Here's another reason not to smoke if you're a woman.

Women from 27 to 44 years old who smoke are twice as likely to develop pre-menstrual syndrome (PMS) over the next two to four years, especially hormonally related symptoms like backaches, bloating, breast tenderness and acne, Dr Elizabeth Bertone-Johnson of the University of Massachusetts in Amherst and her colleagues found.

"Our findings lend further support to the idea that smoking increases the risk of moderate to severe PMS and provides another reason for women, especially adolescents and young women, not to smoke," Dr Bertone-Johnson told Reuters Health.

Up to 20 per cent of women have PMS severe enough to affect their relationships and interfere with their normal activities, Dr Bertone-Johnson and her team noted in the American Journal Of Epidemiology.

Smoking has been shown to affect levels of several different hormones and the handful of studies looking into PMS and smoking have suggested that women with the syndrome are more likely to be smokers, the researchers added.

To investigate the relationship further, they analysed data from the Nurses' Health Study II, which has been following 116,678 United States registered nurses since 1989.

The researchers looked at a subset of women who were PMS-free during the first two years of the study, comparing 1,057 who did go on to develop PMS to 1,968 who did not.

The women who were current smokers were 2.1 times more likely than non-smokers to report PMS within the next two to four years, the researchers found.

The risk increased with the amount they smoked and women who had picked up the habit in adolescence or young adulthood were at even greater risk. Those who had begun smoking before their 15th birthday, for example, were 2.53 times more likely to develop PMS.

"Our findings do not suggest that this is entirely due to the fact that women who start smoking at younger ages smoke for more years than those who start when they are older. Additional research on the impact of smoking at different times in women's lives is needed," Dr Bertone-Johnson said.

She continued: "Previous studies suggested that smoking may alter levels of oestrogen, progesterone, testosterone and other hormones, many of which may be involved in the development of PMS.

"Some studies have found that smokers have shorter and more irregular menstrual cycles than non-smokers.

"Smoking may also lower levels of vitamin D in the body, which also may increase a woman's risk of developing PMS."

This article was first published in Mind Your Body, The Straits Times on November 20, 2008.

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