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expert reaction to study investigating active and passive smoking, infertility and early menopause

A study published in the journal Tobacco Control has investigated the impacts of tobacco exposure on women’s health, which reports an increased risk of infertility and early onset of menopause with passive (secondhand smoke) as well as active exposure to tobacco.


Dr Roger Marwood, gynaecologist, obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) said:

“This study adds to the weight of data demonstrating the negative impacts of smoking on a person’s health. Smoking, as well as being exposed to second hand smoke can lead to heart disease, lung cancer and other lung diseases, and smoking during pregnancy can increase the risk of having a low-birth weight baby, preterm birth or stillbirth, and can have long term effects on a child’s health.

“This study found that smoking has a detrimental effect on the reproductive health of a woman. Women who smoked at any point in their lives, or who were passive smokers, were more likely to have problems with infertility or an early menopause. On average they started the menopause 22 months before women who had never smoked.

“As healthcare professionals, we need to support and help women to lead healthier lives and this must include smoking cessation. Women must be made aware of the risks of smoking on their fertility, in pregnancy, as well as their health later in life. They must also be signposted to the excellent support systems that are available to help them quit.”


Dr Richard Quinton, Consultant Endocrinologist, Newcastle upon Tyne Hospitals NHS Foundation Trust, Senior Lecturer, Institute of Genetic Medicine, Newcastle University, and Member of the Society for Endocrinology, said:

“This paper pretty well does what it says on the tin and confirms what we thought we already knew from previous studies, i.e. that exposure to cigarette smoke (active or passive) is associated with advancing menopause onset by 1-2 years.

“However, they have also taken this a step further to show that active cigarette-smoking is also associated with infertility, presumably through the same process of toxic ovarian damage that later results in early menopause. There are well-established basic studies to show putative cellular mechanisms for this effect, so it’s not at all surprising, but nice to have it laid out more convincingly.

“Bearing in mind that, when this cohort was recruited, smoking was far more prevalent in women of reproductive age, the authors hint at an interesting hypothesis that is implied, without being explicitly formulated: “Consistent with other studies, we observed an approximate 1–2 year earlier onset of menopause in participants exposed to passive and active smoke, the clinical importance of which is somewhat unclear. However, we should note that evidence shows that the risk of all-cause mortality increases with earlier age at menopause” i.e. was at least some of the higher mortality associated with earlier menopause in previous studies non-causal, mediated by a common driver? So smoking might have been the underlying risk factor causing both early menopause and higher mortality.”


Prof. Ashley Grossman, Professor of Endocrinology, University of Oxford, said:

“This is slightly worrying – there is only a slightly increased risk of infertility in smokers compared to never-smokers, but this new study suggests that so-called passive smokers might be similarly affected. Maybe more convincing is the nearly 2-year earlier menopause in smokers and around one year in passive smokers; this dose-response effect does suggest we are looking at a true phenomenon.

“This is one more significant reason not to smoke, especially as the fall-off in tobacco use in male smokers may not be equally paralleled in women.”


‘Associations between lifetime tobacco exposure with infertility and age at natural menopause: the Women’s Health Initiative Observational Study’ by Andrew Hyland et al. published in Tobacco Control on Tuesday 15 December 2015. 


Declared interests

Dr Roger Marwood, Dr Richard Quinton and Prof. Ashley Grossman both declare that they have no relevant interests.

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