Lung function dropped as women moved through menopause — whether or not they had HIV

Menopause is known to accelerate lung function decline in women generally, but whether HIV — which carries its own inflammatory and immune effects — changes that relationship had not been established. A study published this week in Chest used pulmonary function testing from a long-running cohort of women with and without HIV to find out [s1].

The design

Researchers analyzed pulmonary function tests — spirometry in 1,116 participants and diffusing capacity for carbon monoxide (Dlco, a measure of how well the lungs transfer gas into the blood) in 615 — collected between 2018 and 2019 from 1,206 participants in the Women's Interagency HIV Study [s1]. In this cross-sectional analysis, women were grouped by age (41–50 and 51–60) and by menopausal phase, determined using anti-Müllerian hormone, a biomarker of ovarian reserve [s1]. Linear regression models compared mean FEV1 (the volume of air forcefully exhaled in one second), FVC (total forced vital capacity), and Dlco across menopausal phases within each age group [s1]. Overall, 71% of participants were women with HIV, 65% were Black, and the median age was 52 [s1]; 36% currently smoked and 31% had formerly smoked [s1]. Of the total sample, 30% were premenopausal or early perimenopausal, 40% were late perimenopausal, and 30% were postmenopausal [s1].

What it found

HIV status alone was not associated with FEV1 or FVC, but it was associated with lower Dlco (p = .004) [s1] — meaning HIV appeared to specifically affect the lungs' gas-exchange efficiency without affecting how much air participants could move in and out.

The menopause findings were age-specific. Among women aged 41 to 50, significant differences in lung function emerged by menopausal phase; among women 51 to 60, they did not [s1]. In the younger group, compared with premenopausal or early perimenopausal women, late perimenopausal women had 109 mL lower mean FEV1 (95% CI −201 to −16) and 125 mL lower mean FVC (95% CI −223 to −28) [s1]. Postmenopausal women in the same age group showed larger declines: 310 mL lower mean FEV1 (95% CI −525 to −96) and 307 mL lower mean FVC (95% CI −534 to −80) [s1]. Late perimenopausal women also had 1.40 mL/min/mmHg lower mean Dlco (95% CI −2.39 to −0.41), though no clear Dlco difference was seen in postmenopausal women [s1]. These associations held after adjusting for demographic, clinical, and behavioral factors [s1].

Reading the numbers

A 310 mL drop in FEV1 is a meaningful decline — for context, that's roughly the loss some studies associate with several years of accelerated aging or several pack-years of additional smoking history, though this study doesn't make that specific comparison directly. The fact that the menopause-lung function association appeared in the 41–50 age group but not the 51–60 group is a notable detail: it suggests the transition itself, rather than simply older age or more time since menopause, may be what's driving the measured decline, though the cross-sectional design can't confirm that interpretation.

Why HIV didn't change the core pattern

The study's central finding — that menopausal phase was associated with lung function decline "in WWH [women with HIV] and women without HIV" [s1] — indicates the menopause-lung function relationship isn't unique to or amplified by HIV status, at least as measured here, even though HIV independently affects a different aspect of lung function (gas transfer, via Dlco). That's a reassuring finding for a population — women with HIV, who are living longer with the condition as effective antiretroviral therapy has become standard — who face compounding questions about how HIV and aging-related processes interact.

What this doesn't establish

This is a cross-sectional analysis, comparing different women at different menopausal phases at one point in time rather than tracking the same women through the transition, which limits how confidently it can attribute the observed differences to the menopausal transition itself rather than to some other factor that happens to correlate with menopausal phase. The population was 65% Black women specifically enrolled in an HIV-focused cohort study, which may not generalize to all women. The study's authors state that further research is needed to understand how estrogen depletion alters lung function [s1] — an acknowledgment that the mechanism remains unestablished.

What to watch

Longitudinal studies following the same women through the menopausal transition, which would more directly test whether the transition itself drives the lung function changes observed here. This article is not medical advice.

Sources

1. The Association of Menopause With Lung Function in Women With and Without HIV — Chest, 23 April 2026