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Add PMS to the Antismoking Arsenal

Smokers were more likely to develop moderate-to-severe PMS than were nonsmokers.

Young women who are not persuaded to quit smoking by the health threats of breast, lung, and cervical cancer or myocardial infarction might want to consider another smoking-related consequence: premenstrual syndrome (PMS). In a substudy of the Nurses’ Health Study II, 117,000 U.S. female registered nurses (age range at study entry, 25–42) were asked to report smoking status and diagnoses of PMS. In 1057 participants, diagnoses were validated with additional questionnaires that documented symptoms of moderate or severe PMS (at least 1 physical and 1 affective symptom that correlated temporally with menses, was absent during the week when menses ended, and significantly affected life activities and relationships). The control group consisted of 1968 women who experienced mild or no menstrual symptoms.

Women with incident PMS were younger (mean age, 34 vs. 35), heavier (BMI, 25 vs. 24 kg/m²), and more likely to have used oral contraceptives (86% vs. 78%) or antidepressants (12% vs. 5%) at baseline than were controls (P<0.001 for all comparisons); analyses that excluded women who reported diagnoses of depression yielded similar results. Adjusted relative risk for PMS in current smokers compared with never smokers was 2.1; in former smokers (25 cigarettes daily) compared with never smokers, adjusted RR for PMS was 1.8. Risk rose incrementally with higher total pack-years and longer duration of smoking prior to diagnosis (P for trend = 0.03). Analysis adjusted for pack-years showed that women who started smoking before age 15 were nearly twice as likely to develop PMS as were those who never smoked (RR, 1.9). Excess risk was seen in women who started smoking prior to developing menstrual symptoms and in those who started smoking after symptom onset (RR, 1.7 and 1.4, respectively, compared with never smokers), which suggested that smoking was a contributor rather than a response to PMS.

Comment: The authors speculate that smoking might contribute to PMS by affecting premenopausal sex steroid and gonadotropin levels. Although we can’t promise that women who don’t start smoking will never develop PMS — or that women who quit will experience fewer symptoms — the more reasons that clinicians can provide to quit (or not start) smoking, the more likely we are to find a rationale that resonates with our patients.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women's Health December 4, 2008

Citation(s):

Bertone-Johnson ER et al. Cigarette smoking and the development of premenstrual syndrome. Am J Epidemiol 2008 Oct 15; 168:938.

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