Quitting smoking may not be easy, but it’s one of the best health decisions women who smoke can make. Doctors, smoking-cessation programs and medications can set you on the path to a cigarette-free life. Read on for advice from a Yale doctor about how to overcome your fears of quitting and what happens when you stop smoking...
For many women who smoke, quitting is like climbing Mt. Everest without oxygen. It takes about as much planning and fortitude as the high-mountain summit, experts say.
And as with mountain climbing, quitting smoking often requires several attempts before you reach your goal of a cigarette-free life.
For the 18% of American women who smoke, there is help. Counseling, medications, exercise, relaxation and social support can help you overcome the urge to light up.
Andrea Weinberger, Ph.D., assistant professor of psychiatry at Yale University School of Medicine, is an expert in strategies to quit cigarettes, even when prior attempts have failed. She focuses on women and depressed smokers.
Here, Weinberger discusses why women smoke, what happens when
you quit smoking and how to go about it.
Women who smoke know it’s bad for them – so why do they keep doing it?
Smokers have cravings for a cigarette one hour after smoking one. Anxiety, depression, irritability, nervousness, difficulty concentrating and increased appetite come on within a few hours of smoking.
More than men, women who smoke start in order to cope with stress and depression. Weight control also is a reason: Nicotine is a stimulant that suppresses appetite.
A person’s social network plays a role: If a woman’s friends and family smoke, she may too.
And some people just enjoy smoking – the ritual of the last cigarette of the day, the process of lighting one up and smelling the smoke. Quitting smoking represents a loss of that.
People say it’s very difficult to quit. It takes most smokers several attempts.
Are women who smoke more susceptible than men to the effects of nicotine?
No, but women have a tougher time quitting smoking than men do. Researchers are looking at the reasons. One may be depression.
Women experience depression at a higher rate than men, and for them there’s a stronger relationship between depression and smoking.
Women are more concerned about how they’ll manage stress and
depression when they quit.
Which smoking health risks are specific to women?
Women face a higher risk of lung cancer and coronary heart disease.
Smoking is harmful to all areas of reproductive health. It can affect fertility and the menstrual cycle and delay conception. Women who smoke face a higher risk of ectopic pregnancy (an abnormal pregnancy that occurs outside the uterus) than nonsmokers, [as well as] spontaneous abortion, preterm delivery, low birth weight for babies and perinatal (the period just before and after birth) fatalities.
Women who smoke have a shorter reproductive life span and face a higher risk of cervical cancer than nonsmokers.
The surgeon general says that post-menopausal women who smoke experience lower bone density and are at increased risk for hip fracture compared to nonsmoking women.
What reasons do women usually give for quitting smoking?
Mainly, their health: They want to live longer and see their kids grow up. Women often say they want to avoid cancer and other diseases.
Some are concerned about short-term health problems – getting winded when climbing stairs, playing with their kids or having a smoker’s cough.
Sometimes a spouse or children encourage women who smoke to quit. They also don’t want their kids to model their behavior, and breathe
secondhand smoke. Women also mention financial reasons. The cost of cigarettes keeps going up.
What concerns women the most about quitting smoking?
Women who smoke worry about managing cigarette cravings. The first 48 hours after quitting are the worst, but it gets better after a week or so. Women who’ve quit before know that even after the nicotine urges are gone, however, psychological cravings continue.
Women also have concerns about weight gain. That plays a larger role in why women smoke and why they have more trouble quitting than men do.
Women who smoke are concerned they might relapse if they gain weight. Food helps quitting smokers cope with cravings.
Women who smoke need to know that only some smokers gain weight when they quit, and if so, they typically gain fewer than 10 pounds during the first year after quitting.
The [bad] health effects of gaining a few pounds can’t compare with those of smoking a pack of cigarettes a day.
Do certain psychiatric or psychological conditions make smoking cessation more difficult for women?
In general, people who suffer from depression smoke at higher rates and have a more difficult time quitting smoking.
