Association of Menopause and Hormonal Contraceptive Use With Chronic Rhinosinusitis: An "All of Us" Analysis

The role of sex hormones in inflammation has attracted increased attention, but the impact of hormone-modifying states in chronic rhinosinusitis (CRS) has not been thoroughly studied. We aim to investigate the association of menopause and systemic hormonal contraceptive (SHC) use with both CRS with (CRSwNP) and without (CRSsNP) nasal polyps.

Cross-sectional analysis of data.

A large, national dataset of adults from the All of Us Research Program.

This study was conducted using data from 239,564 participants. CRS diagnoses, biomarker data, menopause status, and SHC use, including both estrogen-containing contraceptives (ECCs) and progestin-only contraceptives (POCs), were extracted. Multivariable logistic and linear regression models were constructed to analyze the associations of CRS diagnosis and biomarkers with menopause and SHC use.

Postmenopausal participants had no significant difference in CRS odds compared to premenopausal patients (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 0.94-1.11). Compared to no SHC use, POCs were not associated with CRS, but ECC use was associated with a lower odds of CRSsNP (OR: 0.71; 95% CI: 0.64-0.80) while being not associated with CRSwNP (OR: 0.82; 95% CI: 0.51-1.25). Biomarker analysis revealed that ECC use was associated with a decreased serum neutrophil concentration among participants without CRS (β: -1.29; 95% CI: -1.72 to -0.85) and among participants with CRSsNP (β: -1.66; 95% CI: -3.02 to -0.29) compared to no SHC use.

Menopause was not associated with CRS, while ECC use was associated with a lower odds of CRSsNP. Further research is needed to clarify underlying mechanisms.