From Menarche to Menopause: A Narrative Review of Female Reproductive Milestones and Risk of Chronic Airway Disease.

Authors

Shilpa Sridhar, Keegan Riggs, Amanda Kaley, Dawn C Newcomb, Dharini M Bhammar, Rachel Meislin, Dawn L DeMeo, Sonali Bose, Jing Gennie Wang

Published in

Chest. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

Female reproductive factors are underrecognized determinants of lifelong respiratory health. This narrative review examines relationships between reproductive milestones and chronic airway disease risk.
Early menarche is associated with reduced adult lung function and a higher incidence of asthma. Polyendocrine metabolic ovarian syndrome is also associated with increased asthma risk, particularly in obese individuals, through sex hormone dysregulation, metabolic dysfunction, and chronic low-grade inflammation. Adverse pregnancy outcomes are associated with lower lung function and heightened future asthma and chronic obstructive pulmonary disease (COPD) susceptibility, potentially from persistent systemic inflammation, endothelial injury, and oxidative stress beyond the perinatal period. Effects of exogenous sex hormones on the airways are complex and context-dependent. Hormonal contraception may reduce asthma risk in lean females by stabilizing estrogen and progesterone fluctuations, but increase risk in obesity, as exogenous estrogen can amplify airway inflammation. Similarly, effects of menopause hormone therapy (MHT) vary by formulation, timing of initiation, and use duration. Estrogen-only MHT - particularly when started at younger ages, before menopause, or used for longer duration - may increase asthma risk. Early menopause is linked to accelerated lung function decline, higher asthma incidence among those with obesity, and increased COPD risk.
Female reproductive factors may influence susceptibility to chronic airway disease, although these relationships involve multiple pathways, with obesity as a major confounder. A dedicated life-course cohort with deep phenotyping and hormone profiling is needed to elucidate how reproductive exposures, sex hormones, metabolic determinants and other susceptibility factors interact to shape respiratory outcomes in females.

PMID:
42833548
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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