Early periods and early menopause raise COPD risk

A research, published online in the journal Thorax, finds that various reproductive factors, such as the age at which menstruation begins and early menopause, are associated with an increased risk of COPD—a collective term for progressive lung diseases that leads to breathing difficulties.

Miscarriage, stillbirth, infertility, and having 3 or more children are also associated with a heightened risk of COPD, which includes emphysema and chronic bronchitis.

For the study, the researchers analysed data from three groups of women—totalling 283,070, with an average age of 54—across the Australian Longitudinal Study on Women’s Health 1946–51 (ALSWH-mid), the UK Biobank, and the Swedish Women’s Lifestyle and Health Study (WLH), focusing on reproductive factors and COPD. Tracking in the ALSWH-mid and UK Biobank groups continued until the end of December 2019, while the WLH group was monitored until the end of 2010.

Data on reproductive factors was collected along with potentially influential factors such as birth year, ethnicity, educational level, duration of smoking, asthma, and weight (BMI).Several reproductive factors were associated with the risk of COPD, including age when periods first started; number of children; a history of infertility, miscarriage or stillbirth, and age at menopause.

The findings revealed a U-shaped association between the onset age of menstruation and COPD risk, with increased risks for those starting before age 11 (17% higher) and after age 16 (24% higher), compared to starting at age 13. Women with children faced greater COPD risks than childless ones, particularly those with more than three children (34% higher risk) or one child (18% higher). Infertility and a history of miscarriage or stillbirth also elevated COPD risk by 13%, 15-36%, and 42% respectively, with risks escalating with the number of miscarriages or stillbirths. Early menopause (before age 40) significantly raised COPD risk by 69%, whereas menopause at or after age 54 reduced it by 21%.

“The overall effect of oestrogen might differ depending on the timing,” researchers suggest. “In the early or middle reproductive stage, long or higher accumulated exposure to oestrogen would be detrimental to the lung, leading to a higher risk of COPD among women with early menarche or multiple live births. In the later stage, oestrogen may be protective, since earlier age at menopause or [ovary removal] (indicates shorter exposure to oestrogen) were associated with a higher risk of COPD.”

Reference:DOI: 10.1136/thorax-2023-220388