How Hormones May Influence Addiction in Women
Dr. Anna Konova, Associate Professor of Psychiatry at Rutgers Robert Wood Johnson Medical School, and co-Director of the Center for Computational Cognitive Neuropsychiatry (CCNP) in BHI, leads the Addiction & Decision Neuroscience Laboratory. A cognitive neuroscientist by training, Dr. Konova has built a research program focused on the computational and neural basis of motivation, decision-making, and addiction. Her lab uses advanced neuroimaging, computational modeling, and real-world behavioral assessments to identify risk and resilience factors in addiction escalation, recovery, and treatment.
Francesca LoFaro, a PhD student in Dr. Konova’s lab is leading a novel project studying addictive behaviors in women during the menstrual cycle. Women with opioid use disorder (OUD) often face higher relapse rates and poorer treatment retention than men. Yet the biological reasons for this disparity — particularly the powerful role of fluctuating ovarian hormones — have been largely overlooked in treatment approaches. Francesca’s project investigates how natural rises and falls in hormones like estradiol and progesterone act as time-varying signals that influence dopamine signaling, reward sensitivity, craving, and opioid reuse risk in naturally cycling women receiving medications for OUD (MOUD).
Using a high-precision, within-person design, the study follows women across their full menstrual cycle. It combines regular hormone measurements (estradiol, progesterone, and cortisol), daily smartphone-based experience sampling of real-life cravings and behaviors, and dense-sampling (“precision”) fMRI brain imaging with a computational task that measures dopamine-mediated decision-making behaviors.
The central idea is that hormones act like a “biological switch,” creating windows of higher or lower vulnerability: higher estradiol levels may increase reward sensitivity, craving, and risk of opioid reuse, while higher progesterone levels may offer protection by improving self-control and buffering stress. Early pilot data support this hypothesis: within-person increases in estradiol are linked to heightened opioid craving/vulnerability and stronger reward-related signals in the striatum, while progesterone-dominant periods appear to buffer these effects through better self-regulation and stress management.
Francesca shares the personal impact of the work: “It has been eye-opening to have this project where I am solely collecting data from other women, hearing their stories and relationships with their drug use. We are seeing research on the female brain rapidly advancing, demonstrating estradiol and progesterone as powerful neuromodulators, and that’s clinically meaningful. If our research could play a role for women, raising treatment retention, dropping relapse rates, that would change a lot of women’s lives.”
Traditional neuroscience and addiction studies have rarely accounted for the dramatic hormonal fluctuations women experience. By mapping exactly how hormones influence brain decision-making processes in real time, this project aims to identify precise “windows of risk or resilience” for each woman and lay the foundation for cycle-aware, personalized treatments that are timed to a woman’s biology (e.g., adjusting therapy, medication support, or behavioral strategies at vulnerable times). This represents an important step toward more effective, sex-specific care for women with opioid use disorder.
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