Early natural menopause increases risk for lung diseases, death in women who smoke

In midlife and older smokers, natural menopause before age 45 years was associated with malignant and nonmalignant lung diseases and mortality, according to data published in the American Journal of Obstetrics & Gynecology.

The data also showed that women who continued to smoke had worse outcomes compared with those who quit smoking.

“These findings have strong clinical and public health relevance as preventive strategies including smoking cessation and chest computed tomography screening should target this population (ie, female smokers with early natural menopause) to improve their postmenopausal health and well-being,” Shuguang Leng, MBBS, PhD, an assistant professor in the department of internal medicine at The University of New Mexico in Albuquerque, told Healio.

Leng and colleagues assessed the impact of early menopause on lung health, lung cancer risk, all-cause mortality and cause-specific mortality in 1,666 former or current moderate to heavy smokers who were enrolled in the Pittsburgh Lung Screening Study. Most participants were non-Hispanic white (91.2%) and currently smoked (63.9%), with an average age of 59.4 ± 6.7 years.

Early menopause was reported by 19.1% of the 1,038 women who experienced natural menopause and by 71.3% of the 628 women who underwent surgical menopause, with no significant differences in demographics between early and non-early menopause regardless of menopause type.

Lung health

Shuguang Leng

Among women with natural menopause, those who experienced menopause early had greater odds of self-reported wheeze (OR = 1.65; 95% CI, 1.18-2.3), having a diagnosis of chronic bronchitis (OR = 1.73; 95% CI, 1.19-2.53) or CVD (OR = 1.87; 95% CI, 1.13-3.11), radiographic emphysema (OR = 1.7; 95% CI, 1.25-2.31) and incident airway obstruction (OR = 2.02; 95% CI, 1.03-3.96).

Compared with other women who had surgical menopause, those who had early menopause did not have a greater risk for these outcomes, except physician-diagnosed CVD (OR = 4.03; 95% CI, 1.78-9.14).

Early natural menopause was associated with lower lung function and a faster decline in lung function compared with non-early natural menopause. Those associations were not observed between women with early and non-early surgical menopause.

Cancer and mortality

Women who underwent early natural menopause had a greater risk for all-cause mortality (HR = 1.4; 95% CI, 1.05-1.86) compared with other women who experienced non-early natural menopause, primarily due to respiratory death (HR = 2.32; 1.52-3.52). Early menopause in this group also was linked a greater risk for cancer mortality (HR = 1.74; 95% CI, 1.11-2.74) and lung cancer mortality specifically (HR = 1.94; 95% CI, 1.05-3.58).

Although the trends were similar in women with early vs. non-early surgical menopause, none of the differences were significant, according to the study.

Smoking status, menopause timing

Analyses of smoking status and menopause timing among women with natural menopause revealed that women who experienced menopause early and currently smoked had the highest risk for lung cancer (HR = 4.65; 95% CI, 2.55-8.49) and cancer mortality (HR = 4.61; 95% CI, 2.63-8.07) compared with women who had non-early menopause and had quit smoking.

Moving forward, Leng expressed interest in determining whether lung cancer screening recommendations for women who are former or current smokers could be improved by factoring in menopause type and timing.

“We would also like to assess whether findings can be generalized to female smokers with non-natural menopause, eg, women receiving oophorectomy and/or hysterectomy,” Leng said.