Brenda McAllister Quit Smoking During Menopause: The Double Whammy Nobody Talks About

Brenda McAllister is 57 years old and lives in Nashville, Tennessee. She spent 33 years as an elementary school librarian and retired two years ago. She’s been married to her husband, Glen, for 31 years. She has two grown sons, a golden retriever named Biscuit, and until 14 months ago, a 35-year smoking habit.

Brenda also happens to be going through menopause. And she wants to talk about what it’s like to quit smoking while your body is already in revolt.

“Nobody talks about this combination,” Brenda says. “There are articles about quitting smoking. There are articles about menopause. But almost nothing about doing both at the same time. And a lot of women my age are in exactly this situation. You’re 50-something, you’ve been smoking for decades, you know you need to quit, but your body is already going through this massive hormonal shift and you’re supposed to add nicotine withdrawal on top of it? It’s a lot. I’m going to be real honest about how much of a lot it was.”

The Overlap

Brenda started perimenopause at 52. By 55, she was in full menopause. Her symptoms included hot flashes (multiple times daily), night sweats, insomnia, mood swings, brain fog, and weight gain. Standard menopause roster.

She was also smoking about a pack a day of Virginia Slims, a habit she’d picked up at 22 when she was in college. Thirty-five years of daily smoking.

Here’s what Brenda didn’t realize until she talked to her gynecologist, Dr. Anand: smoking makes menopause symptoms worse. Nicotine affects estrogen levels. Women who smoke tend to enter menopause earlier and experience more severe symptoms, particularly hot flashes. Studies have shown that smokers have significantly more frequent and more intense hot flashes than non-smokers.

“Dr. Anand told me that quitting smoking could actually reduce my hot flashes,” Brenda says. “I was skeptical. I’d been having hot flashes for three years at that point and they were brutal. The idea that stopping cigarettes could help seemed too convenient. But she showed me research. Smoking increases the frequency of hot flashes by messing with your thermoregulatory system. Your body is already struggling to regulate temperature during menopause, and nicotine makes it worse.”

This information was part of what motivated Brenda to quit. Not the whole motivation, but a real piece of it. The other pieces were her grandchildren (her older son had a baby on the way), her doctor’s warnings about osteoporosis risk (smoking plus menopause is particularly bad for bone density), and the simple fact that she was retired now and wanted to enjoy the years ahead.

The Plan: Patches Plus Bupropion

Brenda’s primary care doctor, Dr. Hartley, set up a dual approach. Nicotine patches for the physical dependency, and a low-dose prescription of bupropion (brand name Wellbutrin or Zyban) for the psychological and neurological aspects of quitting.

Bupropion is an antidepressant that’s also FDA-approved for smoking cessation. It works on dopamine and norepinephrine pathways in the brain, reducing cravings and blunting the reward response that smoking triggers. For Brenda, there was an additional benefit: bupropion can help with mood stabilization, which is relevant when you’re dealing with menopause-related mood swings.

“Dr. Hartley said the bupropion would help with two things at once,” Brenda explains. “The quit-smoking cravings and the emotional roller coaster of menopause. She said it’s not a magic bullet but it can take the edge off both. I was willing to try anything that could take any edge off anything at that point.”

Brenda started bupropion two weeks before her quit date, which is standard protocol. The medication needs time to build up in your system before it’s effective. She took 150mg once daily for three days, then increased to 150mg twice daily.

On her quit date, she applied her first NicoDerm CQ 21mg patch and stopped smoking.

“Starting the bupropion before the patches was smart,” Brenda says. “By the time I put the first patch on, the medication was already working. I could feel a slight difference in my mood. Not dramatic, but a subtle steadiness. Like the emotional seas had calmed down from a storm to just choppy waves.”

NicoDerm CQ 21mg patches ran about $42 for a 14-count box. The bupropion was covered by her insurance with a $15 copay for a 30-day supply.

Week One: Sorting Out Which Symptom Belongs to What

The first week of Brenda’s quit was a confusing mess of overlapping symptoms. Nicotine withdrawal and menopause share several symptoms, and Brenda couldn’t always tell which was which.

