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Early Age at Natural Menopause Is Related to Lower Post-Bronchodilator Lung Function: A Longitudinal Population-based Study

Campbell B1, Bui DS2, Simpson JA3, Lodge CJ4, Lowe AJ1, Bowatte G5, Leynaert B6, Gómez Real F7,8, Thomas PS9, Giles GG10, Johns DP11, Garcia-Aymerich J12, Hopper JL13, Jarvis D14, Abramson MJ15, Walters EH16, Perret JL17, Dharmage SC18.

Ann Am Thorac Soc. 2020 Jan 22. doi: 10.1513/AnnalsATS.201902-180OC. [Epub ahead of print]

Abstract
RATIONALE:
Poor lung function, a significant predictor of mortality, has been observed in post-menopausal women when compared to those still menstruating. Menopausal age is a risk factor for several adverse health outcomes, but little evidence exists on the impact of menopausal age on lung function impairments, especially on post-bronchodilator lung function measures.

OBJECTIVES:
Investigate the association between age at menopause and pre- and post-bronchodilator lung function outcomes.

METHODS:
During the 6th decade follow-up of the Tasmanian Longitudinal Health Study (TAHS) cohort (mean age 53 years), information was collected on most recent menstrual period and menopausal status. Lung function was measured at age 7 and again at 53 years. Multiple linear regression was performed to determine the association between age at menopause and pre- and post-bronchodilator spirometry controlling for early and adult life confounders.

RESULTS:
Women reporting an early age at natural menopause (<45 years) had lower post-bronchodilator forced expiratory volume in one second (-168mL; 95%Confidence Interval [CI] -273, -63) and forced vital capacity (-186mL; 95%CI -302, -70) compared with post-menopausal women who experienced menopause at a later age (≥45 years). No association was observed with FEV1/FVC ratio. Adjustment for early life confounders strengthened these associations. CONCLUSIONS: This study provides new evidence that early menopause is associated with reduced lung function that is suggestive of restriction, but not obstruction, even after adjustment for early life confounders. Given the important link between poor lung function and mortality, clinicians should be aware of the risk of diminished lung function in post-menopausal women who experience menopause at an early age.