Quitting Smoking: It’s Harder for Women

Anyone who has ever tried to quit smoking knows that it’s much more difficult than simply tossing the last pack of cigarettes in the trash.

Now, an increasing body of research shows what’s been known for some time—that it’s harder for women to stop smoking than it is for men. Plus, female smokers have a higher risk for heart attack, stroke, lung cancer, and other health complications compared to male smokers.

The reasons why female smokers find it harder to quit and face more health risks aren’t entirely known, but researchers believe biological factors, including hormones, contribute. One thing that is known is that cigarette smoking is the leading cause of both preventable disease and death in the United States, killing more than 480,000 adults a year, according to the Centers for Disease Control and Prevention (CDC).

While more men smoke than women, according to the CDC, the difference is relatively small: 10.1% of women 18 and older have reported cigarette use “every day” or “some days” and say they have smoked at least 100 cigarettes during their lifetime. For men, that figure is 13.1%.

Even if it’s harder for women to quit, they should still try, and perseverance is what makes it happen, says Sherry McKee, PhD, a Yale School of Medicine researcher who investigates the impact of smoking on women and the most effective treatments to help them quit.

“Often, women try several times before they're successful. But smoking is one of the most important things you can do to improve your health, so it’s important to keep trying—and there is support for that,” McKee says.

Here are three key points women should know if they want to quit smoking:

There is an entire body of research going back at least 40 years showing that it’s harder for women to quit smoking, McKee says. One study, published in the journal Addictive Behaviors in 2022, shed new light on the reasons by showing that the first day of quitting is more challenging for women than for men. The first day of an attempt to quit smoking is also considered to be a critical predictor of long-term success, McKee says.

There are a variety of explanations for this, including that men tend to smoke to satisfy nicotine cravings, whereas women smoke more to manage negative moods.

Another reason is that women are more likely to smoke as a way to control their weight, and many women who quit will start smoking again at the first sign that the scale is inching upward, McKee says. “The reality is that men and women gain about five pounds, on average, during a quit attempt,” she says. “Balance the five-pound weight gain against the significant consequences to your health from smoking, and quitting may be a pretty clear decision.”

Estrogen levels, which fluctuate in menstruating women, can also make breaking the cigarette habit more challenging, McKee says. For example, although more research is needed, there's strong evidence suggesting that higher estrogen levels make addictive substances, such as nicotine, more rewarding.

Medication is considered a key part of quitting smoking—most people who quit without medicine experience more difficult cravings and withdrawal, according to the CDC. But the type of medication women take matters because not all the drugs approved by the Food and Drug Administration (FDA) for smoking cessation work as well for them as they do for men.

For example, this is true with nicotine-replacement therapies (NRTs) in the form of transdermal nicotine (patches worn on the skin), gum, lozenges, oral inhalers, and nasal sprays. Experts don’t know why NRT is less effective for women—one theory is that women metabolize nicotine faster than men, McKee says. Also, neuroimaging studies have shown that nicotine receptors in the brain function differently in men and women, impacting the effectiveness of NRTs, she adds.

Likewise, the antidepressant prescription pill bupropion (Wellbutrin®) has been shown to work better for men than for women as an aid for smoking cessation. Wellbutrin is believed to block nicotine receptors and raise levels of brain chemicals, such as dopamine and norepinephrine.

For these reasons, the first-line medication for women, McKee says, should be varenicline (Chantix®), a prescription pill that works by attaching to the same receptors that are stimulated by nicotine. When a person takes varenicline, it becomes harder for nicotine from a cigarette to find and attach to these receptors.

Varenicline, McKee says, has a quit rate of 53% in women after three months—similar to men.

A Yale study published in the journal Nicotine and Tobacco Research compared varenicline, bupropion, and transdermal nicotine, and showed all three to be similarly effective for men trying to quit smoking. “For women, varenicline was the only effective medication,” McKee says, adding that the reasons for this are unclear.

Even varenicline doesn’t work for all women, but in those cases, these behavioral approaches, McKee says, may help:

• Get rid of all cigarettes and smoking paraphernalia.
• Limit coffee and alcoholic beverages, which can increase nicotine cravings.
• Don’t give up if you gain a few pounds; the weight gain often stabilizes.
• Surround yourself with people who are supportive.
• Take time to think about triggers. For instance, some women are sensitive to negative emotions and reminders of smoking, including seeing or smelling a cigarette.

“Part of it is understanding why you smoke,” says McKee. “What are your high-risk situations? If you are part of a workgroup and they are all going out for a smoke break, how are you going to handle that situation? Are you going to feel socially isolated because you're not hanging around with those people anymore?” It can help to think about situations like that ahead of time, she says.

Women may appreciate knowing they don’t have to do it alone, McKee says. “It’s a chronic, relapsing behavior,” she says. “Because it often takes several tries before you're successful, don’t get discouraged. It can be done. It’s never too late—and you’ll almost always improve your health.”

More tips for anyone who wants to quit smoking are available at Smokefree.gov. Most health insurance plans cover FDA-approved smoking-cessation medicines, including over-the-counter medicines. If you have questions or don’t have health insurance, call 1-800-QUIT-NOW.