title: The relationship between smoking and age at the menopause: A systematic review.
abstract: OBJECTIVE
  Increasing life expectancy has made it ever more important to study the factors that influence the age at the menopause, given that when it is reached outside of the normal range, it is associated with increased risk of osteoporosis and cardiovascular diseases, among other conditions. Among the factors studied in relation to early menopause, smoking is prominent. Destruction of the ovarian follicles is one of the mechanisms postulated for this effect. The aim of this study was to review and describe the associations between age at the menopause and the habit of smoking, its duration and its intensity.
  
  
  METHODS
  A systematic review of the literature indexed in the MEDLINE and LILACS databases was conducted, without restriction on publication date. After initially identifying 1325 articles and preselecting 161 articles for consideration of their complete texts, 96 articles reporting on the results from 109 studies were selected for analysis.
  
  
  RESULTS
  A great majority of the studies reported an association between the habit of smoking and early menopause, but there was no clear evidence that the duration of smoking and quantity of cigarettes smoked had any association with age at the natural menopause.
  
  
  CONCLUSIONS
  Additional studies are needed, preferably of prospective nature and with a large number of women, in order to deepen the knowledge of the effects of various aspects of smoking on age at the menopause. Experimental studies on animals may also contribute towards clarifying the physiopathological mechanisms through which smoking influences age at the menopause.
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. raphaelgnomo@hotmail.com
authors.forename: Raphael C
authors.initials: RC
authors.lastname: Parente
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
authors.forename: Roger Keller
authors.initials: RK
authors.lastname: Celeste
authors.forename: Guilherme L
authors.initials: GL
authors.lastname: Werneck
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*