Can you name some of the biggest public health epidemics?

You’re probably thinking influenza, human immunodeficiency virus (HIV), Ebola, or, for the history lovers among us, bubonic plague.

Did you know that tobacco use is one of them?

Tobacco use kills 8 million people worldwide every year, according to the World Health Organization. The CDC confirms that it’s the leading cause of preventable death in the US: more people die from cigarette smoking each year than HIV, illegal drug use, alcohol use, car crashes, and guns combined.

No matter your age, smoking is one of the worst decisions you can make for your health. The 250 harmful chemicals in cigarette smoke cause all forms of cancer (not just lung cancer), emphysema, diabetes, heart disease, and a host of other issues in both smokers and those exposed to secondhand smoke.

However, there are few additional concerns that pre-menopausal, perimenopausal, and menopausal smokers need to be aware of.

Cigarette smoking amplifies what’s already bad about menopause

Earlier Menopause

If you’re pre-menopausal or perimenopausal, you have an extra big reason to kick cigarettes to the curb.

“Women who smoke can actually go into menopause a full year earlier than other people,” said Dr. Wendy Ellis, Naturopathic Physician and educator.

Tobacco users are 43% more likely to have early menopause compared to those who don’t. This means less time with the protective benefits of estrogen, leading to higher incidences of osteoporosis, heart disease, diabetes, obesity, and Alzheimer's disease post-menopause.

“Can’t I just supplement my estrogen with hormone replacement therapy,” you may ask?

“Hormone replacement therapy can be very beneficial for hot flashes. However, in smokers, it increases the risk of cardiovascular disease,” cautioned Dr. Ellis. “Therefore, although it is not out of the question, it is not recommended to combine smoking and hormone replacement.”

Speaking of hot flashes...

More frequent and severe hot flashes

Your face turns red, your heart races, you want to rip off your sweat-drenched clothes in the middle of your presentation to the board: you’re having a hot flash.

If you’ve had one, you know: hot flashes are a drag.

And here’s something to think about the next time you take a drag off a cigarette: “Smoking can make hot flashes worse,” said Dr. Ellis.

Women who smoke experience more frequent and severe hot flashes during menopause than women who don’t, especially if you’re African American or carry certain gene variants.

Bone loss and osteoporosis

Women who smoke have twice the risk of a fracture as non-smokers, as bone loss in women who smoke happens faster than in those who don’t, increasing the risk of osteoporosis.

This happens because cigarette smoke creates free radicals, molecules that attack the organs, hormones, and cells responsible for keeping your bones healthy, including the cells that regenerate bone.

Smoking reduces also blood flow throughout your body, which in turn damages your nerves. When your feet and toes lose feeling, you’re more likely to fall on your already weakened bones.

Vaginal dryness

As estrogen production decreases in menopause and further decelerates from smoking, so does the production of lubricating fluid in your vagina. Vaginal dryness can make activities like exercise and sex very uncomfortable to downright agonizing.

Less estrogen production from smoking = less natural lubrication. Ouch.

Dry Eye Disease

Like your vagina, your eyes need moisture, and when sex hormones fall because of menopause and smoking, it can lead to itchy, gritty, painful, stinging, blurry Dry Eye Disease. The particles in smoke itself can further irritate your eyes.

Second-hand smoke causes first-hand damage

The link between second-hand smoke and the severity of menopause is well-documented. If you’re a non-smoker but are frequently exposed to others’ smoke, all of the above applies to you as well.

How to quit for good

It’s perfectly normal to be scared of quitting, especially before and during menopause. Maybe you’re worried you’ll gain weight as your body is already going through changes. Maybe you’re worried about increased irritability when you already want to bite off your partner’s head.

Talk to your doctor or one of ours about quitting. They should ask you about your smoking habits during your regular office visits, and if they do not, bring it up. Insurance companies in the US are required to provide support for smoking cessation, but you can’t get this help if your doctor doesn’t know you need it.

Your doctor will assess that you are ready, help you develop a quitting plan, and give you the resources you need.

Many healthcare professionals recommend a combination of behavioral and pharmacologic therapies.


“Some people go cold turkey, and that works, for some,” said Dr. Ellis. “Most people really need medical intervention.”

