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Tobacco and Menopause

There are still a lot of people smoking nowadays, despite the amount of information and warnings that are continuously promoted by healthcare providers and specialists.

Smoking can have detrimental effects during our fertile time, correlated with fertility itself, cancer and cardiovascular disease, but what about smoking and menopause? Has there been any proof that there is any connection between the two or any impact of smoking on our menopausal age?

Beside the fact that it has been demonstrated that smoking really affects fertility, a recent study shows that women who smoke are more likely to enter menopause earlier. This is due to the effects of tobacco toxins on hormones of the female reproductive system and hormone levels itself.

Moreover, being a smoker can affect the timing of the onset of menopause, the intensity of symptoms of menopause, and the incidence of osteoporosis and other diseases after entering menopause.

In fact, smoke is to be considered a modifiable health-related behaviour that influences menopausal age. Since life expectancy increases, it is pivotal to understand that the proportion of post-menopausal life also increases. It is then important to understand that the impact of menopause in a woman’s life and wellbeing has to become a priority.

But why smoking is so detrimental to our hormonal system? It is mostly due by the pharmacological action of nicotine.

Smoking affects the pituitary, thyroid, adrenal, testicular and ovarian function (most of hormone-secretors’ glands/organs), calcium metabolism and the action of insulin. Talking about tobacco and menopause, for us is more relevant its anti-oestrogenic effect in women. This is probably due to changes in hepatic oestrogen metabolism (liver is a site for biosynthesis of oestrogens but it is also the main site for further bio-transformation of them, meaning that oestrogens become functional for the many functions it has) induced by smoking. Furthermore, in the circulation, oestrogens bind avidly to the sex hormone binding globulin (SHBG) (38%), in a less solid way to albumin (60%) and the remaining is the free unbound fraction (meaning it stays circulating without binding to anything). In smokers, concentrations of Sex Hormone Binding Globuline are higher, and lower concentrations of biologically active oestrogens are therefore seen. Therefore, some of the normal oestrogen-dependent physiological processes such as the menstrual cycle and menopause are affected. Women who smoke have a significantly greater variable portion and menses length than non-smokers, with specifically heavy smokers (considered heavy smokers who smoke more than 20 cigarettes per day) running a risk of shorter period lengths than non-smokers, due almost entirely to the shortening of the follicular phase. In synthesis, the likelihood of irregular cycles increases with the number of cigarettes smoked. This leads to an increased risk of anovulation, which becomes even greater with the degree of smoking. These effects can decrease fertility in women as well as reducing the age of menopause. Menopausal symptoms such as hot flushes are experienced more commonly and harder among smokers, due to the already existing unbalance of the oestrogens. It is still unclear whether the effect of smoking is reversible on the hormonal balance or not. Some research assesses yes, some others are more doubtful. More research needs to be done on this matter.

So, the real problem about hitting menopause earlier is that all the post-menopausal complications are more likely to hit harder, such as osteoporosis, cardiovascular disease, diabetes and obesity.

This can lead to a greater risk for women and also to a worse outcome of the menopause as well. Moreover, oestrogen is protective against ageing and entering menopause earlier can therefore lead to a longer aging process. On the other hand, quitting smoking is not easy. Entering menopause isn’t easy either. Doing both together could be an absolute nightmare. But, being a smoker during menopause can lead you to have worsened symptoms and moreover to have more complications afterwards, especially if you are a heavy smoker or if you have been smoking for all your life. It is then advisable to look for support and try to quit smoking. There are many doctors and support groups out there, for the menopause and for smokers, it is just a matter of finding the way that works for you.

By Ornella Cappellari