Asthma, a complex disease with adverse outcomes, presents an ongoing public health challenge in the United States [1,2]. Etiologic factors of asthma and associated mechanisms have not been fully described. Observations of increasing asthma incidence, decreasing age at menarche, common risk factors led investigators to hypothesize potential associations of age at menarche or menstrual characteristics with incidence of adult onset asthma [3]. Investigators have hypothesized the role of several pathophysiologic pathways (including those that involve hormonal changes) in the development of asthma [4]. Higher levels of leptin and increased insulin resistance in women with early menarche may influence inflammation and innate immunity, potentially contributing to higher risk of asthma [5-8]. Early menarche, menstrual irregularity, and longer cycle length have been shown to be risk factors for asthma symptoms, adult onset asthma, and bronchial hyperactivity in some [3,6,9-12] but not all [5,13] studies. Potential reasons for observed inconsistencies could be differences in study population characteristics (e.g. obesity), including those that may modify observed associations [14,15]. To date, few US studies have examined associations of age at menarche, menstrual regularity or cycle length with adult onset asthma; and, even fewer evaluated role of potential effect modifiers (such as overweight/obesity status or physical activity). The objectives of this study were to examine associations of age at menarche and menstrual characteristics with adult onset asthma among reproductive age women and to evaluate the extent to which potential effect modifiers influence these associations. Findings of this study may enhance understanding of risk factors of incident adult onset asthma and identification of high risk populations for targeted preventive interventions.

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