Menopausal hormone therapy and pulmonary diseases

Menopause is accompanied by loss of ovarian estrogen and progesterone production and by age-related changes in circulating androgens, with implications for respiratory physiology and chronic pulmonary disease. Sex steroids influence lung development, immune responses, airway tone, vascular remodeling and pathways involved in lung carcinogenesis. Epidemiological evidence linking menopausal hormone therapy (MHT) to asthma is heterogeneous; some cohorts show increased incident asthma or exacerbations, particularly with estrogen therapy and in specific subgroups, whereas others suggest preserved lung function or reduced late-onset asthma. Data on chronic obstructive pulmonary disease remain limited and inconsistent. In pulmonary hypertension, evidence is conflicting, and clinical decisions must weigh thrombotic risk, strongly influenced by the route of estrogen administration. Studies on obstructive sleep apnea and sleep-disordered breathing suggest possible modest benefits of MHT in selected populations but are methodologically heterogeneous. For lung cancer, large cohorts, meta-analyses and randomized trials essentially show no clear increase in incidence with MHT and suggest potential survival advantages in some subgroups. Overall, MHT use in women with or at risk for pulmonary disease should be individualized, integrating symptom burden, cardiometabolic and respiratory risk, disease phenotype and formulation/route.