Early natural menopause is a risk factor for lung diseases and death in middle-age and older women who smoke, according to study findings published in the American Journal of Obstetrics & Gynecology.

Researchers sought to evaluate the associations between early menopause and the risk of lung cancer, multiple lung health and aging biomarkers, and all-cause and cause-specific death in postmenopausal women with heavy or moderate smoking levels.

The researchers conducted a community-based retrospective study that included 1666 postmenopausal women who smoked currently (63.9%) or previously. Among the entire cohort (average age, 59.4±6.7 years; 91.2% non-Hispanic White), 1038 women had natural menopause and 628 had surgical menopause. Participant data came from the Pittsburgh Lung Screening Study, a community-based research cohort of women who currently smoke or had smoked previously who were screened with low-dose CT and followed up for lung cancer.

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Researchers found that 646 (39%) of the women studied had reported early menopause. Of these, 198 had natural menopause, and 448 had surgical menopause (P <.001). Demographics remained similar between early and nonearly menopause groups, both natural and surgical.

Researchers found significant associations between early natural menopause and higher risk of chronic bronchitis (odds ratio [OR] 1.73; P <.01), wheezing (OR 1.65; P <.01), radiographic emphysema (OR 1.70; P <.001), and lower baseline lung spirometry in an obstructive pattern.

The investigators also found that early natural menopause was associated with a more rapid decline in the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1:FVC; -0.16% per year; P =.01) and incident airway obstruction (OR 2.02; P =.04). A 40% increased risk of mortality (P =.023) was also found among women with early natural menopause, with respiratory diseases as the main cause (hazard ratio 2.32; P <.001).

In further analysis of study participants with natural menopause, the researchers found that those who continued smoking post-menopause had a more than 4.5-fold greater risk of lung cancer and cancer-related death.

Study limitations include the lack of generalizability of findings to women of Hispanic ethnicity or Black race, possible selection bias, and the retrospective design.

“Early natural menopause was found to be a risk factor for malignant and nonmalignant lung diseases and mortality in middle-age and older female smokers,” the researchers concluded.

They suggest that women who smoke and have natural early menopause consider preventive strategies, including chest CT screening and smoking cessation.


Zhai T, Diergaarde B, Wilson DO, et al. Early natural menopause is associated with poor lung health and increased mortality among female smokers. Am J Obstet Gynecol. Published online August 4, 2022. doi:10.1016/j.ajog.2022.07.031

This article originally appeared on Pulmonology Advisor