ASTHMA

Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey

F Gómez Real^1,2, C Svanes^2,3, E H Björnsson⁴, K Franklin⁵, D Gislason⁴, T Gislason⁴, A Gulsvik^2,3, C Janson⁶, R Jögi⁷, T Kiserud^1,10, D Norbäck⁶, L Nyström⁸, K Torén⁹, T Wentzel-Larsen¹¹, E Omenaas^3,11

¹ Department of Gynecology and Obstetrics, Haukeland University Hospital, 5021 Bergen, Norway
² Institute of Medicine, University of Bergen, Norway
³ Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
⁴ Department of Pulmonary Medicine, Landspitali University Hospital, 105 Reykjavik, Iceland
⁵ Department of Pulmonary Medicine and Allergology, Umeå University, 90185 Umeå, Sweden
⁶ Department of Medical Sciences, Uppsala University, 75185 Uppsala, Sweden
⁷ Foundation Tartu University Clinics, Lung Clinic, 51014 Tartu, Estonia
⁸ Department of Public Health, Clinical Medicine and Epidemiology, Umeå University, 90185 Umeå, Sweden
⁹ Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, 41266 Gothenburg, Sweden
¹⁰ Institute of Clinical Medicine, University of Bergen, Norway
¹¹ Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

Correspondence to:
Dr F Gómez Real
Department of Gynecology and Obstetrics, Haukeland University Hospital, 5021 Bergen, Norway; francisco.real{at}med.uib.no

Background: Hormone replacement therapy (HRT) and obesity both appear to increase the risk of asthma. A study was undertaken to investigate the association of HRT with asthma and hay fever in a population of perimenopausal women, focusing on a possible interaction with body mass index (BMI).

Methods: A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway, and Sweden in 1999–2001, and 8588 women aged 25–54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46–54 years of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed.

Results: HRT was associated with an increased risk for asthma (OR 1.57 (95% CI 1.07 to 2.30)), wheeze (OR 1.60 (95% CI 1.22 to 2.10)), and hay fever (OR 1.48 (95% CI 1.15 to 1.90)). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR 2.41 (95% CI 1.21 to 4.77); wheeze OR 2.04 (95% CI 1.23 to 3.36)) than in heavier women (asthma: p_interaction = 0.030; wheeze: p_interaction = 0.042). Increasing BMI was associated with more asthma (OR 1.08 (95% CI 1.05 to 1.12) per kg/m²). This effect was only found in women not taking HRT (OR 1.10 (95% CI 1.05 to 1.14) per kg/m²); no such association was detected in HRT users (OR 1.00 (95% CI 0.92 to 1.08) per kg/m²) (p_interaction = 0.046). Menopause was not significantly associated with asthma, wheeze, or hay fever.

Conclusions: In perimenopausal women there is an interaction between HRT and BMI in the effects on asthma. Lean women who were HRT users had as high a risk for asthma as overweight women not taking HRT. It is suggested that HRT and overweight increase the risk of asthma through partly common pathways.

Abbreviations: BMI, body mass index; ECRHS, European Community Respiratory Health Survey; HRT, hormone replacement therapy; IR, insulin resistance; RHINE, Respiratory Health in Northern Europe

Keywords: asthma; menopause; hormone replacement therapy; body mass index

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