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Alcohol, smoking and substance use: what the research says

186 studies on alcohol, smoking and substance use in PMS and PMDD, each explained in plain English. 13 of them use the strongest designs: randomised trials and systematic reviews.

Survey study 91Cohort study 21Study 18Randomised trial 16Case-control study 11Review 8
Survey study, 2025

Does PMDD or PMS affect quality of life?

Women with PMDD had noticeably lower quality of life scores. Women with only PMS had quality of life similar to those without these conditions. The study accounted for smoking, obesity, education, and other factors.

Cohort study, 2025

Are irregular menstrual cycles linked to lower thinking and memory skills in middle-aged women?

Yes. Women with irregular cycles at ages 29-46 and women with very short cycles (25 days or less) at ages 18-22 both had slightly lower memory scores later in life.

Randomised trial, 2025

Does the menstrual cycle phase affect how much alcohol impairs women's memory?

Yes, women's working memory was less impaired by alcohol during the late follicular phase (when estradiol is high) compared to the early follicular phase (when estradiol is low), suggesting higher estradiol may protect against alcohol's cognitive effects.

Systematic review, 2025

Does alcohol use affect menstrual health in teenage girls?

Yes. Alcohol use is linked to irregular periods, PMS, period pain, and early or unintended pregnancy in teenage girls, though more research is needed to prove alcohol directly causes these problems.

Systematic review, 2022

What factors increase risk of period pain and PMS symptoms?

Stress, poor sleep, late bedtimes, low weight, and family history increase risk. Smoking makes symptoms more severe. Most of these factors can be modified through lifestyle changes.

Systematic review, 2021

Does substance use change across the menstrual cycle, especially in women with PMS or PMDD?

Yes. Women use more nicotine before and during their period, especially those with PMDD or PMS, and alcohol use also increases during these phases.

Systematic review, 2019

Do women take more health-related risks at certain times in their menstrual cycle?

Women show higher sexual activity and better risk awareness during ovulation, but no consistent pattern for alcohol or cigarette smoking across the cycle.

Review, 2018

Which women are most likely to experience hot flashes during menopause?

Up to 80% of women experience hot flashes during menopause, lasting about 10 years on average. Black and Hispanic women are more likely to experience them, while Asian women are less likely.

Case-control study, 2016

Does caffeine intake cause or worsen PMS?

No. Total caffeine intake was not associated with PMS development, and high coffee intake also was not associated with PMS. Current recommendations for women to reduce caffeine to prevent PMS may not be helpful.

Cohort study, 2014

Does childhood abuse increase the risk of PMS in adulthood?

Yes, women with childhood emotional abuse had 2.6 times higher PMS risk, and those with physical abuse had 2.1 times higher risk. This 14-year prospective study provides strong evidence.

Cohort study, 2014

How common are PMS and dysmenorrhea in young women and do they change over time?

Both are very common. PMS affected 80% of Australian women at some point over 13 years; dysmenorrhea affected 60%. Both tend to persist if present, but women follow different patterns: some have symptoms continuously, others develop them later, some recover, and some have them on and off.

Survey study, 2011

Is premenstrual syndrome related to major depression?

Yes. Women with moderate to severe PMS are significantly more likely to have depression (11.3% to 24.6% depending on PMS severity). Women with both conditions are more severely impaired than those with either alone.

Cohort study, 1999

What causes negative mood during menopause?

The menopause transition itself and hormone levels do not directly cause negative mood. Instead, past premenstrual problems, negative attitudes to aging, life stress, health problems, smoking, low exercise, and relationship issues are the main causes.

Cohort study, 2026

Do early-life exposures like antibiotics or breastfeeding affect PMS risk?

Yes. Long-term antibiotic use, earlier puberty, maternal smoking, and not being breastfed were linked to higher PMS odds. But only 0.07% of the study had PMS, so findings need careful interpretation.

Survey study, 2026

What lifestyle and work factors are linked to PMDD symptoms in Chinese nurses?

42.4% of Chinese nurses have PMDD symptoms. Risk is higher in those who work night shifts, do not exercise, drink alcohol, are overweight in a certain range, or have depression, anxiety, or poor sleep.

Cohort study, 2026

Are diet and lifestyle linked to premenstrual symptoms in college students?

Yes. Regular exercise was linked to lower rates of significant PMS, while smoking and certain foods were linked to higher rates. However, this is an observational study so we cannot know if these factors actually cause PMS.

Cohort study, 2026

Which established risk factors genetically cause premenstrual disorder?

Genetic analysis suggests three factors cause premenstrual disorder: earlier age at first period, higher BMI, and smoking. However, when tested in a smaller group, results were not consistent, so more research is needed to be sure.

Cohort study, 2026

Does cannabis use vary across the menstrual cycle in people with premenstrual disorders?

Yes, the amount of cannabis used peaks before menstruation and around ovulation in people with premenstrual disorders. The pattern is stronger when emotional symptoms worsen.

Cohort study, 2026

What life and psychological factors are linked to PMS and PMDD?

Both are linked to smoking, childhood trauma, poor mental health, and poor work-life balance. PMDD is also linked to being married with children. PMS is linked to alcohol use.

