Smoking and vaping = worse PMS and PMDD

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Smoking and vaping = worse PMS and PMDD



  • Key finding: A review of 13 studies shows that cigarettes, e-cigarettes and other nicotine products are linked to worse PMS and PMDD symptoms.

MARCH 2, 2021—Despite the many health hazards of smoking cigarettes and vaping nicotine (including heart trouble, stroke and cancer), they’re still popular habits. So, if you need one more excuse to kick your unhealthy nicotine addiction, consider this:

A 2020 meta-analysis of 13 studies involving 25,828 menstrual cycling women found that using nicotine makes you one-and-a-half times more likely to have worse symptoms of premenstrual syndrome (PMS).1 These symptoms can include worry, sadness, irritability, sleep problems and aches that crop up in the six days leading up to your period.

But, the findings are even more startling for those with premenstrual dysphoric disorder (PMDD)–a condition where severely bothersome symptoms (such as depression, anxiety, anger, insomnia and pain) interfere with everyday life during the one to two weeks before your period. The same study found that nicotine makes you three times more likely to have worse symptoms of PMDD.

The nicotine/premenstrual link

Reporting in the journal Frontiers in Psychiatry, University of Illinois at Chicago researchers explain that nicotine disrupts the balance of a part of the brain that handles stress–the hypothalamic-pituitary-adrenal (HPA) axis.

The result: You become more sensitive to stress triggers and your body churns out greater amounts of stress hormones, such as cortisol. All this extra stress can put you on edge, affect your mood, impair sleep and cause muscle tension that intensifies aches and pains.

Unfortunately, during your pre-period days, dropping levels of estrogen are already putting you at risk of emotional and physical symptoms by altering levels of mood-affecting brain chemicals, such as serotonin.

In fact, the study authors point out that many women use cigarettes and vaping as a way to help counter hormone-fueled premenstrual complaints. That’s because the initial rush of nicotine, which is a stimulant drug, lights up reward centers in the brain, giving you a quick mood boost…before it goes on to throw off your stress-regulating HPA, making pre-period problems even worse.

The takeaway

If you smoke, vape or use other nicotine products, you’ll be doing your health a favor by quitting. And an added bonus is that there’s a good chance it will help lessen PMS and PMDD symptoms.

Cycle-syncing tip: When to quit nicotine

If you’re looking for an optimal time in your menstrual cycle to quit smoking or vaping, I recommend aiming for Day 4 of your cycle (that’s 4 days into your period) through ovulation. On these cycle days, estrogen is rising, which results in fewer withdrawal symptoms, such as irritability and aches, compared to the second half of your cycle (the day after ovulation through the day before your next period) when estrogen dips twice.

But be careful if you slip and use nicotine while trying to quit on these cycle days: Rising estrogen intensifies the pleasurable feeling you get from this stimulant, making it more difficult to give it up for good. So, have a plan ready if you happen to cave to a craving, for example, allow yourself the mistake, but resolve to not beat yourself up about it, then try quitting again.


Do you have PMDD or suspect someone you know may have it? Learn more about this condition that strikes up to an estimated 1 in 10 of those with menstrual cycles at the International Association of Premenstrual Disorders at They offer peer counseling and share the latest news and treatments.

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(1) So Hee Choi, Ajna Hamidovic, “Association Between Smoking and Premenstrual Syndrome: A Meta-Analysis”, Frontiers in Psychiatry, published online November 26, 2020

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