Association Between Smoking and Premenstrual Syndrome: A Meta-Analysis Original paper

What was reviewed?

This meta-analysis systematically reviewed studies investigating the association between smoking and premenstrual syndrome (PMS). The authors sought to quantify the relationship between smoking behaviors and the risk of developing PMS or its more severe form, premenstrual dysphoric disorder (PMDD). Thirteen studies involving 25,828 participants were included in this analysis, which aimed to synthesize the results from multiple cohorts, case-control, and cross-sectional studies. The review specifically examined the effect of smoking on the likelihood of developing PMS, with a focus on the severity of symptoms and potential biological mechanisms.

Who was reviewed?

The studies reviewed in this meta-analysis involved a range of populations, including university students, general populations, and patients from different regions. Participants were primarily women of reproductive age, including those diagnosed with PMS or PMDD. The reviewed studies used varying methods for assessing smoking (e.g., self-reported smoking status, smoking quantity) and PMS (e.g., standardized questionnaires, prospective symptom tracking). The sample sizes ranged from smaller case-control studies with fewer than 100 participants to larger cross-sectional studies with over 3,000 participants.

What were the most important findings?

The meta-analysis found a statistically significant association between smoking and the increased risk of PMS. Specifically, smoking was linked to a moderate increase in the odds of developing PMS. This relationship was even stronger for PMDD. The results indicated that women who smoke are more likely to experience PMS, with a stronger association observed in women with the more severe form of PMS, PMDD. Interestingly, the study also identified that smoking behavior during the luteal phase of the menstrual cycle may be influenced by hormonal fluctuations, with nicotine intake potentially exacerbating mood disturbances commonly associated with PMS. Nicotine’s effects on the hypothalamic-pituitary-adrenal (HPA) axis, which is already compromised in PMS, may worsen the stress response, further complicating both PMS and Tobacco Use Disorder in this population.

What are the greatest implications of this review?

The findings suggest that smoking should be considered a modifiable risk factor for PMS and PMDD. The moderate increase in risk, particularly for PMDD, highlights the need for targeted interventions in women who smoke, particularly those suffering from PMS. Clinicians should be aware of the potential exacerbating effects of smoking on menstrual health and consider integrating smoking cessation strategies into the management plans for women with PMS or PMDD. Additionally, the review emphasizes the need for further research into the underlying biological mechanisms, including the role of nicotine in neurocircuitry and stress responses, to improve treatment strategies for both PMS and smoking dependence.