1. Women who smoked were more likely to experience chronic dysmenorrhea compared to women who used to smoke or who never smoked.
2. Women who started smoking at a younger age had higher risk of contracting chronic dysmenorrhea compared to those who began smoking at an older age.
Evidence Rating Level: 2 (Good)
Study Rundown: The association between smoking and dysmenorrhea has been studied but with mixed results. In this prospective cohort study, the link between smoking status and long-term patterns of dysmenorrhea was investigated. A significant association was found between smoking status and odds of experiencing chronic dysmenorrhea, with current smokers at increased odds compared to former or never smokers. An inverse relationship between age of smoking initiation and odds of chronic dysmenorrhea was also found, with women who started smoking younger than age 13 years having nearly twice the odds of chronic dysmenorrhea compared to never smokers. Further, women who started smoking before menarche had higher odds of chronic dysmenorrhea compared to women who started smoking after menarche.
The cohort in this study is population-based and representative of the national population of Australia which supports the generalizability of these results. While there was significant attrition between the first and second survey, the prevalence of dysmenorrhea did not change, suggesting random leave from the study. Additionally, although symptoms were based on self-report, these results align with prior studies’ findings of the prevalence of dysmenorrhea. This study was unable to evaluate the relationship between dysmenorrhea and amount of smoking in current smokers given limitations of the available data. Nevertheless, these data provide evidence that smoking is linked with a chronic pattern of dysmenorrhea and give credence to women’s health in the anti-smoking campaign.
Relevant Reading: The prevalence and risk factors of dysmenorrhea
In-Depth [prospective cohort]: This study evaluated the relationship between smoking and long-term trajectories of dysmenorrhea, in a nationally-representation population of Australian women aged 18-23 at baseline who were followed for 13 years and participated in at least 3 follow-up surveys. The association between baseline smoking behaviors and dysmenorrhea trajectories was evaluated with multinomial logistic regression. Women were categorized into four trajectory groups of dysmenorrhea: ‘normative,’ who had few or no symptoms during the study (42%); ‘late-onset,’ who had increasing prevalence over time (11%); ‘recovering,’ who had decreasing prevalence over time (33%); and ‘chronic,’ who had persistently high prevalence of dysmenorrhea throughout the study (14%). Compared to never smokers, current smokers at baseline (OR 1.71, CI95% 1.45-2.02) and former smokers at baseline (OR 1.45, CI95% 1.16-1.80) had increased odds of being in the chronic group. An inverse relationship was found between age at initiation of smoking and odds of being in the chronic group. Compared to never-smokers, women who started smoking by age 13 had nearly double the odds of being in the chronic dysmenorrhea group (OR 1.98, CI95% 1.51-2.62).
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