Women With Natural Menopause at a Later Age May Have an Increased Risk of Asthma

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A recent study published in the Menopause Society’s journal, Menopause, shows that later age at the time of natural menopause onset is associated with a greater risk for asthma. The investigators note that these findings differ from previous research, which shows that an earlier age at the time of menopause is correlated with an increased risk of adverse health conditions, such as heart disease, diabetes, osteoporosis, and depression, among others.^1,2

Asthma is a common chronic disease that affects over 300 million people worldwide. With the prevalence increasing over recent years, adult-onset asthma is often more severe and difficult to treat compared with childhood asthma. Following puberty, asthma is more likely to occur in females than in males. Additionally, prior studies have suggested a potential link between sex hormones and asthma, with adult-onset asthma being more common in women than in men.¹

For this retrospective study, postmenopausal women between the ages of 45 through 85 years were followed for a 10-year duration. A total of 26,155 women were included and self-reported their age at natural menopause (ANM). Additionally, the participants were asked to self-report ANM from all 3 cycles by the following yes-or-no question, “Have you gone through menopause, meaning that your menstrual periods stopped for at least 1 year and did not restart?” Those who replied “yes” were asked to report their age when their menstrual cycles stopped for at least 1 year without restarting. These ages were examined using the following age categories: 40 to 44 years; 45 to 49 years; 50 to 54 years; and 55 years and older.²

Further, all postmenopausal women were asked about their asthma status based on whether they received a diagnosis from a health care profession. If yes, participants were asked to report their age when they were diagnosed. Those who replied “no” were asked again in the next cycle.²

The 14,406 postmenopausal women who were included in the final analysis had a mean age of 61.4 years at baseline, and most were White (95.5%). Incident asthma was reported by 732 (5.08%), and the incidence of asthma in the study was about 2.82 per 1000 person-years, considering the follow-up time of 259,464.2 person-years. Further, the mean and median ANM were about 50.7 and 51.0 years, respectively, and ANM differed across several sociodemographic, health-related, and reproductive factors. Notably, women with an ANM of 40 to 44 years showed about a 30% decreased risk for asthma incidence (HR: 0.7, 95% CI 0.49-0.95) compared with those aged 50 to 54 years.²

The authors note that most of the prior studies looked at menopause status and not age at menopause. They emphasized that the change in estrogen levels post-menopause can help provide further guidance on the study’s findings. Particularly, estrogen is an immunoenhancer and can control both inflammatory and autoimmune diseases, such as asthma, by promoting lung inflammation. Additionally, estrogen can also increase Th2 cytokine production and alter eosinophil behavior, which contributes to type 2 inflammation that underlies some asthma phenotypes.²

“This study highlights sex-based differences in asthma, with women at a greater risk for asthma than men in adulthood. It also showed that women with later onset of menopause are at greater risk than those with early onset of menopause,” Stephanie Faubion, MD, MBA, FACP, MSCP, IF, medical director for The Menopause Society, said in a news release. “[Health care professionals] should be aware of this link and should monitor women with later age at natural menopause for asthma symptoms.”¹

REFERENCES

1. The Menopause Society. Women entering menopause later in life at greater risk for asthma. News release. October 30, 2024. Accessed November 18, 2024. https://www.eurekalert.org/news-releases/1063058

2. Kesibi D, Rotondi M, Edgell H, Tamim H. The association between age at natural menopause and risk of asthma among postmenopausal women from the Canadian Longitudinal Study on Aging. Menopause. ():10.1097/GME.0000000000002443, October 29, 2024. doi:10.1097/GME.0000000000002443