Hot flashes vs. nicotine withdrawal sweating. “I was having hot flashes four to five times a day before I quit. The first week without cigarettes, I was sweating even more. But was that extra sweating from withdrawal or were my hot flashes getting worse? I couldn’t tell. My thermostat was completely broken.”

Menopause insomnia vs. nicotine withdrawal insomnia. Brenda was already sleeping poorly because of menopause. Night sweats would wake her up at 2 AM. Add nicotine withdrawal to the mix, and her sleep was destroyed. “I was getting maybe three or four hours a night that first week. Broken sleep. I’d fall asleep at 10, wake up at midnight drenched in sweat, lie there until 2, fall back asleep, wake up at 4 with a craving. It was miserable.”

Mood swings on top of mood swings. Menopause had already made Brenda’s emotions unpredictable. She’d cry at commercials. She’d get angry at minor inconveniences. Nicotine withdrawal amplified all of it. “Glen walked on eggshells that first week. He couldn’t say anything right. I yelled at him for chewing too loudly. I cried because we were out of coffee filters. I was not a fun person to be around.”

Brain fog squared. Both menopause and nicotine withdrawal cause cognitive difficulties. Concentration problems, forgetfulness, difficulty with word finding. Brenda experienced both simultaneously. “I lost my keys four times in one week. I forgot a dentist appointment. I walked into rooms and forgot why I was there. I’d been blaming menopause for my brain fog, but quitting smoking made it twice as bad. I couldn’t complete a thought.”

The bupropion helped moderate some of these symptoms, particularly the mood swings. Brenda says that without it, she doesn’t think she could have managed the emotional chaos.

“The bupropion was the floor under my mood,” she says. “It didn’t eliminate the swings, but it raised the floor. On bupropion, my lowest lows weren’t as low. I’d still get irritable and teary, but I wasn’t falling into the pit. Before the medication, menopause alone was putting me in dark places. Adding nicotine withdrawal without the medication would have been dangerous for my mental health.”

The Hot Flash Situation

Let’s talk about hot flashes in detail, because this is the symptom that made Brenda’s quit uniquely challenging.

A hot flash feels like someone turned on a furnace inside your chest. Your skin flushes, your heart rate increases, and you sweat profusely. They can last anywhere from 30 seconds to five minutes. They can happen at any time, day or night, with no warning.

Brenda was having about five hot flashes a day and two or three at night before she quit smoking. During the first two weeks of her quit, the frequency increased to seven or eight during the day and three or four at night.

“I went through shirts,” Brenda says. “I’d be sitting on the couch watching TV and suddenly I’m drenched. My face is red, I’m fanning myself, and sweat is literally dripping off me. Glen bought me a handheld fan and I carried it everywhere. In my purse, on the nightstand, in the kitchen. I was never without that fan.”

The increase in hot flashes during early smoking cessation is documented. When you remove nicotine, your body undergoes a vasomotor adjustment. Blood vessels that nicotine was constricting begin to dilate. This vascular change, combined with the hormonal instability of menopause, can temporarily worsen hot flashes.

“My gynecologist told me this was expected and temporary,” Brenda says. “She said it would get worse before it got better. That was hard to hear during week two when I was soaking through my nightgown every single night. But she was right. By week four or five, the hot flashes started decreasing. And by week eight, I was having fewer hot flashes than before I quit. The research was right. Quitting eventually helped.”

What Brenda Did About the Hot Flashes

Since Brenda couldn’t take hormone replacement therapy (HRT) due to a family history of breast cancer, she managed hot flashes through other methods:

Layered clothing. “I wore layers so I could strip down fast when a flash hit. A tank top under a cardigan. Never a pullover, because you can’t get a pullover off fast enough when you’re on fire.”

Cold water. She kept a large insulated water bottle filled with ice water with her at all times. Drinking cold water during a hot flash helped reduce the intensity. She also kept cold washcloths in the freezer and would drape one around her neck.

Temperature control. Glen tolerated a thermostat set to 65 degrees. They got a ceiling fan for the bedroom. Brenda slept with a cooling pillow.

