Smoking worsens menstrual pain.

Die-hard smokers claim a cigarette relaxes them, alleviates tension, and makes them feel better. But new research from the University of Milan suggests that this temporary relief may cause dysmenorrhea, or in laywoman's terms, killer cramps.

The study, published in the July Epidemiology, looked at 251 women age 15 through 44--106 with menstrual pain and 145 without--over an 18-month period. The trial excluded women with previous dysmenorrhea, fibroid tumors, ovarian cysts, or endometriosis, all of which can contribute to the severe pelvic pain identified by the authors. The investigators had no way of determining whether or not a woman developed endometriosis during the study: A laparoscopy, the "belly-button cut," is the only sure way to confirm the presence of the disease.

Women who smoked 10 to 30 cigarettes a day doubled their risk of dysmenorrhea, compared to nonsmokers. And women who had smoked for 10 to 20 years nearly tripled their risk.

Smoking is a known vasoconstrictor--it narrows blood vessels and reduces blood flow. According to Laura Luchini, one of the report's authors, this might explain some of the dysmenorrhea. As in the rest of the body's blood vessels, she says, "the endometrial blood flow reduces in smokers." In addition, she says, "Women with heaviest menstrual flow have greater risk of dysmenorrhea."

The researchers also confirmed a palliative for cramps that many women have already discovered themselves: alcohol.

Devotees of the grape will be pleased to know that wine lessens the pain. Women who consumed 8 to 28 glasses a week (an amount more acceptable in Europe than in the United States) had half the risk of dysmenorrhea as the teetotalers. Beer, however, showed no such association.

"We did not find these results in other studies," says Luchini. "We should look to these results with caution."