The Association between In Utero Cigarette Smoke Exposure and Age at Menopause (original) (raw)
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Cigarette Smoking and Risk of Early Natural Menopause
American Journal of Epidemiology
Menopause before 45 years of age affects roughly 5%-10% of women and is associated with a higher risk of adverse health conditions. Although smoking may increase the risk of early menopause, evidence is inconsistent, and data regarding smoking amount, duration, cessation, associated risks, and patterns over time are scant. We analyzed data of 116,429 nurses from the Nurses' Health Study II from 1989 through 2011 and used Cox proportional hazards models to estimate hazard ratios adjusted for confounders. Compared with never-smokers, current smokers (hazard ratio (HR) = 1.90, 95% confidence interval (CI): 1.71, 2.11) and former smokers (HR = 1.10, 95% CI: 1.00, 1.21) showed an increased risk of early menopause. Increased risks were observed among women who reported current smoking for 11-15 pack-years (HR = 1.72, 95% CI: 1.36, 2.18), 16-20 pack-years (HR = 1.72, 95% CI: 1.38, 2.14), and more than 20 pack-years (HR = 2.42, 95% CI: 2.11, 2.77). Elevated risk was observed in former smokers who reported 11-15 pack-years (
Life course exposure to smoke and early menopause and menopausal transition
Menopause, 2015
Objective-Early age at menopause is associated with increased risk of cardiovascular disease, stroke, osteoporosis and all-cause mortality. Cigarette smoke exposure in adulthood is an established risk factor for earlier age at natural menopause and may be related to age at menopausal transition. Using data from two U.S. birth cohorts, we examined the association between smoke exposure at various stages of the life course (prenatal, childhood exposure to parental smoking and adult smoke exposure) with menopause status in 1,001 women aged 39-49 years at follow-up. Methods-We used logistic regression analysis, adjusting for age at follow-up, to estimate odds ratios (ORs) and 95% confidence intervals (CI) relating smoke exposure to natural menopause and menopausal transition. Results-The magnitudes of the associations for natural menopause were similar, but not statistically significant after adjustment for confounders for i) women with prenatal smoke exposure who did not smoke at adult follow-up (OR= 2.7 [95% CI 0.8, 9.4]) and ii) current adult smokers who were not exposed prenatally (OR= 2.8 [95% CI 0.9, 9.0]). Women who had been exposed to prenatal smoke and were current smokers had three times the risk of experiencing natural menopause (adjusted OR=3.4 [95% CI 1.1, 10.3]) compared to women without smoke
Tobacco control, 2015
Several studies have investigated the association of tobacco use with infertility and age at natural menopause, yet few have explored secondhand smoke (SHS) exposure with these outcomes. This study offers a comprehensive, quantified secondary data analysis of these issues using the Women's Health Initiative Observational Study (WHI OS). This study examines associations between lifetime tobacco exposure-active smoking and SHS-and infertility and natural menopause (before age 50). Information on smoking, lifetime fertility status, and age at natural menopause was collected and available from 93 676 postmenopausal women aged 50-79 enrolled in the WHI OS from 1993 to 1998 at 40 centres in the USA. Multivariate-adjusted regression models were used to estimate ORs and 95% CI according to levels of active smoking and SHS exposure, and trends were tested across categories. Overall, 15.4% of the 88 732 women included in the analysis on infertility met criteria for the condition. 45% of t...
[Influence of Selected Reproductive Factors and Smoking on Age at Menopause.]
Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)), 2015
Introduction: Early menopause may be associated with serious health risks resulting from, for example, decreased oestrogen levels. This may occur despite hormone replacement therapy. Aim: The aim of this study was the determination of the effect of selected reproductive factors and smoking on age at the onset of menopause in women from Szczecin and surrounding areas. Material and Methods: 305 women after natural menopause were asked to complete a questionnaire, and blood samples were collected from them to test for the levels of follicle stimulating hormone (FSH) and oestradiol (E2). Results: Smoking women experienced menopause on average more than a year earlier than non-smokers, but this difference was not statistically significant. There was no statistically significant effect of age at menarche or first birth on age at the last menstrual period. Conclusions: Age at menarche and first birth were not related to age at menopause. In smoking women, menopause occurred earlier but the...
