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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.

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Fig. 1


  1. Throughout this manuscript, we refer to biological sex (female) versus the socially constructed term gender (women). We use sex (versus gender) as participants in the reviewed studies were biologically female with a menstrual cycle. Since individuals who are biologically female do not always identify as women (gender), we believe it is more appropriate to use the term female (versus woman).


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At the time of conducting this review, K.M.J.’s graduate studies were supported by a Nova Scotia Graduate Scholarship, a Scotia Scholar Award from the Nova Scotia Health Research Foundation (NSHRF), a Joseph Armand Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council of Canada (SSHRC), a University of Manitoba Graduate Fellowship, and a Master’s Studentship Award from Research Manitoba in partnership with the Children's Hospital Research Institute of Manitoba. K.G.’s research was supported by the Canadian Institutes of Health Research (CIHR) and the NSHRF. P.T. was supported by a Dr. Paul Janssen Chair in Psychotic Disorders, and S.H.S by a CIHR Tier 1 Canada Research Chair in Addictions and Mental Health at Dalhousie University.

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Correspondence to Kayla M. Joyce.

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Online Resource 1

Caption Search criteria used for literature searches within PsycINFO, CIHAHL, and PubMed databases (DOCX 14 kb)

Online Resource 2

Caption Characteristics of studies excluded at the full-text review stage (DOCX 14 kb)

Online Resource 3

Caption List of references excluded at the full-text screening state as reported in online resource 2 (DOCX 14 kb)

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Joyce, K.M., Good, K.P., Tibbo, P. et al. Addictive behaviors across the menstrual cycle: a systematic review. Arch Womens Ment Health 24, 529–542 (2021).

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  • Addictive behaviors
  • Substance use
  • Behavioral addiction
  • Motivation
  • Menstrual cycle
  • Females