Cigarette smoking and effects on menstrual function

Objective: To examine the relationship between smoking and menstrual function, using biologic measures rather than self-report of menstrual cycle characteristics. Methods: In a prospective study, 408 women collected urine daily for one to seven menstrual segments (cycles), maintained daily diaries, and completed detailed interviews. Smoking data from the diaries were averaged over each segment and verified by cotinine assay. Urine samples were analyzed for metabolites of steroid hormones to define the day of ovulation and various menstrual characteristics, including: 1) segment, follicular, luteal phase, and menses length, 2) variability, and 3) anovulation. Results: Heavy smoking (at least 20 cigarettes per day) was associated with nearly four times the risk of short segment (less than 25 days) as was nonsmoking (adjusted odds ratio 3.8, 95% confidence limits 1.1, 12.7). Mean segment length was on average 2.6 days shorter with heavy versus no smoking (95% confidence limits 0.14, 5.0), due almost entirely to shortening of the follicular phase. Women who smoked an average of ten or more cigarettes per day had significantly more variable segment and menses lengths than nonsmokers. Based on small numbers, the data suggested that with greater smoking, there was a possible increased risk of anovulation and short luteal phase. Segments of exsmokers with ten or more pack-years of exposure were more likely to be short and have shorter luteal phases than those of never smokers. Conclusion: The effects found in this study of smoking on the menstrual cycle might explain in part associations of smoking with other reproductive endpoints, such as subfecundity and early menopause. (Obstet Gynecol 1999;93:59-65.