Cigarette smoking and age of menopause: A large prospective study
Maturitas, 2012
Objectives: One of the possible consequences of tobacco consumption is that it contributes to an earlier age of menopause, though the causal relationship is yet to be confirmed. This study aimed to examine the prospective association between smoking and earlier age of menopause in a cohort of middle age Australian women after adjustment for a number of potential confounders. Study design: 21-Year follow-up of a cohort prospective study, Brisbane, Australia. Main outcome measures: Age of menopause measured at the 21-year follow-up. Smoking and menopausal status were assessed by self-report. Other covariates were measured prospectively in the previous followups.
Smoking Cigarettes before First Childbirth and Risk of Breast Cancer
American Journal of Epidemiology, 2007
Inconsistent epidemiologic findings on cigarette smoking and female breast cancer risk may reflect insufficient assessment of smoking onset and amount relative to reproductive events. To determine the risk of breast cancer associated with smoking during different periods of reproductive life, the authors evaluated 906 incident breast cancer cases in a nationwide cohort of 56,042 female US radiologic technologists (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)) who responded to two questionnaire surveys. After they accounted for age, birth cohort, and established breast cancer risk factors, smoking-related breast cancer risks differed by smoking during three reproductive time periods (p ¼ 0.003), with a statistically significant 3% increase per pack-year of smoking between menarche and first childbirth (relative risk ¼ 1.03, 95% confidence interval: 1.02, 1.05) and no significant association for smoking after first childbirth. Risk also increased with younger age at smoking initiation (p-trend ¼ 0.06), after adjustment for pack-years of smoking before and after first childbirth, indicating an independent effect of age at smoking initiation. The findings from this study suggest that sensitivity of the female breast to tobacco carcinogens is increased during adolescence and early adulthood but decreases after first childbirth, when most breast tissue has terminally differentiated. breast neoplasms; reproduction; smoking Correspondence to Dr.
Ovarian function and cigarette smoking: Ovarian function and cigarette smoking
Paediatric and Perinatal Epidemiology, 2010
Cigarette smoking has been implicated in reproductive outcomes including delayed conception, but mechanisms underlying these associations remain unclear. One potential mechanism is the effect of cigarette smoking on reproductive hormones; however, studies evaluating associations between smoking and hormone levels are complicated by variability of hormones and timing of specimen collection. We evaluated smoking and its relationship to reproductive hormones among women participating in the BioCycle study, a longitudinal study of menstrual cycle function in healthy, premenopausal, regularly menstruating women (n=259). Fertility monitors were used to help guide timing of specimen collection. Serum levels of estradiol, progesterone, folliclestimulating hormone (FSH), luteinizing hormone (LH) and total sex-hormone binding globulin (SHBG) across phases of the menstrual cycle were compared between smokers and nonsmokers. We observed statistically significant phase-specific differences in hormone levels between smokers and nonsmokers. Compared to nonsmokers, smokers had higher levels of FSH in the early follicular phase higher LH at menses after adjusting for potential confounding factors of age, race, BMI, nulliparity, vigorous exercise, and alcohol and caffeine intake through inverse probability of treatment weights. No statistically significant differences were observed for estradiol, progesterone or SHBG. These phase-specific differences in levels of LH and FSH in healthy, regularly menstruating women who are current smokers compared to nonsmokers reflect one mechanism by which smoking may impact fertility and reproductive health.
The relationship between smoking and age at the menopause: a systematic review
Maturitas, 2008
Context and objective: Increasing life expectancy has made it ever more important to study the factors that influence the age at the menopause, given that when it is reached outside of the normal range, it is associated with increased risk of osteoporosis and cardiovascular diseases, among other conditions. Among the factors studied in relation to early menopause, smoking is prominent. Destruction of the ovarian follicles is one of the mechanisms postulated for this effect. The aim of this study was to review and describe the associations between age at the menopause and the habit of smoking, its duration and its intensity. Method: A systematic review of the literature indexed in the MEDLINE and LILACS databases was conducted, without restriction on publication date. After initially identifying 1325 articles and preselecting 161 articles for consideration of their complete texts, 96 articles reporting on the results from 109 studies were selected for analysis. Results: A great majority of the studies reported an association between the habit of smoking and early menopause, but there was no clear evidence that the duration of smoking and quantity of cigarettes smoked had any association with age at the natural menopause. Conclusion: Additional studies are needed, preferably of prospective nature and with a large number of women, in order to deepen the knowledge of the effects of various aspects of smoking on age at the menopause. Experimental studies on animals may also contribute towards clarifying the physiopathological mechanisms through which smoking influences age at the menopause.