Talk to your doctor about...

Nicotine replacement therapy (NRT). Cigarette smoke contains thousands of chemicals, but nicotine is the one that hooks you. NRT gives you just the nicotine, minus the other toxins, in the form of gum, patches, lozenges, sprays, and inhalers. Over time, you gradually step down your nicotine consumption. Short-acting NRTs like varenicline (Chantix) block the effects of nicotine on your brain to reduce your urge to smoke.

Note: E-cigarettes are not an NRT. People have been gravitating to vaping as an alternative to smoking, but don’t buy into the hype: “In light of the lung diseases now being found to be associated with vaping, we cannot recommend vaping as an alternative to cigarette smoking,” said Dr. Ellis.

Mood stabilizing medications. Kids, bills, fluctuating hormones: you’re already more irritable than you would like to be without nicotine withdrawals. Talk to your doctor about mood support. She may recommend an antidepressant like a selective serotonin reuptake inhibitors (SSRI) to balance the chemicals in your brain while you’re adjusting to your new, smoke-free lifestyle. If you’re worried about the stigma of medication, don’t be: antidepressant use is likely more common than you think.

Behavioral therapy

When you’re ready to quit, counseling in the form of one-one meetings or group therapy can make a huge difference. Many providers offer options in-person, over the phone, or through the web to fit your schedule: you have no excuses.

Alternate therapies

There are other options that you can explore as well.

  • Cognitive-behavioral therapy (CBT). You used to enjoy your morning cigarette break. What do you do now? With CBT, you can train your brain to break the habits that lead you to wanting a smoke. (Yes, it works!)
  • You’re getting very sleepy… and you could wake up without cravings. While studies have not confirmed whether or not hypnotherapy works for nicotine addiction, some former smokers swear by it.
  • Put a pin in your addiction: acupuncture is proven to be clinically effective as a form to smoking cessation. Good news if you’re afraid of needles: most people receiving acupuncture don’t even feel them.

If you’re worried about weight changes

  • Keep your blood sugar stable. Many people experience a drop in blood sugar during the first three days of quitting, which increases withdrawal symptoms like headaches, dizziness, and cravings for desserts. Pick healthy snacks like yogurt, fruit, or air-popped popcorn.
  • But don’t substitute sweets for cigarettes. Many smokers try to replace the ‘hand to mouth’ act of smoking with food or use sugary treats to balance their mood. This can lead to weight gain and irritability.
  • Get more exercise. Exercise burns off those extra calories you may be snacking on and stabilizes your mood.
  • Work with a dietitian to determine a balanced, healthy diet. Depriving yourself of food to avoid weight gain causes drops in dopamine levels, which increases your cravings for nicotine and makes it harder to quit.

Need a little extra motivation? Gennev's health practitioners can help you manage your cravings and any other concerns.

You are not alone in this

Most smokers attempt to quit a number of times before kicking the habit for good. Research shows that the more support and reinforcement a person receives during and after quitting, the better their long-term outlook for staying smoke-free.

Lean on others who have been there

We’re here to help. Share your questions or tips for quitting smoking in Gennev's online community  to connect with other women who have quit smoking for good.

Additional resources

  • The Great American Smokeout: The American Cancer Society offers support ranging from phone to text to a free ride to treatment.
  • Stop Smoking: Call the American Lung Association at 1-800-LUNGUSA or visit online for chat support.
  • National Cancer Institute: The National Cancer institute provides a bevy of cancer research, and they also run a hotline to help you quit: 1-877-44U-QUIT(1-877-448-7848)
  • Smokefree: Smokefree has tools targeted specifically to women. The site can even help you build your quit plan.

A new, smoke-free you starts today! Or whenever you’re ready to quit.

Have you quit smoking or are you trying to quit? We'd love to hear more about it, and support your efforts to be smoke-free, so join our community forums and tell us all about it. 

Helen PitlickWriter Helen Pitlick is a seasoned communicator with a master's degree in digital media to back it all up, Helen loves to create content that helps women feel more confident at all stages of their lives. When she's not in front of her laptop, Helen enjoys pottery, pretending to play soccer, and hanging out with her dog.