Smoking, secondhand exposure associated with earlier menopause, infertility

Women who are active smokers or exposed to high levels of secondhand smoke are more likely to experience infertility or earlier-onset menopause than women who never smoked, according to research in Tobacco Control.

“The study found that both active smoking as well as the highest levels of secondhand smoke exposure were significantly associated with being infertile and experiencing early menopause,” Andrew Hyland, PhD, chair of the department of health behavior at Roswell Park Cancer Institute in Buffalo, New York, told Endocrine Today. “For never-smoking women, the associations were strongest for those who had high levels of secondhand smoke exposure in childhood as well as at home and work as an adult, which suggests the cumulative dose of secondhand smoke exposure is driving the association rather than exposure at any particular point in time.”

Hyland and colleagues analyzed data from 93,676 postmenopausal women aged 50 to 79 years enrolled in the WHI observational study between 1993 and 1998. Within the cohort, 88,732 women provided complete data on tobacco exposure and lifetime fertility status via questionnaire; 79,690 women reported natural menopause (45% reported menopause before age 50 years) and no bilateral oophorectomy. Researchers used multivariate-adjusted regression models to estimate ORs for infertility and earlier-onset menopause (before age 50 years) according to reported levels of active smoking and secondhand smoke exposure.

Researchers found that active smokers had higher odds for infertility (adjusted OR = 1.14; 95% CI, 1.03-1.26) and early-onset menopause (adjusted OR = 1.27; 95% CI, 1.18-1.37) compared with never smokers with no lifetime exposure to secondhand smoke. An earlier age at smoking initiation also was linked to earlier age at menopause (P <.001), but not infertility (P = .124). Those who reported smoking at age 15 years or younger with high levels of tobacco use reached menopause an average of 1.8 years earlier than never smokers not exposed to secondhand smoke and were more likely to report difficulty conceiving for 1 year or more, according to researchers, whereas those who reported smoking 25 cigarettes per day or more reached menopause an average of 1.5 years earlier than never smokers.

Women who never smoked and who had the highest reported exposure to secondhand smoke (exposure in childhood 10 years; exposure in the adult home 20 years; exposure at work 10 years) were more likely to experience infertility (adjusted OR = 1.18; 95% CI, 1.02-1.35) and earlier menopause (adjusted OR = 1.18; 95% CI, 1.06-1.31) vs. never smokers not exposed to secondhand smoke. Women exposed to the highest levels of secondhand smoke also reached menopause an average of 13 months earlier than women not exposed to secondhand smoke.

“Not only should clinicians help their smoking patients quit, but they should also ask their patients about their past and current secondhand smoke exposure and advise them to reduce their secondhand smoke exposure,” Hyland toldEndocrine Today. “Patients should understand that secondhand smoke has far greater health impacts than cancer and heart disease, and women of reproductive age can help themselves by reducing secondhand smoke exposure.”

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