When it comes to women and asthma, the ability to breathe can be affected by pregnancy, the menstrual cycle, and menopause. Women who also have allergies and other asthma triggers may struggle to get a breath of fresh air.
“Unequivocally, women with asthma face an extra challenge simply because they are women,” says Neil Kao, MD, an asthma and allergy specialist in Greenville, S.C.
“Not only are they challenged with balancing known triggers like pollen and mold, but they must also manage the fact that the female hormones in their bodies are constantly changing in ways that might impact how well they can breathe.”
Women must manage the effect of female hormones on asthma. Often they must manage asthma during pregnancy. Managing asthma poses greater challenges for women, but it can be done. Here’s how women with this chronic lung disease can start to breath easier.
Female Hormones and Asthma
Female hormones such as estrogen may have almost as much impact on the airways as allergies and hay fever. But estrogen itself is not the culprit in triggering the symptoms of asthma. Rather, it’s the fluctuation of estrogen — the up and down of hormone levels — that may cause inflammation in the airways.
“Fluctuating estrogen levels can activate proteins that produce an inflammatory response, which can bring on asthma symptoms,” says Christiana Dimitropoulou-Catravas, PhD, assistant professor in the department of pharmacology and toxicology at the Medical College of Georgia.
Dimitropoulou-Catravas, who was the lead author on a study investigating the role of estrogen in asthma, explains that by stabilizing estrogen levels, inflammation and asthma may be better controlled.
“With any medication, it’s a balance of risk vs. benefit,” says Dimitropoulou-Catravas. “Estrogen replacement therapy, which can bring estrogen levels into balance, has been associated with an increased cardiovascular risk, such as a higher risk of stroke. But if someone has severe asthma and it can be linked to low levels of estrogen, replacement therapy might be an answer.”
Asthma and Female Milestones, Pregnancy, and Menopause
Most women living with asthma are conscious of the seasons and specific allergies that might trigger their symptoms. They should be aware of their menstrual cycles, as well. Shifting hormone levels can impact the state of their airways. So can pregnancy and menopause, when hormones and other factors may affect asthma symptoms.
Menstrual Cycles: A woman’s hormone levels change dramatically over the course of her menstrual cycle — whether it’s regular, or irregular. The trouble spot, however, may be right before her period starts, when estrogen levels are at a cycle low.
“Most hospitalizations for asthma in women occur around the peri-menstrual stage of the menstrual cycle — right before a woman’s period begins,” says Maeve O’Connor, MD, an allergist and immunologist in Charlotte, N.C. “This is when estrogen levels drop down to almost zero.”
Pregnancy: It’s a roll of the dice whether pregnancy has an impact on asthma. Kao says pregnant women with asthma are broken down into thirds: in 1/3 of women, asthma symptoms worsen; in the next 1/3 they improve; and in the last 1/3, they stay the same.
Whatever group you fall into, the good news is that asthma during pregnancy, if kept under control, does not increase the risk of maternal or infant complications.
Menopause: Menopause causes peaks and valleys in a woman’s estrogen levels — in many cases, more valleys than peaks. By keeping these levels more constant and avoiding dramatic drops that might trigger inflammation, asthma symptoms can be better managed. Women with asthma triggered by menopause should talk to their doctor about temporarily using hormone replacement therapy, and gradually tapering it off.
Keeping Asthma in Check
For women living with chronic asthma, the trick to keeping your symptoms in check is working closely with your doctor to manage your ability to breath. Here are practical tips from the experts on how to keep your airways open, despite what’s happening with your hormones:
- For women with regular menstrual cycles: Avoid your known allergens right before your period is about to begin, suggests Kao.
- For women with irregular menstrual cycles: Watch your symptoms carefully, says O’Connor. Use a peak flow meter to measure your ability to push air out of your lungs. Decreasing numbers can help indicate when your period might be approaching — and you can be vigilant about avoiding triggers.
- For all women: Always use maintenance medication, at the direction of your doctor, instead of relying on rescue inhalers. It’s far more important for lung health to prevent symptoms, Kao says, instead of treating symptoms once they have started.
- For pregnant women with asthma: Take maintenance medication; It’s critical. “For women who are dealing with asthma during pregnancy, maintenance medications are essential for your health and for the health of your baby, so talk to your health care provider,” says Clifford Bassett, MD, medical director of Allergy & Asthma Care of New York.
In many cases, pregnant women avoid maintenance medication out of fear the medicine may harm their unborn child. In fact, the opposite is true. “When a pregnant woman has an asthma attack, you aren’t getting oxygen, and neither is baby, which can be detrimental to the health of mother and child,” says Kao.
- For women in menopause: Watch for symptoms that may indicate asthma, such as wheezing and coughing.
“Women who go through menopause can develop asthma for the first time in their lives, which can be surprising,” says Basset. But, it’s important to know that you can have asthma at any age, especially women whose hormones are changing so dramatically, he explains. So don’t ignore wheezing and coughing, whatever your age.
If you experience asthma symptoms, talk to your doctor about treatment, including the option of temporary hormone replacement therapy.
Asthma in women is a serious health issue, Basset says. Asthma is more common in women than men. Women also suffer more hospitalizations and deaths related to asthma. In addition, cases of asthma have increased in women vs. men over the last decade or two, especially in women ages 20 to 50.
Still, the numbers aren’t the whole story. “We need to educate women about the fact that asthma is totally treatable,” says Basset. “When you have proper monitoring and insight into the disease it is a recipe for success.”