For women in midlife, smoking can make menopause symptoms even worse. Anxiety, mood swings, sleep, skin issues and hot flashes get worse when you smoke. Trust me, you’ll really want to get rid of hot flashes when you smoke. 

Yes, we’re here to warn you about smoking and estrogen--it’s not good news. But you’re also going to get a complete picture of the female body on cigarettes. Did you know that tobacco is one of the biggest public health epidemics in the U.S.? The Centers for Disease Control and Prevention (CDC) reports that it’s the leading cause of preventable death in the U.S. More people die from cigarettes each year than HIV, illegal drug use, alcohol use, car crashes, and guns combined. Use the information below to make the right decision about smoking for yourself. Hint: It probably involves giving up the ciggies.

If you need help letting go of cigarettes, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

How Does Smoking Affect Estrogen Levels?  

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 a few additional concerns that premenopausal, perimenopausal, and menopausal smokers need to be aware of. Strap in. It’s going to be a bumpy ride.

Let’s start with the science. The National Center for Biotechnology Information (NCBI) shows “Smoking-attributed nicotine is known to inhibit aromatase enzyme activity, which catalyzes the conversion of androgens into estrogens. Consequently, nicotine reduces circulating estrogen levels and leads to early onset of menopause in women.” In plain speak, this means smoking not only makes your estrogen levels fall faster than a non-smoker’s menopausal estrogen experience, but it also brings on menopause sooner. And, as you likely already know, decreasing estrogen (as well as other key hormones) is tied to many menopause symptoms. So we’re looking at a habit that has the ability to both intensify menopause symptoms and start this midlife process sooner. This is a lose-lose, if there ever was one.

You might be wondering if it’s possible to simply supplement your estrogen with hormone replacement therapy (HRT). “HRT can be very beneficial for some menopausal women. However, in smokers, it increases the risk of cardiovascular disease,” cautioned Naturopathic Doctor and educator Wendy Ellis.** “Therefore, although it is not out of the question, it is not recommended to combine smoking and hormone replacement.”

Gennev menopause-certified gynecologists can give you a trusted opinion and if medication is right for you, they can provide prescription support. Book an appointment with a doctor here

Cigarettes Amplify What’s Already Bad About Menopause

Remember when your parents used to tell you, “If you don’t have anything good to say, don’t say anything at all”? They were talking about menopause symptoms. From a dry vagina to insomnia and every last challenging point in between, the midlife woman’s experience is not easy. So why would you do something that only made things worse? Because that’s what smoking does. No joke.

Earlier menopause

If you’re perimenopausal, you have an extra reason to kick cigarettes to the curb. “Women who smoke can actually go into menopause a full year earlier than other people,” says Dr. Ellis. 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 bone issues, heart disease, diabetes, obesity, and Alzheimer's disease post-menopause.

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 awful.

And here’s something to think about the next time you light up: “Smoking can make hot flashes worse,” says Dr. Ellis. Women who smoke experience more frequent and severe hot flashes during menopause than women who don’t, especially if they’re African American or carry certain gene variants.

Bone loss and osteoporosis 

Women who smoke are two times more at risk for fractures than non-smokers. Bone density decreases loss in women who smoke happens faster, increasing the risk of osteoporosis. This is due to the free radicals cigarette smoke creates--molecules that attack the organs, hormones, and cells responsible for keeping your bones healthy, including the cells that regenerate bone. Smoking also reduces 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. You’ll definitely need feminine dryness remedies Less estrogen production (in part from smoking) equals less natural lubrication. Ouch.

Dry eye disease 

Like your vagina, your eyes need moisture, and when sex hormones fall due to menopause and smoking, it can lead to itchy, gritty, painful, stinging, blurry Dry Eye Disease. Dry eyes and menopause is no fun. Bonus, the particles in the smoke itself can further irritate your eyes.

Second-hand smoke 

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. Talk about a drag.

How to Quit For Good

It’s perfectly normal to be scared of quitting, especially before and during menopause. Maybe you’re thinking you’ll gain hormonal weight. Or you’re worried about increased irritability.

Talk to your doctor* or one of ours about quitting. They should ask about your smoking habits during your regular office visits, and if they don’t, bring it up. Insurance companies in the U.S. are required to provide support for smoking cessation, but you can’t get this help if your GP doesn’t know you need it. Your doctor will assess your situation, 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 it works,” says Dr. Ellis. “But most people really need medical intervention.”

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 being linked with vaping, we cannot recommend it as an alternative to cigarette smoking,” Dr. Ellis suggests.

Mood support

You’re likely already more irritable than you would want to be without nicotine withdrawals. So talk to your doctor about mood support. She may recommend an antidepressant-like selective serotonin reuptake inhibitor (SSRI) to balance the chemicals in your brain while you’re adjusting to your new, smoke-free lifestyle. 

Behavioral therapy

Menopause affects mental health in many ways. Many women have reported that behavioral therapy can make a huge difference when tackling their emotional issues and their tobacco addiction. Many providers offer options in-person, over the phone, or through the web to fit your schedule.

Alternative options

You used to enjoy your morning cigarette break. What do you do now? With Cognitive-behavioral therapy (CBT), you can train your brain to break the habits that lead you to wanting a smoke. Or, 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. Finally, how about putting a pin in your addiction? Acupuncture in menopause is proven to be a clinically effective method. Good news if you’re afraid of needles: Most people receiving acupuncture don’t even feel the needles.

You Aren’t Alone In This

Most smokers attempt to quit a number of times before kicking the habit for good. Research shows the more support and reinforcement a person receives during and after quitting, the better their long-term outlook for staying smoke-free. So lean on those you know who’ve fought the fight and won. And take advantage of the many resources out there just waiting to help:

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> has tools targeted specifically to women. The site can even help you build your quit plan. And we’re here to help, too.

Share your questions or tips for quitting smoking in Gennev's online community to communicate with other women who have quit smoking for good. Through determination, grit, and tapping into a powerful community of smokefree women, you’ll not only solve the smoking and estrogen issue, but every other nasty, sneaky way that nicotine is negatively impacting your life.

A menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

Dr. Wendy Ellis is a Seattle-based Naturopathic Doctor and educator.

*It is not Gennev’s intention to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and Gennev urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.

**We are providing these links for informational purposes only; they do not constitute an endorsement or an approval by Gennev of any of the products, services, or opinions of the corporation, or organization, or individual. Gennev bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links.

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


Shannon Perry

October 15, 2019
Director of Programming & Media

Medically Reviewed By

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