While overall more men than women smoke cigarettes, women and girls take less time to become dependent after initial use and have more difficulties quitting the habit. One of the factors contributing to these differences may be that women crave cigarettes more than men and that their desire to smoke is influenced by hormonal fluctuations across the menstrual cycle. Therefore, the purpose of the present study was twofold: (a) to examine potential sex/gender differences in functional neuroanatomy of craving and to (b) delineate neural correlates of cigarette cravings in women across their menstrual cycle. Fifteen tobacco-smoking men and 19 women underwent a functional MRI during presentation of neutral and smoking-related images, known to elicit craving. Women were tested twice: once during early follicular phase and once during midluteal phase of their menstrual cycle. The analysis did not reveal any significant sex differences in the cerebral activations associated with craving. Nevertheless, the pattern of activations in women varied across their menstrual cycle with significant activations in parts of the frontal, temporal, and parietal lobe, during follicular phase, and only limited activations in the right hippocampus during the luteal phase. 1. Introduction Although the number of smokers is gradually decreasing in the Western world, the decline has been less pronounced in women than in men [1, 2]. In fact, international and local epidemiological reports from the World Health Organization and the Quebec (Canada) Statistics Institute suggest that cigarette smoking is on the rise in young women and teen girls [3, 4]. Among adults still more men than women smoke, but women take less time to become dependent after initial use, report shorter and less frequent abstinence periods, smoke for longer periods of time in their lives, and have more difficulties quitting the habit, than men [5–7]. The reasons for these sex/gender differences remain unclear, but one of the contributing factors may be that women crave cigarettes with greater intensity than men do. For example, Field and Duka [8] showed that cigarette craving was increased in the presence of smoking cues in women but not in men. Regardless of sex differences, several functional imaging studies have been performed on cigarette cue reactivity. Recently, a meta-analysis of 11 functional imaging studies has shown that cigarette cues evoke activations in the anterior extended visual system, precuneus, anterior and posterior cingulate gyri, medial and dorsal prefrontal cortex, and insula and dorsal
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