The Unique Dangers of Smoking for Women

Woman smoking in outdoor cafe
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We all have heard the warnings about smoking, especially that cigarettes can cause cancer and increase our risk of heart disease, but women smokers face unique challenges. The sad fact is that approximately 23 million women in the U.S. (23% of the female population) still smoke cigarettes.

Smoking is the most preventable cause of death in the U.S., yet more than 140,000 women die each year from smoking-related causes. The highest rate of smoking (27%) occurs among women between 25 and 44.

Despite all the warnings today's teens have heard about the dangers of smoking, the reality is that almost all of the new smokers today are teenagers; over 1.5 million teenage girls smoke cigarettes.

Women who smoke are at risk of the same health concerns as men who smoke such as increased risk of various cancers (including lung, mouth, larynx, pharynx, esophagus, kidney, pancreas, kidney, and bladder) and respiratory diseases, but there are also smoking-related health risks that are unique to women.

Oral Contraceptives

Oral contraceptives ("the pill") and other hormonal methods of birth control come with risks and warnings specifically for people who smoke.

Women who smoke and use oral contraceptives have an increased risk of developing cardiovascular diseases such as blood clots, heart attacks, and strokes. This risk increases with age, and women over 35 who smoke should not use oral contraceptives.

Historically, people who used the pill also experienced a mild elevation in blood pressure. However, blood pressure often returned to normal "pre-pill" levels once oral contraceptives were discontinued. New studies indicate that high blood pressure is not a common problem today. Nonetheless, all people who take oral contraceptives should have their blood pressure checked every six to 12 months.


Chemicals in cigarettes are passed from pregnant people through the bloodstream to the fetus. These toxic chemicals present serious risks to the unborn child as well as the pregnant person. According to "Our Bodies, Ourselves for the New Century," by the Boston Women's Health Book Collective:

"Smoking during pregnancy is associated with preterm delivery, low birth weight, premature rupture of membranes, placenta previa, miscarriage, and neonatal death. Newborns whose mothers smoked during pregnancy have the same nicotine levels in their bloodstreams as adults who smoke, and they go through withdrawal during their first days of life."

Children born to mothers who smoke experience more colds, earaches, respiratory problems, and illnesses requiring visits to the pediatrician than children born to people who don't smoke.


Is a baby part of your future plans? Many women today delay childbirth until they are in their 30s or even 40s, which can cause fertility problems even for nonsmoking women. But women who smoke and delay childbirth are putting themselves at a substantially greater risk of future infertility than nonsmokers.

The fact is female smokers have around 72% of the fertility of nonsmokers. When all other factors are equal, it is 3.4 times more likely that smokers will require over one year to conceive.

Increasingly, studies are showing that decreased ovulatory response, as well as the fertilization and implantation of the zygote, may be impaired in women who smoke. Chemicals in tobacco may also alter the cervical fluid, making it toxic to sperm causing the pregnancy to be difficult to achieve.

We can't leave the men out on this one, though. Male smokers are 50% more likely to become impotent. Some of the toxic chemicals found in cigarettes may result in gene mutations that can also cause miscarriage, birth defects, cancer, and other health problems in their children.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease occurs with 33% more frequency in smokers than in nonsmokers.

What Is PID?

Pelvic inflammatory disease (PID) is a painful disease that requires immediate medical intervention and is often a contributing factor in ectopic pregnancies as well as pelvic adhesions and other fertility problems.

Premature Menopause

Beginning to smoke as a teenager increases a woman's risk of early menopause three times. Women who smoke notice symptoms of menopause two to three years earlier than nonsmokers on average. Menstrual problems such as abnormal bleeding, amenorrhea (absence of periods), and vaginal infections are also common complaints among women who smoke.

Menstrual abnormalities and early menopause may be caused by a toxic effect on the ovaries or by the significantly lower levels of estrogens noted in many studies of women smokers.

Hormone Therapy

Estrogen replacement therapy provides beneficial protection to post-menopausal women against the risk of osteoporosis. But these benefits are many times negated by the increased cardiovascular and other health risks associated with smoking while taking hormones.

Women who smoke face increased risk of developing cardiovascular diseases such as heart attack and stroke when using estrogens.

This risk should be discussed with your physician before beginning hormone replacement therapy if you are a smoker. Your doctor will assist you if you choose to quit smoking.


Osteoporosis affects most of us if we live long enough. But there are certain things we can do to reduce our risk of osteoporosis such as participating in regular physical activity and making sure we are getting 1,000mg to 1,500mg of calcium daily.

Smoking causes a significant increase in the risk of bone loss and osteoporosis. Women who smoke one pack of cigarettes a day may experience a loss of bone density equaling 5% to 10% more than nonsmokers by the time they reach menopause.

Bone density scanning to determine the density of your bone structure is recommended for all women beginning at age 40. Bone density scanning is particularly crucial for women who smoke so that changes can be noted and treatment can be started if osteoporosis is noted.

Heart Disease

Approximately 34,000 deaths in women from ischemic heart disease are attributed to smoking each year. Although most of these deaths are in women past menopause, the risk of smoking-related heart disease is significantly higher in young women smokers.

Researchers in Denmark have found a 50% greater risk of a heart attack in women smokers over men smokers. This difference may be due to the interaction of estrogen with the chemicals found in cigarettes.

Cervical Cancer

All women should have regular pelvic exams that include pap smears, and for women who smoke, the necessity is even greater. Studies show that smoking may lead to the development of cervical cancer; one study found an 80% greater risk of developing cervical cancer in smokers.

Cervical cancer patients who quit smoking or who cut down by at least 75% may have a greater chance of remission and survival than patients who continue smoking.

Chemicals found in cervical tissue that are also found in cigarettes may weaken the ability of cervical cells to fight off infection and may create a potential breeding ground for abnormal and cancerous cervical cells to multiply.

Breast Cancer

The American Cancer Society published the results of a study in 1994 which indicated that breast cancer patients who smoke may increase their risk of dying at least 25%—a risk that increases with the number of cigarettes smoked per day.

The possible risk of fatal breast cancer rises up to 75% for women who smoke two packs or more per day. The good news is that if you quit now, your potential risk of dying as a result of future breast cancer remains the same as for a non-smoker.

Vulvar Cancer

Another type of cancer that may occur more frequently in women who smoke is vulvar cancer. Women who smoke experience a 40% higher risk of developing this type of gynecological cancer.

Tips for Quitting

Plan ahead to quit smoking on a certain day. When the quit smoking day arrives, make sure you have thrown out all the ashtrays and cigarettes you have in your home so you won't be tempted. Have plenty of raw vegetables such as carrot sticks and celery available for the times you feel like eating as a result of your desire to have something in your hand/mouth.

Many women fear gaining weight as a result of quitting. Participating in a vigorous exercise program three times per week may help you quit, and exercise can help limit any subsequent weight gain as well as providing overall health benefits.

Joining a support group and actively participating often helps women when difficult times or emotional conflicts occur. Over-the-counter methods that supply nicotine in forms such as gums like Nicorette and patches such as the NicoDerm CQ patch help many people decrease the physical symptoms of nicotine withdrawal. Never smoke simultaneously with one of these methods—nicotine overdose may occur.

See your physician if you need further assistance in achieving your quit smoking goal. They can offer additional methods which are available by prescription.

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