E-cigarette use (vaping) and cigarette smoking are associated with reduced markers of ovarian reserve: a cross-sectional study of 16,087 women
Abstract
E-cigarette use (vaping) is rapidly increasing among women of reproductive age, with an estimated one in five women aged 15–45 now using e-cigarettes in England. Despite being promoted as a safer alternative to cigarettes, the reproductive health consequences of e-cigarettes remain poorly understood, despite products being on the market for 2 decades. This study aimed to investigate the association between e-cigarette use, cigarette smoking, and two hormonal markers of ovarian reserve in women of reproductive age. A cross-sectional analysis was conducted using data from 16,087 women aged 18-45 who accessed a private reproductive hormone testing service between 11/2022 and 02/2025. Women with pre-existing reproductive health conditions (including PMOS, endometriosis, POI, and hypothalamic amenorrhoea) and those using hormonal contraception were excluded, ensuring a reproductively healthy population for analysis. Self-reported vaping and smoking were primary exposures, captured as never, former, occasional, or current use. Serum AMH and FSH were measured via standardised immunoassay from capillary blood samples. Multiple linear regression with log-transformed outcomes was performed, adjusting for age, BMI, and ethnicity. Vaping and smoking were modelled simultaneously to account for overlap between the two behaviours. Current vaping was associated with 5.6% lower serum AMH compared to never-vapers (p=0.023), with no significant association observed for FSH. Current cigarette…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 16,087 participants or records.
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