Dear Doc,
I’ve been smoking since I was 15 and I’m now 30. Every year my doctor bugs me about quitting. I did quit cold turkey twice while I was pregnant but soon after having my children, I ended up smoking again. Now my kids are old enough to start asking me to quit and I want to be a good example to them. I hate how much money I spend on cigarettes! I have started to use some e-cigarettes but I’m not sure if those are healthier than regular cigarettes. Now its New Year’s Resolution time and I need some motivation to try to quite once and for all.

Doc
Just like most things worth doing, quitting smoking takes practice. Most people are not successful quitting long term their first time and up to 70% of women that quit smoking while pregnant will relapse. It is wonderful that you are considering quitting again and are taking the time to develop some strategies to be successful.

We are all pretty familiar with the impact of smoking on our heart and lungs. Lung cancers rates in women have increased 600% in the past 50 years and 90% of these cancers are due to smoking. It also increases the risk of other cancers such as throat, esophageal, larynx, colorectal, bladder, kidney and pancreas. Women who smoke as few as 1-4 cigarettes a day have double the risk of coronary heart disease compared to non-smokers. Additionally smoking appears to have a more negative effect on women as compared to men. Women smokers are twice as likely to have a heart attack compared to male smokers.

As a gynecologist I think about how smoking effects women’s bodies specifically. Smoking increases the risk of cervical cancer 3 to 4 times in women exposed to high risk types of Human Papilloma Virus (HPV). During our reproductive years smoking is linked to menstrual cycle irregularities as well as infertility. Smoking can also cause poor pregnancy outcomes including preterm delivery, low birth weights and still births.

Options for birth control can be limited for smokers. Most birth control pills contain estrogen which increases the risk of blood clots causing heart attacks and strokes. Smokers over the age of 35 should not use a birth control pill with estrogen as the risk of blood clots becomes very high. Menopause occurs 1.5-2.0 years earlier in smokers. Symptoms including hot flashes, night sweats and insomnia tend to be more severe in smokers.

Additionally the risk of osteoporosis and hip fracture is significantly higher in smokers.
Quitting smoking can be difficult and is typically harder for women as compared to men. Some women have concerns about weight gain while quitting. Many women may experience mood issues such as depression or simply mood swings. Women are also more concerned about disrupting relationships with their friends, family, and significant others who smoke.

If you are feeling ready to quit smoking it is important to take some steps to improve your chance of success. Asking for support from friends and family can be an excellent first step. Women who feel that they have good social support are more likely to be successful. Other quick tips for success include:

1. Set a quit date – usually within about 2 weeks
2. Avoid smoking at home, at work or in the car.
3. Prepare for nicotine withdrawal symptoms such as anxiety, irritability, and cravings. Consider oral substitutes (gum, sunflower seeds) and starting relaxation techniques (exercise, meditation).
4. Prepare to avoid things that trigger smoking for you (alcohol, stressful situations, consider quitting while on a vacation).
5. Talk to your doctor about medication that may help you manage cravings and withdrawal symptoms.

There are many medical options available to assist people in quitting smoking. Over the counter and prescription nicotine replacement therapy with a gum, lozenge or patch will help with withdrawal symptoms. Nicotine replacement is most effective when used in combination with a behavioral program. Chantix can be very effective in treating withdrawal and cravings. In a small group of patients it may have negative side effects on mood. Zyban is an antidepressant that can also be very effective in assisting people to quit smoking. You can speak with your doctor about which medication or combination of medications may be right for you.

Electronic cigarettes are not a completely safe form of nicotine. The US Food and Drug Administration (FDA) reported that e-cigarettes have been found to contain cancer causing toxins. Thus far, e-cigarettes have not been studied or proven to be a smoking cessation aide. The products themselves vary and are not regulated by the FDA. At this time, I would not recommend using them as a tool for smoking cessation.

In Wayne County 20% of adults smoke, this is higher than the New York state rate of 17%. 25,500 people in NYS die each year from smoking related illnesses and an additional 2,500 die from illnesses related to second hand exposure to smoking. The Wayne County Health Department offers some tobacco cessation programs designed to assist people interested in quitting.

Please see the link below for more information: http://www.co.wayne.ny.us/departments/publichlth/tobacco.html.

Good luck with your efforts! You will be setting an excellent example for your children by continuing to work on quitting smoking.

Tara Gellasch, MD, is the Associate Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email Dr. Tara Gellasch’ s assistant, Monica Decory with questions for Dr. Gellasch at Monica.Decory@rochestergeneral.org. and write “Ask a Doc” in the subject line. The Women’s Center at NWCH is located at 1250 Driving Park Avenue, Newark. Call (315) 332-2427 to schedule an appointment.