopregnanolone (IV) were present for 60 min, with a return to complete water-appropriate responding at 90 min post-treatment. The results indicate that the endogenous neuroactive steroid allopregnanolone produces subjective effects in cynomolgus monkeys that are similar to ethanol. These findings suggest that changes in the endogenous levels of allopregnanolone could alter sensitivity to the subjective effects of ethanol.

Perimenstrual symptoms among Chinese women in an urban area of China

We explored perimenstrual symptoms among 16 Chinese women in an urban area of southeastern China using a retrospective questionnaire, the Menstrual Distress Questionnaire (MDQ), and a prospective daily symptom diary, the Daily Health Diary (DHD), modified for cultural relevance. Mean scores on the DHD were significantly (p < .03) higher during the perimenstrual phase for the symptoms fatigue, increased sensitivity to cold, increased sleeping, abdominal pain/discomfort, painful or tender breasts, and decreased sexual desire. The women who reported higher DHD physical symptom scores prospectively were more likely to recall more severe physical symptoms retrospectively on the MDQ. However, there were remarkable discrepancies between the DHD and MDQ regarding psychoemotional symptoms. By retrospective MDQ, the percentages of women who experienced severe mood swings and irritability ranged from 13% to 25% during the premenstrual and menstrual phases; on the DHDs, however, these emotional symptoms were not statistically associated with the menstrual cycle. The failure of prospective charting to confirm the retrospective reports of cyclic psychoemotional symptoms agrees with findings of studies of U.S. samples. We conclude that perimenstrual distress in Chinese women may be affected by the data collection methods.

Family history of alcoholism in women with generalized anxiety disorder who have premenstrual syndrome: patient reports of premenstrual alcohol consumption and symptoms of anxiety

This study sought to determine whether family history of alcoholism is related to patient reports of premenstrual alcohol consumption and whether family history of alcoholism is related to severity of anxiety-related symptoms, in women who suffer simultaneously from both premenstrual syndrome and generalized anxiety disorder. Fifty-four women with generalized anxiety disorder and prospectively demonstrated premenstrual syndrome were questioned about family history of alcoholism and alcohol consumption patterns across the menstrual cycle. Seventy-six percent of the sample reported having an alcoholic first- or second-degree relative. Furthermore, 74% of those women having a paternal-side family history of alcoholism, but only 22% of those without such a family history, reported increased alcohol consumption premenstrually. Forty-one of these women were assessed by means of psychiatric rating scales during both the premenstrual and follicular phases of the menstrual cycle. During the premenstrual, but not the follicular, phase of the menstrual cycle, women with a paternal-side family history of alcoholism experienced more severe anxiety-related somatic, but not psychic, symptoms of anxiety, than those without such a family history. These findings suggest that family history of alcoholism may be related to premenstrual alcohol consumption patterns and to the severity of premenstrually experienced somatic symptoms of anxiety in women with premenstrual syndrome, and that these women may be self-medicating with alcohol.

Mood effects of alcohol and expectancies across the menstrual cycle

To examine menstrual cycle phase variations in alcohol absorption and mood before and after drinking alcohol, 96 volunteers female heavy drinkers, unaware they were in a menstrual cycle study, were randomly assigned to 12 equal-sized groups with controls for the effects of alcohol, expectancy, and menstrual cycle phase. Alcohol subjects received sufficient alcohol to raise their blood alcohol level to .07 mg %. Mood, assessed with the Profile of Mood States, did not differ across menstrual cycle phases at baseline, failing to support the notion of menstrual phase-related moods. The only mood changes were a Beverage by Trials interaction on the Vigor and Confusion scales and a main effect for trials on the Tension-Anxiety and Vigor scales. Peak intoxication level did not differ across phases. The present findings of an absence of menstrual cycle phase-related differences in mood or alcohol absorption support social learning theory and suggest that phasic variations in mood are socially learned. They also suggest the need for systematic study of methodologic factors in this research area.

