THE NEW analysis shows that lung function changes across the menopausal transition accelerate several years before menopause and remain elevated thereafter.
Lung Function Changes Across the Menopausal Transition
This longitudinal retrospective cohort analysis evaluated pulmonary trajectories in 5554 women who had at least one health examination before and after self-reported menopause and no respiratory disease. Women were classified as premenopausal perimenopausal or postmenopausal using a data driven approach. Outcomes included FVC and FEV1 and annual changes were estimated using interrupted time series and multivariable linear mixed effects models. The median age at menopause was 52 years with a median follow up of more than a decade.
At menopause the median predicted FVC was 98.9% and the median predicted FEV1 was 97.4%. Segmented regression placed the inflection for the premenopause to perimenopause shift five years before menopause. Relative to the slow premenopausal FVC slope the decline accelerated significantly during perimenopause and continued at a similar pace postmenopause. The corresponding FEV1 differences were modest compared with the FVC findings.
Clinical Meaning for Midlife Care
This study suggests lung function changes across the menopausal transition are not a narrow postmenopausal phenomenon but an earlier progressive issue beginning years before the final menstrual period. These findings reinforce the importance of awareness in midlife counselling and integrated respiratory risk review in preventive visits. Although the absolute declines were small in annual terms they accumulated substantially over time which may be clinically relevant in women who also have risk amplifiers such as higher BMI sedentary behavior or prior smoking history.
Clinicians who routinely manage cardiometabolic markers in midlife women should consider respiratory fitness patterns as well. Although causation cannot be inferred this study underscores that the menopausal transition represents a window of vulnerability for pulmonary trajectories.
Reference: Imai R et al. Lung Function Changes Across the Menopausal Transition. Chest. 2025;doi: S0012-3692(25)05257-2.
