Women are as willing as men to quit smoking; however, their motivation patterns differ, and they are more likely to seek help through smoking cessation consultations. Evidence from the literature and clinical studies also suggests that women often have greater difficulty quitting. They are more frequently victims of tobacco industry marketing and may be more vulnerable to socioeconomic pressures, as well as to using tobacco to cope with negative emotions.

Behavioral aspects of smoking also play a stronger role in maintaining tobacco use among women. The physical gestures of smoking and the smell associated with tobacco can reinforce this habit. Additionally, women often use smoking to control body weight. Together, these factors contribute to lower rates of cessation success.

“Some studies estimate that women have up to a 30% higher risk of failing smoking cessation attempts compared to their male counterparts,” said Gérard Peiffer, MD, pulmonologist and tobacco specialist at the Department of Respiratory Disease, Metz-Thionville Regional Hospital, Metz, France. He presented these findings at the French-Language Pneumology Congress, which was held from January 30 to February 1, 2026, in Lille, France.

These differences highlight the need to tailor smoking cessation strategies to individual women, including pharmacologic therapy, nonpharmacologic support, and consideration of life stages, such as pregnancy, menopause, or gender transition.

Psychosocial and Biological Differences

Important biological differences between men and women also influence smoking behavior and smoking cessation outcomes.

Women metabolize nicotine more rapidly than men, a factor that should be considered when prescribing nicotine replacement therapy. “Clinicians often worry about overdosing female patients, but biological measurements frequently show that they are actually underdosed,” said Jean Perriot, MD, pulmonologist, and addiction specialist at the Émile Roux Dispensary in Clermont-Ferrand, France.

Hormonal variations also play a key role. Smoking urges appear to peak during periods of high estradiol levels and decline during periods of peak progesterone levels. “During menopause, the intensity of craving — the strong urge to smoke — tends to decrease in women and becomes similar to that observed in men older than 60 years,” Peiffer said.

Sex-Specific Management

Considering sex-based biological differences may improve the success of smoking cessation interventions.

Evidence suggests several sex-related differences in treatment response.

• Nicotine metabolism is higher in women, which may require higher doses of nicotine replacement therapy.
• Varenicline is associated with more adverse effects in women.
• Bupropion appears to be less effective in women.
• Cognitive behavioral therapy may be slightly more effective in women.
• Women are more likely to use complementary approaches such as meditation, yoga, or hypnosis.
• During smoking cessation, women more often experience increased appetite for high-fat and high-sugar foods and tend to gain more weight, which can increase the risk for relapse.

Toward Sex-Specific Smoking Cessation Care

These findings support the need for gender-specific approaches to smoking cessation. In addition to pharmacologic treatment, which is often underdosed or insufficiently intensive, clinicians should address stress and trauma related to smoking.

Initiating cessation during the follicular phase of the menstrual cycle may be preferable for menopausal women to address menopausal symptoms simultaneously.

Inequities related to tobacco exposure extend beyond smoking. Women are more frequently exposed to secondhand smoke and experience higher rates of tobacco-related diseases than men do.

This story was translated from Univadis France, part of the Medscape Professional Network.