Gender differences in the effects of ethanol on C57BL/6 mice

The influence of gender on the stimulatory and depressant effects of ethanol was examined in C57BL/6 (C57) mice. In Experiment 1, locomotor activity was assessed in young (2-month-old) male and female mice injected intraperitoneally (IP) with stimulatory (1.5 g/kg) or depressant (2.5 g/kg) doses of ethanol. Both the stimulatory and the depressive effects of ethanol were greater in young male than female C57 mice, and the gender difference was unrelated to blood ethanol concentration (BEC). In Experiment 2, older (9-month-old) male and female mice were given ethanol (2.5 g/kg) either by IP injection or gavage to determine if the gender differences in BEC and ethanol effects observed in the first experiment depended upon the route of ethanol administration. In this experiment, ethanol reduced locomotor activity more in males than females whether given by gavage or IP injection, and the males had higher BECs than females at the time of testing. Thus, the differences in the behavioral effects of ethanol appeared to be related to BEC. The greater depressive effect of ethanol on older male mice in this experiment is consistent with an earlier report of prolonged ethanol-hypnosis in older male C57 mice. Therefore, differences in BEC could account for the gender differences in the behavioral effects of ethanol on older but not young mice. The gender difference in BEC of mice obtained in the present and earlier reports is opposite to that reported for humans.(ABSTRACT TRUNCATED AT 250 WORDS)

Personality, alcohol consumption, and menstrual distress in young women

There has been a longstanding hypothesis that some women develop alcohol dependence as a result of drinking to alleviate premenstrual dysphoria. This study investigated the relationship between personality factors, alcohol consumption, and menstrual distress symptoms in nonalcoholic drinking young women. Normally menstruating women monitored their alcohol intake and physical and affective distress symptoms daily for two consecutive menstrual cycles. Subjects were unaware that their menstrual cycles and symptoms were being monitored. Subjects also completed the Minnesota Multiphasic Personality Inventory (MMPI), the Eysenck Personality Questionnaire (EPQ), Cattel's Sixteen Personality Factor Questionnaire (16PF), and the Vando Reducer-Augmenter Scale. The MMPI scales were factor analyzed to reduce the number of variables. Four derived MMPI factors were added to the VANDO, the three EPQ factors, and the four higher order factors of the 16PF to provide a total of twelve personality predictors. Separate regression analyses were carried out between personality factors and both alcohol consumption and menstrual distress. The results revealed that the women who drank more tended to be significantly more extroverted, spontaneous, carefree, and open to change. By contrast, women who reported greater over-all menstrual distress tended to be less capable, secure, and well-adjusted and reported a greater number of emotional and psychological problems. There was no correlation between alcohol consumption and menstrual distress. It was concluded that the results contradict the alcoholism-menstrual cycle hypothesis.

Personality traits and platelet monoamine oxidase activity in alcoholic women

Twenty-nine women, sent to an inpatient treatment facility for rehabilitation and social training after treatment for heavy alcohol abuse, were compared with 29 female students of pharmacy or medicine with regard to platelet monoamine oxidase (MAO) activity and extraversion-impulsivity and anxiety-proneness personality traits. The alcoholic females were found to have slightly lower platelet MAO activity than the controls, the difference being considerably smaller than that previously found between male alcoholics and male controls. The personality pattern of the female alcoholics is in line with that previously found in alcoholic males. Thus, the female alcoholics were characterized by high anxiety proneness, impulsive acting-out behaviour, sensation seeking, social withdrawal, and a hostile attitude.

Alcohol consumption and menstrual distress in women at higher and lower risk for alcoholism

This study investigated whether alcohol consumption varied as a function of menstrual cycle, menstrual distress symptomatology, and global stress in nonalcoholic drinking young women at higher and lower (HR, LR) risk for alcoholism as assessed by family history. Eighty-two normally menstruating women (52 LR and 30 HR) monitored their alcohol intake, physical and affective distress symptoms, and global stress level daily for two consecutive menstrual cycles. Subjects were unaware that their menstrual cycles were being monitored. The results confirmed the presence of increased physical distress symptomatology during the premenstrual and menstrual phases but did not show variation in negative affect or global stress throughout the menstrual cycle. High risk subjects were aware that they were at higher risk for alcoholism and consumed more alcohol. However, alcohol consumption was not related to the menstrual cycle, distress symptoms, or global stress. Subjects reported that they drank most frequently with others for pleasure enhancement and rarely for pain or tension-reduction. Subjects also drank more on weekends than weekdays. These findings argue against the menstrual cycle as etiological in the development of alcoholism. It would appear that social factors influence alcohol consumption in young nonalcoholic women.

