Menopause (“end of monthly cycles”) is a major but normal biological event in a woman’s life. All sex steroid hormone receptors were expressed in the lung tissue. Menopause is associated with increased respiratory problems1. Menopause is linked with profound changes in the activity of the hypothalamic-pituitary- gonadal axis, as 17b-estradiol secretion in the ovaries ceases. Low levels of 17b-estradiol is associated with increased systemic inflammation and inflammation in the lungs2,3. The inflammation markers C-reactive protein and IL-6 is inversely proportional with FVC and FEV14,5. The literature on menopause and lung health is very limited. Few reports shows that asthma in few women develops or worsens during the age of menopause1 no epidemiologic study has proved. Pulmonary Function Tests (PFTs) provide objective, data of the pulmonary function and spirometry tests based on voluntary forced expiration can detect changes in respiratory system. There is little knowledge of whether hormonal status influences the COPD exacerbations. It seems possible that airway effects of sex hormones may relate to COPD. Although COPD rather rare among the women of fertile age, the disease is being getting more prevalent among women. Thus, there is a need for research on how hormonal and metabolic factors could influence COPD and possible variations in disease intensity.

Aims and Objectives

1) To assess FVC, FEV1 in premenopausal women

2) To assess FVC, FEV1 in postmenopausal women

3) To compare FVC, FEV1 among pre and postmenopausal women.

Study design: Cross sectional study

Sample size calculation: A study done by Jyoti Memoalia et al. on Decline in Pulmonary function test after Menopause took premenopausal (n = 49) and postmenopausal (n = 46) women6, Applying the suitable formula, sample size for our study calculated was 45 in each group.

Inclusion Criteria:

45 voluntary healthy females aged above 38 years and have not attained menopause; Regular menstrual cycle of 28- 30days

Exclusion Criteria:

Less than 38 years and more than 50 years; Pregnant women; Lactating women; On hormonal contraception; Last pregnancy less than 2 years from the time of study; Any known chronic illness; Athletic or defined physical training; Known respiratory disorders; Upper or lower respiratory illness during the time of study; Undergone thoracic or abdominal surgery in the past 1 year; On any chronic medication.

Instrument: Spiro Excel instrument consists of computer -digital spirometer (Spiro excel with Medicaid system) with software installed it for pulmonary function test, it consists of thirty-four parameters with standard laboratory methods and it also has other accessories like paediatric mouth piece, nose clips, USB cable. Other instruments used in the study are measuring tape, for measuring the height of the subject in centimetres, weighing machine.

Institutional Ethical committee clearance was obtained prior to study. Consent from all participants was taken. Detailed history was recorded from study participants. Then they are separated as two groups out of which 45 are premenopausal women (Group 1) and remaining 45 are postmenopausal women (Group 2) and enrolled in the study based on inclusion and exclusion criteria.

Study design: Cross sectional study

Sample size calculation: A study done by Jyoti Memoalia et al. on Decline in Pulmonary function test after Menopause took premenopausal (n = 49) and postmenopausal (n = 46) women6, Applying the suitable formula, sample size for our study calculated was 45 in each group.

Inclusion Criteria:

45 voluntary healthy females aged above 38 years and have not attained menopause; Regular menstrual cycle of 28- 30days

Exclusion Criteria:

Less than 38 years and more than 50 years; Pregnant women; Lactating women; On hormonal contraception; Last pregnancy less than 2 years from the time of study; Any known chronic illness; Athletic or defined physical training; Known respiratory disorders; Upper or lower respiratory illness during the time of study; Undergone thoracic or abdominal surgery in the past 1 year; On any chronic medication.

Instrument: Spiro Excel instrument consists of computer -digital spirometer (Spiro excel with Medicaid system) with software installed it for pulmonary function test, it consists of thirty-four parameters with standard laboratory methods and it also has other accessories like paediatric mouth piece, nose clips, USB cable. Other instruments used in the study are measuring tape, for measuring the height of the subject in centimetres, weighing machine.

Institutional Ethical committee clearance was obtained prior to study. Consent from all participants was taken. Detailed history was recorded from study participants. Then they are separated as two groups out of which 45 are premenopausal women (Group 1) and remaining 45 are postmenopausal women (Group 2) and enrolled in the study based on inclusion and exclusion criteria.

