The Unique Dangers of Smoking for Women

Woman smoking in outdoor cafe
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Most people are familiar by now with the warnings about smoking, especially since cigarettes can cause cancer and increase the risk of heart disease. However, it is important to recognize that women smokers face unique challenges. The fact is that approximately 23 million women in the U.S. (23% of the female population) still smoke cigarettes.

This article discusses the health concerns that women smokers face. It covers the risks to mental health, women's health, and other physical health issues.

Statistics on Women Smokers

Smoking is the most preventable cause of death in the U.S. Yet according to the Centers for Disease Control and Prevention, more than 200,000 women die each year from smoking-related causes. The highest rate of smoking (16.7%) occurs among women between 25 and 44. While men are slightly more likely to smoke than women, nearly 13% of women still smoke.

Despite all the warnings that today's teens have heard about the dangers of smoking, the reality is that almost all of the new smokers today are teenagers. The CDC reports that in 2020, 3.9% of teen girls smoke cigarettes, and 22.5% use some form of tobacco product (which may include e-cigarettes, hookas, or cigars.)

Women who smoke are at risk of the same health concerns as men who smoke such as the 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.

Recap

Smoking rates have declined in recent years, but a large percentage of girls and women continue to smoke cigarettes and consume tobacco in other forms.

Mental Health Risks of Smoking

Studies have found that women who smoke are also more likely to have mental health problems. In one study published in the Journal of Women's Health, women who smoked had significantly higher rates of:

Women smokers were also much more likely to have experienced childhood abuse and intimate partner violence.

The CDC notes that people with mental health or substance abuse disorders smoke cigarettes at higher rates than people who do not have mental health conditions. Around 25% of adults in the U.S. have some type of mental or behavioral health condition and these individuals make up 40% of all adult cigarette use.

This has a significant impact on the health and wellness of people with mental health conditions. The CDC suggests that people with serious mental health disorders who smoke die 15 years earlier than people who do not have mental health conditions and who do not smoke.

Nicotine may also affect health by masking the symptoms of some mental health conditions and impairing the efficacy of some mental health medications. Having a mental health condition may also make it more difficult for women to quit smoking.

Recap

Women smokers are more likely to have co-occurring substance use and mental health conditions. Statistics suggest that smokers who also have mental health issues face increased mortality risks. 

Women's Health and Smoking

Smoking can also have an impact on women's health including areas such as birth control, fertility, pregnancy, pelvic inflammatory disease, and menopause.

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. Some newer 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.

Pregnancy

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 the CDC, smoking during pregnancy increases the risk of:

  • Preterm birth
  • Low birth weight
  • Birth defects of the mouth and lip
  • Sudden infant death syndrome (SIDS)

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.

Infertility

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.

A 2017 study found that women who smoked six or more cigarettes a day experienced significant harm to their ability to conceive.

Studies suggest 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.

It is important to note, however, that smoking doesn't just affect a woman's fertility. 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 a greater 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

Research has found that women who smoke have a 43% increased risk of experiencing menopause before the age of 50 compared to non-smokers. 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.

Recap

Women smokers face increased risks when taking oral contraceptives and are more likely to have issues with pregnancy and fertility. Other issues specific to women's health including an increased risk of pelvic inflammatory disease, premature menopause, and hormone therapy isssues.

Physical Health Risks of Smoking

Women also have unique risks to their physical health. Smoking can increase the risk of certain illnesses and diseases and can impact bone health and heart health. Tobacco products also increase the risk of several types of cancers that affect women.

Osteoporosis

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 cigarettes experience a higher loss of bone density than nonsmokers. Research suggests that women who smoke have a 31% higher risk of osteoporosis. Smoking also slows down healing time after a bone fracture. 

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

According to the CDC, one in every four deaths caused by cardiovascular disease can be attributed to smoking. Although most of these deaths are in women past menopause, the risk of smoking-related heart disease is significantly higher in young women smokers.

According to a 2019 study published in the Journal of the American College of Cardiology, women smokers under the age of 50 have a higher risk of having a specific type of serious heart attack compared to men. 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. According to the American Cancer Society, smoking doubles the risk of developing cervical cancer.

Cervical cancer patients who quit smoking may have a greater chance of remission and survival than patients who continue smoking.

Researchers believe that tobacco damages the DNA cells of the cervix which contributes to the development of cancer. Smoking also affects immunity, which may make the body less able to fight off HPV infections, which are also a risk factor for cervical cancer.

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. This risk increases significantly in women who smoke and who have a history of HPV infection.

Recap

Women have a higher risk of experiencing physical health problems associated with smoking including osteoperosis, heart disease, cervical cancer, breast cancer, and vulvar cancer.

Tips for Quitting

There are different approaches to quitting smoking. One strategy is to quit cold turkey. Another approach is to gradually taper your smoking. Both can be effective, so choose the one that is right for you and your needs.

If you are planning to stop smoking cold turkey, some tips that may help include:

  • 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.

A Word From Verywell

Smoking is a leading cause of death for women, so it is important to be aware of the health risks. Not only can smoking increase your risk for cancer, heart disease, and other health problems, it can also create problems if you are trying to conceive or are currently pregnant. Fortunately, there are tools and resources that are available to help you stop smoking. Quitting now can help lower your health risks and improve your overall health.

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