Tobacco Exposure Linked to Infertility, Earlier Menopause

Diana Phillips

December 23, 2015

Active and passive exposure to tobacco appear to increase the risk for infertility and lower the age of natural menopause, a study has shown.

Of 93,676 postmenopausal women enrolled in the Women's Health Initiative Observational Study between 1993 and 1998 for whom relevant smoke exposure and fertility information was available, the risk for infertility was 14% greater among current and former smokers than nonsmokers, and the risk for menopause before age 50 years was 26% greater, Andrew Hyland, PhD, from the Department of Health Behavior at Roswell Park Cancer Institute in Buffalo, New York, and colleagues report in an article published online December 14 in Tobacco Control. In addition, nonsmokers with a self-reported history of exposure to high levels of secondhand smoke had an 18% increased risk for both infertility and early menopause.

Women who began smoking before age 15 years were at increased risk for fertility difficulties that persisted for longer than 1 year, and they reached natural menopause an average 21.6 months earlier than the cohort median of 50 years observed among never smokers with no secondhand smoke exposure, the authors report.

Nonsmokers who were exposed to the highest level of secondhand smoke were also more likely to experience fertility problems, and they reached menopause, on average, 13.2 months earlier than the comparison group, according to the authors.

Positive trends for cigarettes smoked per day were significant for infertility and earlier menopause, suggesting a dose–response relationship.

The influence of tobacco toxins on hormone production may interfere with fertility, the authors explain, noting that the toxins can damage egg cell production as well as the embryo before implantation, and they can affect important uterine processes that support pregnancy. "Tobacco toxins also seem to lower the age of natural menopause by reducing circulating estrogen¬ — from both synthesis inhibition and endocrine disruption," they write.

The findings of this study, which is one of the first of its size and statistical power to investigate and quantify active and passive smoking and women's health issues, strengthen "the current evidence that all women need to be protected from active and passive tobacco smoke," according to the authors.

"Given the association between tobacco smoke exposure and age at menopause, it is important for clinicians to discuss how lifestyle factors (such as exposure to tobacco smoke) may impact their patient's reproductive health," the authors conclude.

Funding for the Women's Health Initiative program is provided by the National Heart, Lung, and Blood Institute, National Institutes of Health. The authors have disclosed no relevant financial relationships.

Tobacco Control. Published online December 14, 2015. Full text

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