Among the study participants the mean age was 41 in premenopausal women and 51 in postmenopausal women. The mean height and weight among the study participants was 157cm, 60kg in premenopausal women and 155cm, 58kg in postmenopausal women.

Table 1: Difference in FVC between pre-menopausal and post-menopausal women

The Mean FVC value was found to be lower in post-menopausal women (2.5373±0.3053) when compared to that of pre-menopausal women (2.8522±0.2831). This difference in mean was found to be statistically significant with independent t test, t value of 5.073 and p value <0.001.

Table 2: Difference in FEV1 between pre-menopausal and post-menopausal women

The Mean FEV1 value was found to be lower in post-menopausal women (1.8922±0.2967) when compared to that of pre-menopausal women (2.2393±0.2704). This difference in mean was found to be statistically significant with independent t test, t value of 5.79 and p value <0.001.

Table 3: Difference in PEFR between pre-menopausal and post-menopausal women

Postmenopausal women not only experienced physical effects of aging but physiological aspects like lung function are also impacted, cause may be due to lack of ovarian hormones. There is limited literature regarding effect of menopause on lung functions, even worldwide6. So the present study was done to investigate whether the menopausal state is related to the lung health. This study showed significant decrease in the FVC, FEV1 parameters of lung function in the postmenopausal women.

In 2018 Jyoti Memoalia, Batul Anjum, Navinderpal Singh, Mrityunjay Gupta found out there was a significant decrease in FVC, FEV1.Even present study showed similar findings6. ‘Lung function, respiratory symptoms, and the menopausal transition’ by Francisco Gomez et al. in 2008 found that Women not menstruating for the last 6 months had significant decrease in FEV1, and forced vital capacity than those menstruating regularly7.

A study on ‘Lower lung function associates with cessation of menstruation’ by André F.S. et al. showed a decrease in FEV1, FVC and FEV1/FVC. It was performed in 141076 women from the UK Biobank in the year 2016. Present study also showed similar reports8. A study on ‘Menopause is Associated with Accelerated Lung Function Decline’ by Kai Triebner et al. studied in 1438 subjects in the year 2016, showed Lung function was decreased more rapidly among transitional and post-menopausal women, the adjusted mean FVC decline was increased by 210.2 ml/yr (95% confidence interval [CI], 213.1to27.2) in transitional women and 212.5ml/yr(95% CI, 216.2to 28.9) in post-menopausal women, compared with women menstruating regularly. The adjusted mean FEV1 decline increased by23.8 ml/yr (95% CI, 26.3 to 22.9) in transitional women and 25.2 ml/yr (95% CI, 28.3 to 22.0) in post-menopausal women9. A study by Diana A. et.al on ‘Age at menopause and lung function’. They included 94742 naturally post-menopausal women from the UK Biobank. Analyzed on the effect of age at menopause on forced expiratory volume in 1 s (FEV1), FVC, FEV1/FVC, spirometric restriction and airflow obstruction analyses showed higher FEV1/FVC and a 15% lower risk of airflow obstruction for women with early (<45 years) compared to normal (45–55 years) menopause10.

Postmenopausal status is not significantly associated with lower FVC (-33mL, p-value = 0.353), but associated with lower FEV1 (-77mL, p-value = 0.032).92 the mean age at menopause in Indian women was 45.03 years11. In our study the mean age was 51 years, western countries mean age at menopause was higher may be due to nutrition, climate and racial factors. Nutritional factors play important role in menopause. Few studies shows that menopause was higher in better nourished than in the poorly nourished women.

The results from the present study showed statistically significant changes in FEV1, FVC, FEV1/FVC, FEF 25% in post- menopausal women which should be taken into account, because they are highly relevant for the health and quality of life and shows that there is airway limitation and obstructive pattern of airway disease which can lead to asthma. It opens the scope for further research in the same idea. Further studies should address benefits of hormone-replacement therapy in post-menopausal women with respect to lung function. More studies should be done in different lung parameters. Findings together with evidence shows that lung function gets decline after menopause. It should alert clinicians to the risk of poor lung function in post-menopausal women, especially in those who have an early cessation of menstruation.

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