Environmental tobacco smoke and risk of late-diagnosis incident fibroids in the Study of Women's Health across the Nation (SWAN)

In the longitudinal Study of Women’s Health Across the Nation (SWAN), women exposed to environmental tobacco smoke during midlife had a statistically significantly increased risk of late-diagnosis uterine fibroids.

Like Comment

Volume 106, Issue 5, Pages 1157-1164


Jason Y.Y. Wong, Sc.D., Po-Yin Chang, Ph.D., Ellen B. Gold, Ph.D., Wesley O. Johnson, Ph.D., Jennifer S. Lee, M.D., Ph.D.



To assess the longitudinal relationship of environmental tobacco smoke (ETS) exposure during midlife, and its interaction with active smoking, with the risk of late-diagnosis incident uterine fibroids during the menopausal transition.


Thirteen-year prospective cohort study.


Not applicable.


Community-based, multiracial/ethnic cohort of 2,575 women aged 42 to 52 years at baseline, undergoing the menopausal transition.


Questionnaire and blood draws.

Main Outcome Measure(s)

Discrete-time proportional odds models used to estimate the conditional odds ratio (ORs) and 95% confidence interval (CI) of incident fibroids, adjusted for menopausal status, race/ethnicity, site, age, education, estradiol levels, sex hormone use, body mass index, timing of blood draw, age at menarche, alcohol use, and smoking status and pack-years.


As part of SWAN, at each near-annual study visit, ETS exposure, smoking, and fibroid occurrence were self-reported via questionnaire, and blood draws were collected. Women who were exposed to ETS (≥1 person-hour/week) had 1.28 (95% CI, 1.03, 1.60) times the adjusted odds of incident fibroids in the ensuing year compared the unexposed. The odds were elevated in never smokers (adjusted OR 1.34; 95% CI, 1.06, 1.70) and former smokers (adjusted OR 2.57; 95% CI, 1.05, 7.23).


In midlife, ETS exposure was associated with an increased risk of late-diagnosis incident fibroids in women undergoing the menopausal transition.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.