Survey study, 2025

Are premenstrual symptoms linked to depression in teenage girls?

Yes. Girls with premenstrual symptoms were about 1.7 times more likely to have depressive symptoms than girls without PMS.

Survey study, 2025

Is PMS connected to mental health problems and lifestyle choices?

Yes, 64% of nursing students had PMS and it was strongly linked to depression, anxiety and stress. PMS was also more common in students who smoked, drank alcohol, drank coffee or reported psychological problems.

Survey study, 2024

Is physical activity linked to PMS symptoms?

About 68.5% of young women had PMS. There was a weak but statistically significant association between physical activity and PMS severity, though it was too weak to draw strong conclusions.

Survey study, 2024

Which lifestyle choices affect PMS symptoms?

Depression was strongly linked to worse PMS symptoms, but exercise and relaxation showed no significant link. However, this was a snapshot survey that cannot prove depression causes PMS.

Study, 2024

How do lifestyle factors like diet, exercise, and stress affect menstrual health and PMS?

Lifestyle factors significantly affect menstrual health and PMS. A balanced diet with adequate vitamins, regular exercise, good stress management, and healthy weight can reduce PMS symptoms, while poor nutrition, high stress, extreme weight, and substance use make them worse.

Survey study, 2024

What factors are linked to PMS in school-age girls?

22% of these Ethiopian school students had PMS. Heavy coffee drinking and sleep problems were the strongest risk factors, while exercise was protective. Results are from one city in Ethiopia.

Survey study, 2023

Does drinking behavior change across the menstrual cycle?

Yes, clear differences. Women drink more during mid-cycle and are more likely to drink heavily around ovulation and right before their period, especially on weekends. They also drink more to cope with stress right before their period.

Survey study, 2023

Does the menstrual cycle phase affect smoking cessation outcomes?

Withdrawal symptoms and cravings do not differ across menstrual cycle phases, but quit rates were higher during the luteal phase. However, the evidence is limited and contradictory.

Survey study, 2022

What diet, stress, and lifestyle factors are linked to PMS symptoms?

High coffee intake, sugar, stress, smoking, and low physical activity were all linked to worse PMS symptoms, with stress showing the strongest association. These are associations only, not proven causes.

Survey study, 2021

Does secondhand tobacco smoke exposure affect the menstrual cycle and premenstrual symptoms?

Yes. Women exposed to tobacco smoke had significantly more menstrual problems and more severe premenstrual and menstrual symptoms compared to those with no exposure. Past exposure during childhood or adolescence appeared especially harmful.

Survey study, 2021

Does premenstrual syndrome affect sleep quality?

Yes. Women with PMS had shorter total sleep time, took longer to fall asleep, and had worse sleep quality scores than women without PMS.

Systematic review, 2020

Does smoking increase the risk of getting PMS?

Yes, smoking is associated with 1.56 times higher risk of PMS. But it is unclear whether smoking causes PMS to worsen or whether women with PMS smoke to try to cope.

Survey study, 2020

Is period pain common in Polish women and what causes it?

Period pain is very common, affecting 94% of Polish women. It's linked to family history, lack of exercise, and low self-esteem, though this is a cross-sectional study so we cannot be sure these things cause it.

Study, 2020

Does drinking and craving change across the menstrual cycle in women treated for alcohol use disorder?

Yes. Women drank most during the mid-late luteal phase and menses. Women with less depression who felt less emotional stress during these times reported stronger alcohol cravings.

Survey study, 2019

What diet and lifestyle factors are linked to PMS in university students?

Smoking and eating foods high in calories, fat, sugar, and salt were linked to higher PMS risk among university students in the UAE. This observational study cannot prove these factors cause PMS.

Case-control study, 2019

Is smoking linked to higher risk of PMS or PMDD?

Yes. Smokers had higher odds of PMS (1.78 times) and PMDD (2.92 times) compared to non-smokers. This association was stronger with higher smoking amounts.

Systematic review, 2018

Does drinking alcohol increase the risk of premenstrual syndrome?

Yes. Any alcohol drinking was linked to a 45 percent increased risk of PMS, and heavy drinking was linked to a 79 percent increased risk.

Randomised trial, 2017

Does the menstrual cycle affect cortisol levels or cigarette craving during smoking abstinence?

The menstrual cycle did not affect cortisol levels during early smoking abstinence. However, cigarette craving behaved differently in different phases. It increased early in the follicular phase but decreased during the luteal phase.

Study, 2017

Which pregnant women are most likely to feel sick during caesarean delivery under regional anaesthesia?

Women who had severe nausea in early pregnancy, a history of motion sickness, and a history of premenstrual syndrome experienced higher rates of nausea during the surgery.

Survey study, 2017

Do women with high PMS symptoms have more trouble quitting smoking?

Women with high mood-related PMS symptoms had higher tobacco dependence, more withdrawal symptoms during previous quit attempts, and used more smoking cessation aids. This suggests they may have more difficulty quitting.

Case-control study, 2017

What cellular changes might explain why some women develop PMDD?

