Premature menopause spells increased lung diseases risk for smokers

Female smokers with early natural menopause are at high risk of developing malignant and nonmalignant lung diseases, as well as of death, as reported in a study.

The study used data from the Pittsburgh Lung Screening Study (PLuSS), a community-based research cohort of current and former smokers, screened with low-dose computed tomography and followed for lung cancer. Researchers looked at 1,038 women with natural menopause and 628 women with surgical menopause. Early menopause was defined as occurring before 45 years of age.

A total of 1,666 women were smokers (mean age 59.4 years, 91.2 percent non-Hispanic Whites, 63.9 percent current smokers). Overall, 39 percent of the cohort reported early menopause, with the incidence being lower in the natural vs surgical menopause group (19.1 percent vs 71.3 percent; p<0.001).

Early natural menopause was significantly associated with a higher risk of wheezing (odds ratio [OR], 1.65; p<0.01), chronic bronchitis (OR, 1.73; p<0.01), and radiographic emphysema (OR, 1.70; p<0.001), and lower baseline lung spirometry in an obstructive pattern (–104.8 ml/s for forced expiratory volume in the first second [FEV1], p<0.01; –78.6 ml for forced vital capacity [FVC], p=0.04; –2.1 percent for FEV1/FVC ratio, p=0.01).

Women with early natural menopause tended to have a more rapid decline of FEV1/FVC ratio (–0.16 percent per year; p=0.01) and a higher incidence of airway obstruction (OR, 2.02; p=0.04), as well as a 40-percent increased risk of death (p=0.023), which was mainly driven by respiratory diseases (hazard ratio, 2.32; p<0.001).

Further analyses revealed that early menopause status moderated the associations between continuous smoking and subsequent lung cancer risk and cancer mortality. Women with early natural menopause who continued smoking had the worst outcomes (p<0.001). We did not find associations reported above in female smokers with surgical menopause.

The present data highlight the importance of smoking cessation and targeted chest computed tomography screening to improve the postmenopausal health and wellbeing of female smokers with early natural menopause.