Evening primrose oil. Dr. Anand suggested evening primrose oil supplements as a natural option for hot flash management. Brenda took 1,000mg daily. “I can’t say for certain it helped, but I felt like the flashes were less intense after I started taking it. Could be placebo. I don’t care. If the placebo works, it works.”

Exercise. Brenda started walking every morning, 30 to 45 minutes. Research suggests that regular exercise can reduce hot flash frequency and severity. It also helped with the nicotine cravings. “Walking was a two-for-one. It helped with hot flashes and it helped with cravings. When I felt antsy, I’d grab Biscuit’s leash and go. By the time we got back, the craving had passed and I’d gotten my exercise in.”

The Weight Conversation

Brenda gained 14 pounds during her quit. This is a touchy subject for her because she’d already gained weight during menopause. The additional weight from quitting smoking felt like insult on top of injury.

“I’ve gained about 25 pounds total since menopause started,” Brenda says. “Fourteen of those were during the first three months of quitting smoking. My metabolism was already slowing down from the hormonal changes, and then I removed nicotine, which was suppressing my appetite and boosting my metabolism slightly. It was a double metabolic hit.”

She worked with Dr. Anand on a plan that prioritized quitting smoking over weight management. “Both doctors told me the same thing: don’t try to diet while quitting. The nicotine withdrawal cravings and the hunger cravings will blend together and you’ll fail at both. Quit first, then address the weight.”

Brenda has since lost about six pounds through walking and making dietary adjustments. She’s not in a rush. “I’d rather be 57 and overweight and not smoking than 57 and thinner and still smoking. The weight is something I can work on. Lung cancer isn’t.”

Glen’s Role

Glen McAllister, Brenda’s husband, deserves a mention in this story. Brenda says he was patient, present, and practical in ways that made a real difference.

“Glen is not a talker,” Brenda says. “He’s not going to sit down and have a deep conversation about feelings. But he shows up. During that first month, he showed up in small ways every day. He’d refill my ice water without me asking. He’d take Biscuit out so I could rest. He’d rub my back when I was having a hot flash at 3 AM. He didn’t complain about the thermostat. He didn’t complain about my mood. He just held steady.”

Glen also quit drinking beer in the house for the first month, even though Brenda’s primary trigger wasn’t alcohol. “He said, ‘If you’re giving something up, I can give something up too.’ That’s the kind of man he is.”

There was one rough night during week three when Brenda and Glen had a real fight. She was irritable, he said the wrong thing, and it escalated.

“I told him he didn’t understand what I was going through,” Brenda says. “He said, ‘You’re right, I don’t, but I’m here anyway.’ And that snapped me out of it. I sat down and cried. He sat next to me and didn’t say anything else. Sometimes that’s exactly the right thing.”

The Bupropion Experience

Brenda stayed on bupropion for six months total, which is on the longer end but within the range her doctor recommended. Here’s her experience with the medication:

Side effects: Dry mouth was the main one. Brenda drank water constantly, which she was already doing for hot flashes, so it wasn’t a big additional burden. She also noticed decreased appetite, which partly offset the weight gain from quitting smoking. “The bupropion killed my appetite some days. I’d forget to eat lunch. That’s not necessarily healthy, but during a period where I was gaining weight rapidly, it was an unintended benefit.”

Mood impact: The mood stabilization was the most significant benefit. Brenda describes the effect as “turning down the volume on everything.” The highs weren’t as high, the lows weren’t as low, and the middle was more accessible. “I could function. I could be around people without biting their heads off. I could watch a sad commercial without sobbing for 10 minutes. It didn’t eliminate emotions, it moderated them.”

Craving reduction: Bupropion reduced the intensity of cigarette cravings independently of the nicotine patches. “The patches handled the nicotine, the bupropion handled the wanting. They’re different things. Nicotine is a chemical need. Wanting is a psychological pull. The bupropion made the wanting quieter.”