Alcohol use and premenstrual symptoms in social drinkers

The relationship between premenstrual dysphoria and alcohol acquistion and use patterns was studied in 14 women over 35 days on a clinical research ward. A 7-day drug-free baseline was followed by 21 days of alcohol availability and a post-alcohol drug-free period of 7 days. Women could earn alcohol or 50 cents for 30 min of performance on a simple operant task. The Premenstrual Assessment Form (PAF) was administered during baseline and at the premenstruum. Menstrual cycle phase was associated with changes in alcohol use by 8 of the 14 women. Five women drank more during the premenstruum and scored higher on 12 of 18 PAF factors than women whose drinking remained the same (N = 6) or decreased (N = 3). Women who increased drinking had significantly higher PAF scores on impaired social functioning, hostility/anger and hysteroid features (P less than 0.05, 0.01). Women who drank less during the premenstruum reported more pain and physical discomfort, whereas women who drank about the same amount were relatively asymptomatic. PAF profiles reported at the premenstruum and baseline PAF profiles based on recall of the preceding three menstrual cycles were concordant in 13 of the 14 women (P less than 0.001-0.0001). These data suggest that women's perceptions of premenstrual symptomatology are stable through time.

Reasons for alcohol use by female heavy, moderate, and occasional social drinkers

Subjective and behavioral reasons for drinking alcohol were elicited from 26 female social drinkers for 3 points in time by means of standardized questionnaire items selected from the Alcohol Use Inventory and the Alcoholic Stages Index. The 26 women resided for 35 days on a clinical research unit and could consume alcohol on 21 days. On the first study day subjects recalled subjective and behavioral reasons for drinking for the 21 days immediately prior to admission to the study and the 21 days of greatest alcohol consumption during the previous year. On the day after the end of the alcohol acquisition phase of the study, subjects responded to questions about their reasons for alcohol consumption during 21 days on the research unit. Each subject was classified as a heavy, moderate, or occasional drinker on the basis of observed alcohol intake. The heavy, moderate, and occasional drinkers differed significantly in history of alcohol use, and differences in questionnaire response patterns were reported for all 3 time intervals. In contrast to moderate and occasional drinkers, heavy social drinkers had significantly elevated questionnaire item scores for the 21 days of heaviest alcohol consumption during the past year and for the 21 days immediately prior to the study. However, both heavy drinkers and occasional social drinkers had significantly elevated scores for the 21-day alcohol acquisition phase on the research unit. Scores for moderate social drinkers were similar for each of the 3-time intervals.

Alcohol, marijuana, and mood states in young women

Potential predictors of 8 Profile of Mood States (POMS) factor scores were examined for 30 young women (mean age = 26.4 years). Prospective data were obtained from diary questionnaires and POMS ratings submitted daily during 3 consecutive menstrual cycles. Behavioral and social variables (heavy versus light marijuana smoking, consumption of both marijuana and alcohol on a given day, stress, and sexual activity) were stronger mood factor predictors than temporal or biological variables (weekends or menstrual cycle phase). Heavy marijuana users consistently reported higher negative moods and lower positive moods than light marijuana users.

The influence of menstrual cycle changes on the tobacco withdrawal syndrome in women

Women have lower quit rates in smoking cessation than men. There are several factors suggested which are relevant to women's difficulties in smoking programs. One factor cited is the problem that women experience during withdrawal. Similar physiological and psychological symptoms are reported after smoking cessation and during menstrual cycle changes. In this study we evaluated the association between withdrawal and reports of menstrual distress. Results showed that a significant correlation existed between menstrual distress symptoms and initial smoking withdrawal symptoms. Women who quit smoking in the last phase (Phase 2) of their menstrual cycle experienced greater withdrawal than those who quit in the early phase (Phase 1) of the cycle. When these results were compared with male quitters, the Phase 2 women experienced significantly greater withdrawal than males. These results suggest that women may have specific biological needs that should be addressed in smoking treatment programs.