Researchers found that women with PMDD have abnormal differences in genes related to a protein complex called ESC/E(Z), which helps cells respond to hormones. This could explain why women develop PMDD even when their hormone levels are normal.

Survey study, 2017

Are mental health problems linked to irregular periods in teenage girls?

Yes. Girls with high stress are 1.88 times more likely to have irregular periods, those with depression are 2.01 times more likely, and those receiving counseling are 2.92 times more likely.

Survey study, 2016

How common is PMS in nursing and midwifery students, and does smoking affect it?

About one in three students (33%) have PMS. Current smokers have much higher rates (52.9%) than never-smokers (28.7%), suggesting smoking is linked to worse PMS.

Cohort study, 2015

Does drinking alcohol affect reproductive hormones or menstrual cycle regularity?

Recent alcohol drinks raise reproductive hormone levels, but moderate drinking does not appear to disrupt menstrual cycle regularity in the short term.

Randomised trial, 2014

Does alcohol change brain activity during the menstrual cycle?

Yes. Alcohol changed how the brain worked during thinking tasks, with effects varying by menstrual cycle phase, though the study was small.

Randomised trial, 2014

How do menstrual cycle phase and depression affect smoking withdrawal symptoms?

Depression level was more strongly linked to withdrawal symptoms than menstrual phase. However, the combination of depression and menstrual phase may worsen mood and period pain.

Study, 2014

Does the menstrual cycle phase affect how women respond to nicotine?

Yes. Women in the luteal phase showed reduced sensitivity to nicotine's effects and performed better on thinking tasks compared to women in the follicular phase, suggesting the luteal phase may reduce nicotine's rewarding effects.

Randomised trial, 2013

Does menstrual phase and depression affect how women respond to nicotine after quitting smoking?

Yes, but mainly in women without depression. Women without depression showed larger cycle-phase differences in heart rate, blood pressure, and nicotine response.

Non-randomised trial, 2013

Does menstrual cycle phase affect protective hormones during smoking cessation?

Yes. Allopregnanolone (a hormone related to progesterone) decreased by 10% during smoking cessation in the follicular phase but increased by 31% in the luteal phase, which may explain why the luteal phase is better for quitting smoking.

Survey study, 2011

How do premenstrual symptoms change as women age, and what factors influence them?

Premenstrual symptoms follow different patterns as women age: some stay the same, some decrease, some peak around age 35, and others peak around age 40-44. Smoking is linked to more symptoms, and having more pregnancies is linked to fewer symptoms.

Survey study, 2011

Do smoking habits affect premenstrual and menstrual symptoms?

Smokers had significantly more severe premenstrual and menstrual symptoms than non-smokers, especially pain, concentration problems, water retention, and mood changes. Worse symptoms were linked to higher nicotine dependence.

Survey study, 2011

How common is premenstrual syndrome in Turkish college students and how does it affect quality of life?

Premenstrual syndrome was found in 72.1% of college students and was strongly associated with significantly reduced quality of life.

Case-control study, 2010

Does body weight affect the risk of developing PMS?

Yes. Higher body mass index (BMI) is associated with increased PMS risk. Each 1 kg/m² increase in BMI was linked to a 3% increase in PMS risk.

Cohort study, 2010

Which lifestyle factors and contraceptive methods are linked to premenstrual symptoms?

About 1 in 4 women had premenstrual symptoms. Women with higher education and less stress had fewer symptoms. Hormonal birth control was linked with fewer symptoms.

Cohort study, 2010

Does stress before your period make menstrual symptoms worse?

Yes. Women with high stress in the month before their period had much worse menstrual symptoms, including both mood and physical symptoms.

Randomised trial, 2010

Does the menstrual cycle phase affect smoking withdrawal severity and relapse risk?

Yes. Women who quit smoking during the luteal phase (second half of the cycle) experienced more severe withdrawal and premenstrual symptoms. Anger and craving during quit attempts were linked to higher relapse risk.

Randomised trial, 2009

Does the menstrual cycle phase affect a woman's ability to quit smoking?

Yes. Women had significantly higher premenstrual symptoms and smoking urges in the luteal phase, and variability in these measures was linked to relapse.

Case-control study, 2009

Does alcohol use increase the risk of developing PMS or PMDD?

Alcohol use is not strongly linked to developing PMS or PMDD. Starting to drink before age 18 or long-term drinking may minimally increase risk, but the increases are small.

Case-control study, 2008

Does smoking increase the risk of PMS?

Yes. Current smokers were 2.1 times more likely than never smokers to develop PMS over 2-4 years. Women who started smoking before age 15 had 2.53 times higher risk.

Non-randomised trial, 2008

Does the timing of quitting smoking in the menstrual cycle affect success?

Yes. Women who quit during the early cycle phase before ovulation were much more likely to remain abstinent than those who quit during the premenstrual phase. At one week after quitting, 31 percent of early-cycle women were smoking compared with 71 percent of premenstrual-phase women.

Survey study, 2007

Are diet and lifestyle factors associated with premenstrual symptoms?

Most dietary factors were not related to PMS. Smoking increased symptoms, and alcohol was associated with fewer mood and headache symptoms.