Lung Function Changes Across the Menopausal Transition: A Longitudinal Analysis of Annual Examinations

Trajectories of pulmonary function across the menopausal transition remain poorly understood.

How do trajectories of FVC and FEV₁ change across the menopausal transition, and how do their rates of decline differ during the perimenopausal and postmenopausal phases?

In this retrospective cohort study, we analyzed female participants in the St. Luke's Health Check-up Database (2004-2020) with ≥ 1 examination before and after self-reported menopause and with no respiratory disease. Menopausal status was classified into premenopause, perimenopause, or postmenopause using a data-driven method. Outcomes included FVC and FEV₁. Annual rates of change were estimated by interrupted time series and multivariable linear mixed-effects models.

We included 5,554 female participants (53,110 visits; median age at menopause, 52 years [interquartile range (IQR), 50-54 years]). Median follow-up was 11.0 years (IQR, 7.0-14.1 years) with a median of 10 visits (IQR, 6-14 years). Median FVC and FEV₁ at menopause were 98.9% predicted (IQR, 91.2%-106.7% predicted) and 97.4% predicted (IQR, 89.7%-105.1% predicted), respectively. Segmented regression placed the premenopause to perimenopause breakpoint 5.0 years before menopause (95% CI, 4.8-5.2 years). For FVC, relative to the premenopausal slope (-1.0 mL/y), the additional decline was -17.5 mL/y (95% CI, -19.1 to -15.9 mL/y) during perimenopause and -18.8 mL/y (95% CI, -20.2 to -17.4 mL/y) during postmenopause. For FEV₁, the premenopausal slope was -19.2 mL/y (95% CI, -20.2 to -18.3 mL/y); relative to this slope, the additional decline was -1.5 mL/y (95% CI, -2.7 to -0.3 mL/y) during perimenopause and -0.4 mL/y (95% CI, -1.5 to 0.7 mL/y) during postmenopause.

Our results showed that the rate of FVC decline increased 5 years before menopause and persisted at an increased rate of decline thereafter, suggesting that menopausal status is associated with lung function trajectories female individuals in midlife, whereas FEV₁ changes were modest.