Alcohol use, marihuana smoking, and sexual activity in women

This report describes a prospective study of social drinking, marihuana smoking, and sexual activity by 26 healthy adult women (mean age 26.8 years). Each subject completed daily questionnaires for 3 consecutive menstrual cycles, and recorded menstrual cycle status, quantities and frequencies of alcohol consumption, marihuana smoking, and sexual activity. Consistent patterns of alcohol consumption, marihuana smoking, and sexual activity were reported across all 3 menstrual cycles. Heavy drinkers (mean greater than or equal to 1.80 drinks per day) were more likely to smoke marihuana than moderate drinkers (mean less than or equal to 1.75 drinks per day) and they also smoked significantly more marihuana (p less than 0.05). Neither age nor frequency of sexual activity were related to patterns of alcohol or marihuana consumption.

Ethanol metabolism and hepatotoxicity. Does sex make a difference?

The role of gender as a variable that might affect the metabolism of ethanol and thus the hepatotoxicity of ethanol is evaluated. First, the pharmacodynamics of ethanol are reviewed with particular attention to hormone effects on ethanol absorption and metabolism. Specific differences between males and females relative to ethanol pharmacokinetic parameters are discussed, including gender differences in the volume of distribution and putative hormonal effects on achieved blood alcohol levels. In addition, attention is directed toward the metabolic capacity of alcohol dehydrogenase and the microsomal ethanol-oxidizing system with respect to effects of both sex differences and hormonal manipulations on the activity of these ethanol-metabolizing enzymes. Finally, the studies on the concept of sex-related differences in susceptibility to alcohol hepatotoxicity are examined.

Acute alcohol intoxication: sex comparisons on pharmacokinetic and mood measures

This study explored sex differences in pharmacokinetic and mood state responses to acute alcohol intoxication among socially drinking women demonstrated to be normally cycling across two consecutive menstrual cycles and men with similar drinking habits. Subjects were administered moderate or high alcohol doses in six experimental sessions over a 60-day period. Women were tested during the early follicular, ovulatory, and midluteal phases of the cycle, and men were administered alcohol at comparable time intervals. Results showed that men did not differ in alcohol pharmacokinetics across sessions, but women showed significantly shorter elimination times and faster disappearance rates during the midluteal phase of the menstrual cycle compared to the early follicular and ovulatory phases and to their male counterparts. There were no sex or within-group differences in self-reported negative mood states prior to alcohol administration, but women described increased anxiety and depression while intoxicated during the early follicular compared to ovulatory and midluteal phases. Affective responses to intoxication were a complex function of sex, limb of the blood alcohol concentration-time curve, and dose.

Alcohol use across the menstrual cycle among marihuana users

Thirty women completed alcohol, marihuana, and tobacco use diaries and Form T of the Moos Menstrual Distress Questionnaire (MDQ) every day for three consecutive menstrual cycles. A 99.0% response rate was obtained: 2750 of a possible 2778 diaries were returned. Women reported drinking an average of 1.2 (+/- 1.9) alcoholic drinks per day (range for individuals: 2.7 [+/- 1.7] to 0.2 [+/- 0.5]). Frequency of alcohol use was unrelated to menstrual cycle phase. Seven of the 8 MDQ factors were significantly (p less than 0.04 to p less than 0.001) but weakly related to alcohol use: distress and alcohol use were positively related. There was a significant relationship between tobacco and alcohol use in 11 subjects who smoked at least half a pack of tobacco cigarettes per day but not in 10 occasional smokers. Further, heavier drinkers were considerably more likely to smoke tobacco than were more moderate drinkers. These data indicate that in the absence of severe premenstrual distress, menstrual cycle phase is not a good predictor of alcohol use among female social drinkers.

Depression and alcohol consumption in non alcoholic and alcoholic women. A clinical study

The relationship between level of depression and alcohol consumption was studied in 64 alcoholic women, 80 non alcoholic female psychiatric patients and 72 healthy women, using a clinical, semistructured interview, SADS, SSP and HSCL-58. Among DSM-III depressive women, the alcohol consumption was bimodally distributed. Among healthy women, there was an inverse relationship between depressive symptoms and alcohol consumption. Among non alcoholic women dysthymic patients consumed significantly more than major depressive, subclinically depressed and psychotic non depressive patients, and significantly less than healthy, non depressive women. Among alcoholic women, there was no difference in consumption between major depressives, dysthymics and the other diagnostic groups. The results show that there was no general dose-response relationship between level of depression and alcohol consumption. Anxiety level and personality disorder may be more influential on the alcohol consumption than the level of depression among depressive women.

