Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.
<h4>Background</h4>Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irrev...
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2018-11-01
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| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1002704 |
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| author | Dongshan Zhu Hsin-Fang Chung Nirmala Pandeya Annette J Dobson Janet E Cade Darren C Greenwood Sybil L Crawford Nancy E Avis Ellen B Gold Ellen S Mitchell Nancy F Woods Debra Anderson Daniel E Brown Lynnette L Sievert Eric J Brunner Diana Kuh Rebecca Hardy Kunihiko Hayashi Jung Su Lee Hideki Mizunuma Graham G Giles Fiona Bruinsma Therese Tillin Mette Kildevæld Simonsen Mette Kildevæld Simonsen Hans-Olov Adami Elisabete Weiderpass Marianne Canonico Marie-Laure Ancelin Panayotes Demakakos Gita D Mishra |
| author_facet | Dongshan Zhu Hsin-Fang Chung Nirmala Pandeya Annette J Dobson Janet E Cade Darren C Greenwood Sybil L Crawford Nancy E Avis Ellen B Gold Ellen S Mitchell Nancy F Woods Debra Anderson Daniel E Brown Lynnette L Sievert Eric J Brunner Diana Kuh Rebecca Hardy Kunihiko Hayashi Jung Su Lee Hideki Mizunuma Graham G Giles Fiona Bruinsma Therese Tillin Mette Kildevæld Simonsen Mette Kildevæld Simonsen Hans-Olov Adami Elisabete Weiderpass Marianne Canonico Marie-Laure Ancelin Panayotes Demakakos Gita D Mishra |
| author_sort | Dongshan Zhu |
| collection | DOAJ |
| description | <h4>Background</h4>Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause.<h4>Methods and findings</h4>A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias.<h4>Conclusions</h4>The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause. |
| format | Article |
| id | doaj-art-61b5a5e77edf4b669c738ffab60f1b95 |
| institution | OA Journals |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2018-11-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Medicine |
| spelling | doaj-art-61b5a5e77edf4b669c738ffab60f1b952025-08-20T02:22:24ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762018-11-011511e100270410.1371/journal.pmed.1002704Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.Dongshan ZhuHsin-Fang ChungNirmala PandeyaAnnette J DobsonJanet E CadeDarren C GreenwoodSybil L CrawfordNancy E AvisEllen B GoldEllen S MitchellNancy F WoodsDebra AndersonDaniel E BrownLynnette L SievertEric J BrunnerDiana KuhRebecca HardyKunihiko HayashiJung Su LeeHideki MizunumaGraham G GilesFiona BruinsmaTherese TillinMette Kildevæld SimonsenMette Kildevæld SimonsenHans-Olov AdamiElisabete WeiderpassMarianne CanonicoMarie-Laure AncelinPanayotes DemakakosGita D Mishra<h4>Background</h4>Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause.<h4>Methods and findings</h4>A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias.<h4>Conclusions</h4>The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause.https://doi.org/10.1371/journal.pmed.1002704 |
| spellingShingle | Dongshan Zhu Hsin-Fang Chung Nirmala Pandeya Annette J Dobson Janet E Cade Darren C Greenwood Sybil L Crawford Nancy E Avis Ellen B Gold Ellen S Mitchell Nancy F Woods Debra Anderson Daniel E Brown Lynnette L Sievert Eric J Brunner Diana Kuh Rebecca Hardy Kunihiko Hayashi Jung Su Lee Hideki Mizunuma Graham G Giles Fiona Bruinsma Therese Tillin Mette Kildevæld Simonsen Mette Kildevæld Simonsen Hans-Olov Adami Elisabete Weiderpass Marianne Canonico Marie-Laure Ancelin Panayotes Demakakos Gita D Mishra Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. PLoS Medicine |
| title | Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. |
| title_full | Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. |
| title_fullStr | Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. |
| title_full_unstemmed | Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. |
| title_short | Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. |
| title_sort | relationships between intensity duration cumulative dose and timing of smoking with age at menopause a pooled analysis of individual data from 17 observational studies |
| url | https://doi.org/10.1371/journal.pmed.1002704 |
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