Coming off: Brenda tapered off bupropion under Dr. Hartley’s supervision over four weeks. She reduced from 300mg daily to 150mg for two weeks, then to 150mg every other day for two weeks, then stopped. She experienced mild return of mood swings during the taper, which she managed with the coping strategies she’d built.

“Coming off bupropion was its own thing,” Brenda says. “I was nervous because I was afraid the mood swings would come roaring back. They did increase, but they were manageable. By that point, I had six months of coping skills. I could handle it.”

The Patch Timeline

Brenda followed the standard NicoDerm CQ step-down program:

Weeks 1-6: 21mg patches
Weeks 7-8: 14mg patches
Weeks 9-10: 7mg patches

She had the bupropion running concurrently through all 10 weeks and for several months beyond.

“The step-downs were noticeable but not catastrophic,” Brenda says. “Going from 21 to 14 felt like someone turned up the background cravings slightly. Going from 14 to 7 was similar. Coming off entirely at week 10 was the hardest step, but by then the bupropion was still active, so I had a safety net.”

Total patch cost over 10 weeks: approximately $200 for NicoDerm CQ at retail. Bupropion cost: about $90 total in copays over six months.

What Brenda Wants Menopausal Women to Know

This is where Brenda gets passionate. She feels strongly that women going through menopause who want to quit smoking need specific advice that doesn’t exist in most quit-smoking resources.

Your symptoms will overlap and that’s confusing. Accept the confusion. “You won’t always know if you’re irritable because of withdrawal or hormones. You won’t know if you can’t sleep because of nicotine or night sweats. It doesn’t matter. Treat the symptoms. Drink cold water. Take a walk. Use your coping tools. The cause is less important than the response.”

Talk to both your gynecologist and your primary care doctor. “Don’t treat these as separate medical issues. They interact. I was lucky that Dr. Anand and Dr. Hartley communicated. They coordinated my patch dosage, my bupropion prescription, and my menopause management as one integrated plan. If your doctors aren’t talking to each other, make them.”

Consider bupropion seriously. “If your doctor suggests adding bupropion, don’t dismiss it because you don’t think you need an antidepressant. It’s not about depression. It’s about brain chemistry during a period when your brain chemistry is being assaulted from two directions at once. The medication gave me stability I couldn’t have achieved on willpower alone.”

The hot flashes will get worse before they get better. “Expect two to four weeks of increased hot flashes after you quit. It’s temporary. Your body is adjusting to the absence of nicotine. Push through it. On the other side, your hot flashes may actually improve.”

Give yourself permission to be a mess. “I was a mess for about six weeks. A sweaty, moody, foggy, hungry mess. And that’s okay. You’re doing something incredibly hard while your body is going through something incredibly hard. You don’t have to be graceful about it. You just have to get through it.”

The weight gain is temporary and manageable. “You’re going to gain weight. Menopause plus quitting smoking is a weight gain recipe. Deal with it later. Don’t try to do everything at once. Quit the cigarettes first. The weight will wait.”

One Year Later

Brenda is 14 months smoke-free. Her hot flashes have decreased from seven or eight a day to two or three. She can’t attribute all of that improvement to quitting smoking, since menopause symptoms can naturally diminish over time, but she believes quitting played a role.

“My skin looks better,” she says. “I breathe better. I smell better. I can walk uphill without stopping. I can keep up with my granddaughter, Eva, who was born three months after I quit. I want to be here for her. I want to watch her grow up. That’s worth every sweaty, miserable, tearful moment of the last year.”

She still takes evening primrose oil. She still walks every morning with Biscuit. She still keeps a cooling towel in her purse for hot flashes. But she doesn’t keep cigarettes anywhere.

“Glen told me recently that I’m easier to live with now than I was a year ago,” Brenda says. “I said, ‘That’s a low bar, Glen.’ He laughed. We both laughed. It’s nice to be able to laugh about it now.”

For other women dealing with menopause while trying to quit, Brenda recommends checking out nicotine patch side effects so you know what to expect from the patches specifically, and talking to your doctor about whether combining patches with medication might be right for your situation.

“You’re fighting on two fronts,” Brenda says. “Make sure you’ve got reinforcements.”