title: Associations between lifetime tobacco exposure with infertility and age at natural menopause: the Women's Health Initiative Observational Study.
abstract: Several studies have investigated the association of tobacco use with infertility and age at natural menopause, yet few have explored secondhand smoke (SHS) exposure with these outcomes. This study offers a comprehensive, quantified secondary data analysis of these issues using the Women's Health Initiative Observational Study (WHI OS).
  
  
  
  This study examines associations between lifetime tobacco exposure-active smoking and SHS-and infertility and natural menopause (before age 50).
  
  
  
  Information on smoking, lifetime fertility status, and age at natural menopause was collected and available from 93 676 postmenopausal women aged 50-79 enrolled in the WHI OS from 1993 to 1998 at 40 centres in the USA. Multivariate-adjusted regression models were used to estimate ORs and 95% CI according to levels of active smoking and SHS exposure, and trends were tested across categories.
  
  
  
  Overall, 15.4% of the 88 732 women included in the analysis on infertility met criteria for the condition. 45% of the 79 690 women included in the analysis on natural menopause (before age 50) met criteria for the condition. Active-ever smokers had overall OR's of 1.14 (95% CI 1.03 to 1.26) for infertility, and 1.26 (95% CI 1.16 to 1.35) for earlier menopause than never-smoking women. Never-smoking women with the highest levels of lifetime SHS exposure had adjusted OR's of 1.18 (95% CI 1.02 to 1.35) for infertility, and 1.18 (95% CI 1.06 to 1.31) for earlier menopause. Active-ever smokers reached menopause 21.7 months earlier than the mean of 49.4 years for never-smokers not exposed to SHS, and women exposed to the highest level of SHS reached menopause 13.0 months earlier.
  
  
  
  Active smoking and SHS exposure are associated with increased risk of infertility and natural menopause occurring before the age of 50 years.
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hyland
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Piazza
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, School of Public Health & Health Professions, Buffalo, New York, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Hovey
authors.affiliation: Division of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
authors.affiliation: Department of Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Division of Behavioral and Community Health, University of New York at Stony Brook, Stony Brook, New York, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Messina
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rivard
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, School of Public Health & Health Professions, Buffalo, New York, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000209:etiology; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Secondhand smoke; Smoking Caused Disease; Surveillance and monitoring