Asthma and menopause: what you need to know

Your hormones can affect your lungs, even if you’ve not experienced asthma before

Asthma is a serious lung condition that affects millions of women in the UK
Female hormones are thought to have a powerful role in causing symptoms
Discuss your asthma symptoms with your GP when talking about HRT

With three million women having asthma in the UK, many of you will be going through the perimenopause and menopause while managing this common, but serious lung condition.

Getting the right approach matters as women are more likely to have asthma, have more severe symptoms and are almost twice as likely to die from an attack [1].

Asthma is caused by changes in your airways that leads to swelling and temporary narrowing of the tubes that carry air in and out of your lungs.

Part of the higher risk for women is likely to be, at least partly, due to female sex hormones, which are thought to have a powerful role in the condition and can trigger symptoms [2].

If you have asthma, you may have noticed increased symptoms, which include shortness of breath, chest tightness or pain and wheezing, around your period, during pregnancy and your perimenopause.

Charity Asthma + Lung UK says that while the role of hormones in asthma is poorly understood, many women experience a significant worsening of symptoms at times of hormonal change.

Between 20 and 40% of women with asthma have perimenstrual asthma, when your condition gets significantly worse in the phase before your period [3].

Up until puberty, boys have higher rates than girls, when the situation reverses. Women aged 20 to 50 years are three times more likely than men to be admitted to hospital for the potentially dangerous condition [4].

What role may hormones have in asthma?

The role of your hormones, particularly oestrogen, in asthma is complex and poorly understood.

Researchers think that oestrogen may be an asthma trigger, and that it may also make you more sensitive to other triggers, by prompting a stronger allergic response in your body [5]. This may fuel the inflammation that can make breathing difficult.

But oestrogen for some may also have a protective role in the lining of the airways, depending on how the hormone interacts with the cells of the smooth muscle [6].

The hormone testosterone could have a calming effect on inflammation in the lungs, but, again, more research is needed in this area.

Other midlife factors to consider

Stress and anxiety can also be asthma triggers, and these are symptoms you are more likely to experience during the perimenopause and menopause.

Weight is also a risk factor for asthma, with higher rates of the lung condition in those who are obese. You may find your weight creeps up during times of hormonal flux; seek advice on maintaining a healthy weight, eating well and exercising, during the perimenopause and beyond.

During the perimenopausal period there is a significant decline in lung function for women, however, however once the menopause has occurred, women have a lower risk of developing asthma [7]. This suggests the fluctuations in hormone levels have a larger part to play in the inflammatory and allergic responses which contribute to asthma, than low levels on their own.

Researchers concur and report postmenopausal women present a significantly lower risk of developing asthma for the first time than premenopausal women of similar age [8].

But if you do develop asthma for the first time after the menopause, it is likely to be harder to manage than for those who have had it for a long time, according to Asthma + Lung UK [9].

What about HRT?

HRT is the first line treatment for menopausal symptoms. Research has shown it can help with common problems like hot flushes, night sweats, sleep problems, anxiety and low mood and vaginal dryness.

But research around the impact of HRT for women with asthma has been mixed, with a number of studies suggesting that HRT may increase asthma attacks and symptoms in women who already have the condition [10] [11].

However, a large UK study that looked at the records of more than 350,000 women over 17 years, found HRT was associated with a reduced risk of developing asthma in menopausal women without the condition [12].

And neither stopping or restarting HRT in the postmenopausal period was shown to have any effect on asthma [13].

Interestingly, taking the combined pill (with oestrogen and progestogen) for three or more years, has been found to reduce the numbers of attacks in women with severe asthma [14].

Guidance for doctors does not list asthma as a condition which needs to be considered when prescribing HRT [15].

If you’re having perimenopausal or menopausal symptoms and have asthma, or have had it before, arrange a discussion with your GP about HRT. A personalised approach, balancing the risks and benefits, will help you and your healthcare professional decide if HRT is the right approach for you.

If you take steroids for your asthma this may increase your risk of osteoporosis, when your bones are thinner and more likely to fracture. As menopause also increases your risk of this condition, this should be part of your discussion with your GP about HRT, as this can boost your bone strength.

Keeping a diary of your menopausal symptoms and asthma symptoms can help inform this discussion. The balance app has an in-built period tracker which can help you and your healthcare professionals spot trends and links between your cycle and any other symptoms.

If your symptoms of asthma start to worsen when you start HRT, sometimes this can be an allergy-type response prompted by your body’s reaction to histamine, rather than the lung condition. Some people are intolerant to this chemical, which is crucial for the body, but can cause problems if there is too much of it.

RELATED: Histamine Intolerance

What else should I be doing?

Make sure you take any medication you are prescribed to manage your asthma, take it correctly and have an asthma review at least once per year.

Be aware that some painkillers are not recommended for people with asthma. Paracetamol is usually safe, but non-steroidal anti-inflammatory tablets (NSAIDs) such as ibuprofen and mefenamic acid and aspirin, may make your asthma symptoms worse or trigger an asthma attack.

Maintain a healthy weight and keep active to boost bone health. Try to manage your stress levels, which can be an asthma trigger. Breathing techniques, activity, prioritising sleep and spending time in nature may help.

References

1, 2. Asthma + Lung UK: asthma is worse for women report

3. Graziottin A., Serafini A. (2016), ‘Perimenstrual asthma: from pathophysiology to treatment strategies’, Multidiscip Respir Med. Aug 1; 11:30. doi: 10.1186/s40248-016-0065-0.

4. Brenner B.E. et al. (2005), ‘Relation between phase of the menstrual cycle and asthma presentations in the emergency department’, Thorax. 60 (10) pp.806-9. doi: 10.1136/thx.2004.033928.

5. Bonds R.S., Midoro-Horiuti T. (2013), ‘Estrogen effects in allergy and asthma’, Curr Opin Allergy Clin Immunol. 13(1): 92-9. doi: 10.1097/ACI.0b013e32835a6dd6.

6. Aravamudan B. et al. (2017), ‘Differential Expression of Estrogen Receptor Variants in Response to Inflammation Signals in Human Airway Smooth Muscle’, J Cell Physiol. 232(7): 1754-1760. doi: 10.1002/jcp.25674.

7. Asthma + Lung UK: asthma is worse for women report

8. Troisi R.J., Speizer F.E., Willett W.C., Trichopoulos D., Rosner B. (1995), ‘Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study’, Am J Respir Crit Care Med. 152(4 Pt 1): pp1183-8. doi: 10.1164/ajrccm.

9. Asthma + Lung UK

10. Bønnelykke, K. et al. (2015), ‘Postmenopausal hormone therapy and asthma-related hospital admission’, Journal of Allergy and Clinical Immunology. 135 (3), 813 – 816.e5

11. Bright I. et al. (2021), ‘Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study’, The Journal of Allergy and Clinical Immunology: In Practice, Volume 9, Issue 7, doi.org/10.1016/j.jaip.2021.02.052.

12. Shah S.A. et al. (2021), ‘Hormone replacement therapy and asthma onset in menopausal women: National cohort study’, J Allergy Clin Immunol. 147(5):1662-1670. doi: 10.1016/j.jaci.2020.11.024.

13. Hepburn M.J. et al. (2001), ‘The effects of estrogen replacement therapy on airway function in postmenopausal, asthmatic women’, Arch Intern Med. 10-24;161(22):2717-20. doi: 10.1001/archinte.161.22.2717.

14. Nwaru B.I., Tibble H., Shah S.A., et al. (2021), ‘Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study’, Thorax, 76:109-115.

15. NICE: Menopause Diagnosis and Management