Chest · Apr 23, 2026

The Association of Menopause With Lung Function in Women With and Without HIV

By Abelman RA, Xia F, Drummond MB et al.

BACKGROUND: Menopause accelerates lung function decline in women without HIV, but whether menopause modifies lung function in women with HIV (WWH) is unknown. RESEARCH QUESTION: Is menopause associated with lung function in WWH and women at risk for HIV? STUDY DESIGN AND METHODS: Pulmonary function tests (spirometry: n = 1,116; diffusing capacity for carbon monoxide [Dlco]: n = 615) collected from 2018 to 2019 in 1,206 participants from the Women's Interagency HIV Study were included. In this cross-sectional analysis, women were categorized into groups defined by age (41-50 and 51-60 years of age) and by menopausal phase as determined by anti-Müllerian hormone, a biomarker of ovarian reserve. Linear regression models determined the differences in mean FEV₁, FVC, and Dlco by menopausal phase compared with women in the same age group. RESULTS: Overall, 71% were WWH, 65% were Black, and the median age was 52 years. Of the participants, 36% and 31% reported current and former smoking, respectively. A total of 30% were premenopausal/early perimenopausal, 40% were late perimenopausal, and 30% were postmenopausal. There was no statistically significant association of HIV with FEV₁ or FVC, but HIV was associated with lower Dlco (P = .004). After adjusting for demographic, clinical, and behavioral factors, we observed significant differences in lung function by menopausal phase in women 41 to 50 years of age, but not in those 51 to 60 years of age. Among those 41 to 50 years of age, when compared with premenopause/early perimenopause, women in late perimenopause had -109 mL (95% CI, -201 to -16) and -125 mL (95% CI, -223 to -28) and postmenopausal women had -310 mL (95% CI, -525 to -96) and -307 mL (95% CI, -534 to -80) lower mean FEV₁ and FVC, respectively. Late perimenopausal women had -1.40 mL/min/mm Hg (95% CI, -2.39 to -0.41) lower mean Dlco, but no clear evidence of difference in postmenopause. INTERPRETATION: Our results show that menopausal phase is associated with lung function in WWH and women without HIV, even after accounting for age. Further research is needed to understand how estrogen depletion alters lung function.

doi.org/10.1016/j.chest.2026.02.050Open accessPubMed 42034331Populations