Acute alcohol intoxication in women: relationship to dose and menstrual cycle phase

This study investigated relationships between metabolic responses to acute alcohol intoxication and phases of the female menstrual cycle among women demonstrated to have ovulated during two consecutive cycles. Subjects were administered moderate (0.66 ml/kg) and high (1.0 ml/kg) alcohol doses during the early follicular, ovulatory, and midluteal phases of the menstrual cycles. Radioimmunoassays (RIAs) of serum estradiol, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels were performed from blood collected before each alcohol administration. Results showed decreased elimination times, reduced areas under the BAC-time curve (AUCs), and faster disappearance rates associated with the midluteal menstrual phase compared to the early follicular and ovulatory phases which were consistent for both moderate and high alcohol doses. Decreased elimination times, smaller AUCs, and faster disappearance rates were associated with increased levels of progesterone, elevated progesterone to estradiol ratios, and decreased FSH levels. No differences were found in absorption time or peak BAC across phases of the menstrual cycle.

Cigarette smoking by women: interactions with alcohol use

Cigarette smoking increased during alcohol self-administration in comparison to an alcohol-free baseline in 24 women given access to alcohol for 21 days. Heavy smokers (25 or more cigarettes per day) increased smoking significantly during drinking (P less than 0.05). Analysis of tobacco smoking by level of alcohol consumption showed that both heavy and moderate alcohol users increased smoking significantly during alcohol availability (P less than 0.05, 0.01). The heavy and moderate smokers smoked significantly more between noon and midnight (P less than 0.001) than at other times when alcohol was available. The rate of cigarette smoking (defined by inter-cigarette intervals) was faster during alcohol self-administration than during the alcohol-free baseline. Heavy smokers smoked most cigarettes at intervals of 11-20 min during heavy or moderate drinking. During the pre-alcohol baseline, these women smoked most cigarettes at intervals of 21-30 or 31-40 min. Most women (70-74%) also increased tobacco smoking at the premenstruum. Both heavy and occasional smokers increased smoking at the premenstruum significantly more than the moderate smokers (P less than 0.05). All women reported increased psychological discomfort at the premenstruum on the Premenstrual Assessment Form (PAF) but reports of physical discomfort were more marked in women who smoked less at the premenstruum. These data extend previous findings in men that alcohol consumption is associated with increased cigarette smoking to female social drinkers.

Marihuana use across the menstrual cycle

Thirty women completed marihuana use diaries and Form T of the Moos Menstrual Distress Questionnaire (MDQ) every day for three consecutive menstrual cycles. A 99.1% response rate was obtained: 2715 of a possible 2741 diaries were returned. Women reported smoking an average of 1.4 (+/- 2.0) marihuana cigarettes per day (range for individuals: 7.3 [+/- 3.8] to 0.2 [+/- 0.4]). There was no significant covariance between daily marihuana smoking and menstrual cycle phase. The psychological MDQ factors reflecting negative affect, difficulty in concentration, behavior change and arousal also did not vary with menstrual cycle phase. The physiological MDQ factors of pain, autonomic reactions and water retention were significantly increased during the premenstrual and/or menstrual phases of the cycle. MDQ scores during the premenstruum and menstruation were generally very low. These data indicate that in the absence of severe premenstrual dysphoria, changes in drug use are not systematically related to phase of the menstrual cycle.

Cyclic fluctuation in alcohol consumption among female social drinkers

The main objective of this study was to investigate the relationship between menstrual cycle phase and alcohol use in female social drinkers. Sixty-nine normally menstruating women monitored alcohol consumption and basal body temperature daily over three consecutive menstrual cycles. Temperature charts were used to ascertain five cycle phases (menstrual, postmenstrual, ovulatory, luteal, and premenstrual) and data were analyzed using single-group repeated measures analysis of variance. Whereas frequency of alcohol use did not vary among the five cycle phases, quantity of alcohol consumed significantly fluctuated and peaked in the luteal phase. These data suggest that female drinking patterns may be influenced by hormonal fluctuations associated with the menstrual cycle.