Endometriosis And Smoking


Endometriosis is a condition that is thought to affect more than 10% of the women population.1 The diagnosis can be complex and many women may experience the signs of symptoms of endometriosis for years before a diagnosis can be made, leading to frustration and distress. Like many diseases, there are also lifestyle factors that are associated with endometriosis, and the relationship between smoking and endometriosis has long been studied. Let’s find out what science says. 

What is endometriosis?

The endometrium is the inner lining of the uterus, the part that is functionally active in gestation and assists in building the placenta and nourishing the baby during pregnancy. As the functional tissue of the uterus, this is the part that undergoes hypertrophy (growth) during the first part of the menstrual cycle and gets ready to support gestation after ovulation. If conception does not occur, the highly developed endometrial tissue loses its hormonal support, dies and gets shed. This is what menstruation is. And endometriosis is the abnormal presence of endometrial tissue in areas of the body that are not the uterus (the presence of tissues in organs where the tissue is not normally located is called ectopic tissue). Endometriosis can occur anywhere in the body - from anatomically adjacent areas like the ovaries and the bowels to the brain or eyes. No matter where the ectopic endometrial tissue is located, it will be hormone-sensitive, and thus affected by the menstrual cycle.2 


The signs and symptoms of endometriosis are highly dependent on where the ectopic endometrial tissue is located. Though endometriosis can occur anywhere in the body, it is by far most commonly seen in the pelvic area and one of the major symptoms of pelvic endometriosis is recurrent pelvic pain. This pelvic pain most commonly presents as abnormally severe period cramps that can occur up to a week before menstruation begins and can last many days after the period ends. The development of severe period pain (also called dysmenorrhea) especially in women whose periods in the past were not associated with the same, severe level of pain should raise suspicion for endometriosis. In addition, endometriosis is also associated with pain during sexual intercourse (dyspareunia), chronic intermenstrual pelvic pain and subfertility, and even infertility. In addition, as the bowels and the bladder are also pelvic organs that can be affected by pelvic endometriosis, changes in bowel habits, constipation, dysuria (pain upon urination) and even periodic bleeding in the stool or urine are potential signs and symptoms.3

Moreover, although rare, extrapelvic endometriosis can be associated with severe headaches, seizures, blurry vision, coughing up blood, nosebleeds and many other symptoms that coincide with the menstrual cycle. Diagnosis can be challenging, but any alarming symptom that is associated with the menstrual cycle should be evaluated by a gynaecologist.4

The connection between endometriosis and smoking is ambiguous

Though diagnosis and treatment of endometriosis is a very complex topic that is beyond the scope of this article, there are certain lifestyle considerations that women who have been diagnosed with or are suspicious of endometriosis should be aware of. There is high-quality evidence supporting that a diet rich in fish oil and vitamin B12 is associated with a reduction in endometriosis symptoms (especially pain) and that alcohol consumption and a diet excessive in red meat are associated with an increase in symptoms.5,6 No association has been found in one review article between endometriosis symptoms and physical exercise.7 and studies about the connection between endometriosis and tobacco smoking have given ambiguous and often contradictory results.8

Indeed, a careful review of the medical literature presented by the most comprehensive and extensive study of these potential connections found that neither a positive nor a negative association has been detected for either nonsmokers, ex-smokers, moderate smokers or heavy smokers in any type and location of endometriosis.8

That said, smoking is known to interfere with the normal bodily functions of oestrogen, and in contrast to virtually every other known form of cancer, smoking is known to confer a protective effect on a very specific group of oestrogen-dependent cancers, which are endometrial cancer, endometrioid and clear cell ovarian cancers, and thyroid cancer.9 Though a curious observation, this protective effect is minuscule compared to the extremely elevated risks of a myriad of conditions that are associated with smoking, among which are every other form of cancer other than these four. 

Smoking whilst pregnant increases the risk of endometriosis for the baby

Though smoking appears to not affect the development or severity of endometriosis, daughters of women whose mothers had smoked during pregnancy have a significantly elevated rate of endometriosis, suggesting that in-utero exposure to smoking increases the risk for endometriosis.10 This is just another reason among many for pregnant women to avoid smoking.

Tips for quitting smoking

While the stress associated with having endometriosis may make quitting smoking a difficult task, especially in light of the knowledge that smoking is not associated with endometriosis, smoking is nevertheless the most important cause of preventable mortality and morbidity in the developed world. Support groups are available for those who wish to quit smoking, and an appointment with a doctor specialised in smoking cessation might be appropriate as multiple medications can be used to facilitate quitting, some of which can even be taken during pregnancy.


In conclusion, quitting smoking is one of the best steps one can take to preserve and cherish their own body and health. Even if it may not be the panacea to gynaecological help, a healthy body will be able to nourish a healthy reproductive system and a healthy baby.


  1. Endometriosis [Internet]. Endometriosis | Office on Women's Health. [cited 2022 Nov 17]. Available from: https://www.womenshealth.gov/a-z-topics/endometriosis
  2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility. 2012;98(3):511–9.
  3. What are the symptoms of endometriosis? [Internet]. Eunice Kennedy Shriver National Institute of Child Health and Human Development. U.S. Department of Health and Human Services; [cited 2022Nov17]. Available from: https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms.
  4. Andres MP, Arcoverde FVL, Souza CCC, Fernandes LF, Abrão MS, Kho RM. EXTRAPELVIC endometriosis: A systematic review. Journal of Minimally Invasive Gynecology. 2020;27(2):373–89.
  5. Helbig M, Vesper A-S, Beyer I, Fehm T. Does nutrition affect endometriosis? Geburtshilfe und Frauenheilkunde. 2021;81(02):191–9.
  6. Zhang Y, Ma N-Y. Environmental risk factors for endometriosis: An umbrella review of a meta-analysis of 354 observational studies with over 5 million populations. Frontiers in Medicine. 2021;8.
  7. Bonocher CM, Montenegro ML, Rosa e Silva JC, Ferriani RA, Meola J. Endometriosis and physical exercises: A systematic review. Reproductive Biology and Endocrinology. 2014;12(1):4.
  8. Bravi F, Parazzini F, Cipriani S, Chiaffarino F, Ricci E, Chiantera V, et al. Tobacco smoking and risk of endometriosis: A systematic review and meta-analysis. BMJ Open. 2014;4(12).
  9. Baron JA, Nichols HB, Anderson C, Safe S. Cigarette smoking and estrogen-related cancer. Cancer Epidemiology, Biomarkers & Prevention. 2021;30(8):1462–71.
  10. Vannuccini S, Lazzeri L, Orlandini C, Tosti C, Clifton VL, Petraglia F. Potential influence of in utero and early neonatal exposures on the later development of endometriosis. Fertility and Sterility. 2016;105(4):997–1002.

Mert Gurcan

Doctor of Medicine - MD, Medicine, Istanbul University-Cerrahpasa

Dr. Mert Gurcan is a Medical Doctor with extensive experience in conducting, directing, publishing, and presenting clinical research. He is passionate about making positive differences in the lives of individuals and their communities through research and promoting public and personal health solutions that help people live healthier and happier lives.
Having completed part of his medical school in the Charite Universitätsmedizin in Berlin, Dr. Gurcan graduated in 2020 from the Istanbul University - Cerrahpasa Medical Faculty with honors and many academic publications and he practiced for two years in Istanbul as both an emergency practicioner and an ENT trainee and is continuing his career in clinical medicine in the United Kingdom.

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