3.6 Reproductive health

Last updated: March 2015 
Suggested citation: Hurley, S, Greenhalgh, EM & Winstanley, MH. 3.6 Reproductive health. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2015. Available from http://www.tobaccoinaustralia.org.au/3-6-reproductive-health-and-smoking

 

3.6.1 Menstrual function, menarche and menopause

The 2001 US Surgeon General's report reached suggestive conclusions about the impact of smoking on menstrual cycles and reproductive lifespan: the period from the commencement of menstruation (menarche) to its cessation (menopause).1 The 2010 US Surgeon General's report expanded on these conclusions.2

Women who smoke are, generally, at higher risk of dysmenorrhoea (painful menstruation) and a range of other symptoms such as premenstrual tension and heavy periods.2 In the US Nurses' Health Study, for example, smokers were twice as likely as non-smokers to develop premenstrual syndrome over a two- to four-year period.3 Smokers also tend to have a shorter and more variable menstrual cycle. The former has been attributed to a shortening of the follicular phase. A non-statistically significant higher risk of anovulation in smokers has been found in some studies. These effects are consistent with an increased risk of infertility (see Section 3.6.2) as the timing of ovulation is less predictable in women with variable cycle length and a shortened follicular phase may indicate abnormal formation of follicles and maturation of ova.2

Smoking may also result in an earlier menopause. A meta-analysis found that smokers were between 0.8 to 1.7 years younger than non-smokers at menopause.2 More menopausal symptoms have also been reported, although hot flushes associated with smoking may result from a non-hormonal mechanism.2, 4 It has been suggested that shorter cycles may deplete oocytes earlier leading to an earlier menopause and thus a shorter reproductive life span. An earlier age at menarche has been reported for the daughters of women who smoked heavily during pregnancy.2

3.6.2 Fertility

Measures of fertility include fecundability (the monthly probability of conception), infertility (defined as lack of conception after one year of unprotected intercourse), and sub-fertility (reduced fertility, measured by time to conception or inability to conceive within six months). Smoking reduces fertility in women. Studies have found reduced pregnancy rates, longer time to pregnancy and decreased fecundability in women who smoke.2 A trend of decreased fertility with increasing number of cigarettes smoked has been reported.5 The American Society for Reproductive Medicine estimated that 13% of infertility may be attributable to smoking. Impaired fertility has been attributed to the polycyclic aromatic hydrocarbons in cigarette smoke and diminished oviductal functioning.2

In relation to the impact of male smoking on sperm quality and fertility, the 2004 US Surgeon General's report concluded that although the evidence suggests that smoking may decrease semen volume and sperm number, and increase the number of abnormal forms present, it was insufficient to establish causality.6 The 2010 report found strengthened evidence for decreased semen quality and fertility associated with exposure to tobacco smoke either in utero or in adulthood. The report found consistent evidence linking smoking to chromosome changes or DNA damage in sperm, adversely affecting male fertility and pregnancy viability as well as anomalies in offspring. 2

3.6.3 Assisted reproduction

(See 3.15.5 Treatment of infertility)

3.6.4 Sexual function

The link between smoking and erectile dysfunction (ED; defined as the persistent inability to attain and maintain penile erection adequate for satisfactory sexual performance) has been studied extensively.8 The 2014 US Surgeon General’s report concluded that smoking causes ED.8 Vasospasm induced by the nicotine in cigarette smoke has been suggested as a mechanism for the acute deleterious effects of smoking on erectile function, while the chronic effects are caused by impaired vascular physiology of the erectile tissue. The Surgeon General has recommended promoting non-smoking to prevent ED, and cessation to limit the risk of ED.8

A study of about 130 Italian women found that smokers have decreased blood flow to genital blood vessels, which may impair sexual function.9

3.6.5 Sexually transmitted diseases

(See 3.9.7 Infections of reproductive organs)

Recent news and research

For recent news items and research on this topic, click here (Last updated June 2018)  

References

1. US Department of Health and Human Services. Women and smoking. A report of the US Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm

2. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the US Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available from: http://www.surgeongeneral.gov/library/tobaccosmoke/report/index.html

3. Bertone-Johnson E, Hankinson S, Johnson S and Manson J. Cigarette smoking and the development of premenstrual syndrome. American Journal of Epidemiology 2008;168(8):938–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727205/

4. Cochran C, Gallicchio L, Miller S, Zacur H and Flaws J. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstetrics and Gynecology 2008;112(5):1037–44. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673540/pdf/nihms-108532.pdf

5. Howe G, Westhoff C, Vessey M and Yeates D. Effects of age, cigarette smoking, and other factors on fertility: findings in a large prospective study. British Medical Journal (Clinical Research Ed.) 1985;290(6483):1697–700. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1416131&blobtype=pdf

6. US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm

7. Tengs T and Osgood N. The link between smoking and impotence: two decades of evidence. Preventive Medicine 2001;32(6):447–452. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11394947

8.    US Department of Health and Human Services. The health consequences of smoking - 50 years of progress. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress

9. Battaglia C, Battaglia B, Mancini F, Persico N, Nappi R, Paradisi R, et al. Cigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women. Journal of Sexual Medicine 2011; [Epub ahead of print]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21477023

      Previous Chapter Next Chapter