A meta-analysis provides evidence that prenatal smoking exposure decreases age at menarche
Reproductive Toxicology, 2015
Since studies of association between prenatal tobacco exposure and age at menarche have reported inconsistent results so far, we conducted a meta-analysis to examine this association. In total 36 relevant articles (1995-2014) were identified, 17 of which satisfied the inclusion criteria and were used in the analysis. Nearly one month decrease (−0.092 [95% CI:−0.160, −0.024] year) in age at menarche was found in women who were exposed to tobacco in utero. The meta-regression analysis showed that average year of birth in the cohorts might significantly influence association between maternal smoking and daughter's age at menarche. Based on results obtained from 5 studies where age at menarche was treated as a categorical variable, maternal smoking status during pregnancy increased a risk for daughters to have menarche earlier than at 11 years old by 15%.
Human Reproduction, 2012
study question: Does in utero exposure to constituents of cigarette smoke have a programming effect on daughters' age of menarche and markers of long-term reproductive health? summary answer: In utero exposure to constituents of cigarette smoke was associated with earlier age of menarche and-to a lesser extent-changes in the testosterone profile of the young women. what is known already: Studies observe potential effects of in utero exposure to constituents of cigarette smoke on the intrauterine formation of female gonads, but the consequences on long-term reproductive health in daughters remain unclear. study design, size and duration: A prospective cohort study was designed using data from 965 pregnant women enrolled prior to a routine 30th-week antenatal examination at a midwifery practice in Denmark from 1988 to 1989 and a follow-up of their 19-21year-old daughters in 2008. participants/materials, setting and methods: The pregnant women provided information on lifestyle factors during pregnancy, including the exact number of cigarettes smoked per day during the first and the second trimesters. A total of 438 eligible daughters were asked to complete a web-based questionnaire on reproductive health and subsequently invited to participate in a clinical examination during 2008. Of the 367 daughters (84%) who answered the questionnaire, 267 (61%) agreed to further examination. Information on menstrual pattern was provided at examination, blood samples were drawn to be analyzed for serum levels of reproductive hormones [FSH, LH, estradiol (E 2), sex hormone-binding globulin, anti-Müllerian hormone, dehydroepiandrosterone-sulphate (DHEAS), free testosterone and free E 2 ] and number of follicles (2-9 mm) were examined by transvaginal ultrasound. The daughters were divided into three exposure groups according to the level of maternal smoking during first trimester [non-exposed (reference), low-exposed (mother smoking .0-9 cigarettes/day) and high-exposed (mother smoking ≥10 cigarettes/day)]. Data were analyzed by multiple regression analyses in which we adjusted for potential confounders. Both crude and adjusted test for trend were carried out using maternal smoking during the first trimester as a continuous variable. main results and the role of chance: We observed an inverse association between in utero exposure to constituents of cigarette smoke and age of menarche (P ¼ 0.001). Daughters exposed to .0-9 cigarettes/day debuted with-2.7 [95% confidence interval (CI)-5.2 to-0.1] percentage earlier age of menarche, whereas daughters exposed to ≥10 cigarettes/day had-4.1 (95% CI:-6.6 to-1.5) percentage earlier age of menarche corresponding to 6.5 (95% CI:-10.7 to-2.2) months. There was a non-significant tendency towards lower levels of testosterone and DHEAS with increasing in utero exposure to constituents of cigarette smoke but no associations with follicle number, cycle length or serum levels of the other reproductive hormones were observed. limitations and reasons for caution: We collected information on age of menarche retrospectively but the recall time was relatively short (2-10 years) and the reported values were within the normal range of Caucasians. Analyses of reproductive hormones are presented only for the group of daughters who were non-users of hormonal contraceptives because users were excluded, leaving only a low number of daughters available for the analyses (n ¼ 75), as reflected in the wide CIs. The analyses of hormones were