That’s also true for bipolar disorder, schizophrenia, and alcohol and substance
abuse disorders. Smoking is their way to cope with stress. These smokers need more intensive treatments than other smokers.
How can women ease their smoking-cessation worries?
They have to learn new ways to deal with stress and depression. With counseling, they learn that smoking isn’t the only coping tool.
Women who smoke can plan ahead to deal with cravings. Medications help, which I’ll talk about shortly.
Also, drink plenty of water, have healthy snacks and mints available. Avoid places that set off cravings, like bars. At work, avoid spots outside your building where smokers hang out.
Do women experience depression when they quit cigarettes? If so, how can they overcome it?
If you have depression already, it will be worse when you quit smoking. It’s important to be monitored by a doctor, especially if you have a history of depression. If you notice an increase in depression symptoms, tell your doctor.
Which smoking-cessation strategies work best for women?
The Federal Food and Drug Administration (FDA) has approved seven nicotine-replacement treatments. Patches, gum and lozenges may be bought over the counter.
Nicotine inhalers and nasal sprays require prescriptions, as do the drugs Varenicline (sold in pill form as Chantix, it blocks the pleasant effects of nicotine on the brain) and Bupropion (an anti-depressant and smoking-
cessation medication, sold as Zyban or Wellbutrin).
Talk to a professional to find out which treatments work best for you. Research shows that men and women have the same outcomes using Varenicline, which works pretty well, but may have side effects [such as nausea]. It’s not for everyone.
Nicotine patches are among the most popular treatments. They provide a steady flow of nicotine. Nicotine gum is better for cravings.
Patches don’t work as well for women. Female smokers often need counseling along with medications.
Hormones may play a role in how women handle smoking cessation. Premenstrual symptoms add a difficult layer to quitting smoking.
I recommend women who smoke try to quit at the beginning of their menstrual cycle, before PMS starts.
How does counseling help women?
Counseling programs help prepare women for their quit day and handling cravings. I feel they’re very worthwhile.
Women also learn how to be around other smokers. They learn to keep their hands busy when they stop smoking, and that drinking lots of water helps avoid overeating.
Weight concerns often overwhelm women’s other concerns. I tell quitting smokers to avoid strict diets and restricting food intake. Programs teach
you to eat healthy snacks and healthy meals, and to exercise.
If you’ve tried quitting smoking a couple of times, it’s hard to be motivated. Remember that it’s a process – if one strategy doesn’t work, try another. But it’s such an important thing to do for your health.
How can women who smoke stay off cigarettes?
Once they’ve gone through the hard part and are doing well, they need to pay attention to what their smoking triggers are, especially those that occur less frequently.
The most common reason for a relapse is when a significant stress occurs – such as the loss of a relationship or job, death or illness in the family.
Remember that having a cigarette won’t help you cope with the situation. All the gains you’ve made – the physical and psychological improvements since you quit, how much money you’ve saved – will feel lost.
Some people who’ve gone awhile without smoking want a reward – just one cigarette – because they’re doing so well. Be very cautious about that!
If you talk to smokers and ask if they can handle just one cigarette, they’ll
say it’s not possible. You’ve awakened the brain again to nicotine.
Remember all the progress you made when you quit smoking. Don’t smoke again.
Any final thoughts about quitting smoking?
Women can do a lot to help themselves quit smoking. A social support network is very important, as is reminding yourself why you’re quitting. The more people in your support network, the better.
Where can women go for help?
Visit a doctor for programs and medications.
Call QuitLine (1-800-QUIT-NOW), which offers a lot of information. It has chapters in every state.
Smokefree Women, a smoking-cessation program for women.
Nicotine Anonymous offers a 12-step program.
For more information, visit our Smoking Cessation Health Center.
Are You Ready to Quit Smoking?
By now you should know that smoking increases your risk for heart disease, lung cancer, stroke and more. You know you should quit, but do you have a clear plan for overcoming your cravings? Find out if you're really ready to quit smoking once and for all.
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