Hormones like estrogen and progesterone typically get a bad rap, as they’re often blamed for heightened emotional expression during menstruation, pregnancy, and postpartum. Dr. Alicia Allen is changing the way we think and talk about female reproductive hormones. The assistant professor of family and community medicine, clinical translational sciences, and public health, shares how her epidemiological and intervention studies are geared towards educating, empowering, and helping women combat their addictions.
Your research focuses on women's health, particularly female reproductive hormones, substance misuse, and addictions. What makes you passionate about supporting women and their health through your projects?
Two of my current projects focus on the perinatal period, and that really is a passion of mine for two reasons – first, as a mom myself.
After I had my son, I suffered with postpartum depression. I had feelings of isolation and needed some more support. I know I’m not alone in my struggles – most women face these challenges – so we as a community at large need to do more to support moms during that time.
As an epidemiologist, I went right to the peer reviewed literature to do some research about how I could do better with breastfeeding and improve my mood. Unfortunately, there wasn’t much research in this area.
With issues of substance misuse, pregnancy is a really important time to focus on because during pregnancy there's a reduction in substance use - oftentimes women will quit using because they know the health implications on baby and themselves, but also because they get more access to health care. They also have social support in their personal lives, and they have this great motivation to do everything they can to support baby and give baby every opportunity in the world.
In the postpartum, relapse to substances is extremely high, and I think that's partly because women like me suffer from mood challenges and isolation. Oftentimes focus goes on to baby instead of mom - we're bringing baby in for lots of checkups with the pediatrician, but mom only gets one, and oftentimes she can't even make that.
It feels like there's this wonderful opportunity where mom is doing everything she can do to stay abstinent from substances, and then it's almost forgotten because baby’s here. I want to do more to help mom maintain her abstinence or her reduction, because not only is it going to be good for her in the long term, but it's going to be good for her baby.
I’m also focused on women of reproductive age because I’ve learned over the past 20 years that when you think of substance use disorders, people often think of a man. While it is more common in men, women are really more vulnerable, and a lot of the medications that are designed to help people stop using a substance are designed more to a male's needs.
I focus on reproductive age because we know there's an impact of the hormones, so it's about figuring out exactly what that impact is and then how we can use that impact to our advantage.
You’re the director of the Recovery through ENgaging and Empowering Women (RENEW) team. Tell us a bit about the goal or mission of this team, or how you started RENEW.
During my undergraduate, I was conducting research looking at how menstrual cycle phase impacts smoking cessation outcomes in women. That was really my initial experience with ovarian hormones and how they influence substance taking behavior - the foundation of a lot of the work I do. When I came to University of Arizona in 2016, I had done a fair amount of work in looking at ovarian hormones in tobacco research, but my goal expanded into other substances.
Probably almost all women out there can relate to the idea of hearing someone say, “Oh she's PMSing,” or, “Oh, she just had a baby, she's hormonal.”
It's very norm to think these hormones are doing something bad to us, but I think there is a way we can use those hormones to help us as women avoid substance use disorders and a variety of things, so that's kind of the basic premise of RENEW.
What are some of the current projects?
We have two smoking studies. The first one is the pilot study ATHENA, which stands for Administering Therapy and Hormones to End Nicotine Addiction. We're looking to see if Depo-Provera, the birth control shot, will help women of reproductive age quit smoking.
If you think about a woman's menstrual cycle, when she's not taking hormones, her progesterone and estrogen levels go up and down. Both progesterone and estrogen have been shown to influence some substance taking behaviors, so I thought maybe what's happening for women. If we're able to stabilize the hormones for three months using Depo-Provera, maybe that would give her a level playing field, so to speak, to quit smoking.
The second is the PEACH project, or Protecting families by Ending Addiction to Cigarettes with Hormones, which is also a cigarette smoking study but for pregnant women. We’re enrolling women who quit smoking during pregnancy and want to remain quit after they have baby. It's again based on manipulating natural hormones, so they get one of four combinations of active progesterone, Depo-Provera, and two placebos.
Right after a woman has a baby, she doesn't typically have her menstrual cycle for a little while. But during pregnancy, her hormones go really high, and then as soon as she has baby, they plummet. What we're trying to do is after they plummet, modify them in a favorable way to prevent drug taking behaviors.
The next is the ORCHID study - Observing Relationships in Caregiving and Hormones after Infant Delivery. We are enrolling pregnant women, either with opioid use disorder or without. In this study, we're actually not doing any intervention, but we're just observing.
The women enrolled in our study will do surveys throughout their participation, and then we also collect blood saliva samples. We’re trying to see if there are certain hormonal patterns or infant caregiving activities that are protective against relapse, and hopefully if we're able to see some sort of signal to design an intervention around.
What I’m hoping for is one of the infant caregiving activities to prevent relapse - how amazing would it be if we could protect against opioid relapse by simply recommending something like 10 minutes of skin to skin daily, for the first few weeks?!
Lastly, we have a vaping project. It’s a one-time cross sectional anonymous survey for women of reproductive age, and we're looking to see if their use of hormonal contraceptives and/or what menstrual cycle phase they're in is related to their vaping satisfaction.
As a new mom myself, finding time for establishing a good work life balance can be challenging. I’m curious how you support yourself and have a good work life balance.
Two things – first, if your listeners don't know about the National Center for Faculty Development in Diversity, check it out. The University of Arizona is an institutional member, which means the programs are free for us at the university. Their Faculty Bootcamp class teaches how to use your time most efficiently, in a way that supports your long-term goals.
Secondly, I’m admittedly a big dork about strategic planning. Every year, I set out my goals, and then I break it down to the month. Every weekend, I plan out how I’m spending my time the following week, making sure to keep my evenings and weekends open.
I think it's really important to both have family time and allow my brain to turn off that work side and just go and do some fun things!
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