Later Menopause Linked to Fewer Bronchiectasis Diagnoses

LATER menopause was associated with fewer bronchiectasis diagnoses among older U.S. women in a long-running cohort study.

Bronchiectasis and Menopause in a U.S. Cohort

Researchers examined reproductive histories from the Women’s Health Initiative alongside linked Medicare claims for 96,996 postmenopausal women. During a median 16 years of follow-up, 2,586 women, or 2.7%, received a first recorded bronchiectasis diagnosis. The analysis assessed reproductive lifespan, defined as the interval between menarche and menopause, as well as the timing of each event.

Women with a reproductive lifespan of at least 40 years had a 12% lower adjusted rate of bronchiectasis diagnosis than those with fewer than 30 years between menarche and menopause (adjusted approximate hazard ratio [aHR], 0.88; 95% CI, 0.77–0.99). The association was more pronounced among women who had not used menopausal hormone therapy: those in the longest reproductive lifespan group had a 22% lower rate than those in the shortest group (aHR, 0.78; 95% CI, 0.62–0.94).

Menopause Timing and Hormone Therapy

Later menopause appeared to account for much of the reproductive lifespan finding. Compared with menopause before age 40, menopause at ages 50–54 and at age 55 or older was associated with 14% and 17% lower adjusted rates of bronchiectasis diagnosis, respectively. Menarche at age 12 or later was also associated with a lower rate than menarche before age 12.

Hormone therapy complicates the interpretation. The reproductive lifespan association was observed among women without a history of hormone therapy, but not among users. Across the models, hormone therapy use itself was associated with a 19% higher adjusted rate of bronchiectasis diagnosis. These observational findings cannot establish that hormone therapy caused the difference or that changing hormone exposure would prevent bronchiectasis.

What the Findings Mean for Clinicians

Reproductive history may offer useful context when evaluating persistent productive cough or recurrent respiratory infections in older women, but it is not a diagnostic test. Bronchiectasis was identified through claims codes rather than independently confirmed diagnoses, and records before Medicare enrollment were unavailable. When researchers required two bronchiectasis codes, the case count fell to 1,154 and the overall reproductive lifespan association no longer met the threshold for statistical significance, although most associations persisted in a weaker form. Further work is needed to determine whether hormonal, genetic, or environmental factors explain the findings.

Reference
Geyer AI et al. Reproductive lifespan and adult-onset bronchiectasis in U.S. postmenopausal women: an investigation of the Women’s Health Initiative cohort. Chronic Obstr Pulm Dis. 2026;13(4):316–327.

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