Asthma symptoms might increase during and before menstruation for some women. Experts believe that sex hormone fluctuations may be to blame.
I Need My Inhaler For This?
Some people’s bodies change in ways that aren’t just uncomfortable but also dangerous. Research shows that asthma symptoms get worse (anywhere from 10% to 40% of women) right before and during their periods. And when women go to the emergency room for asthma attacks, they are often just a few days away from getting their periods. They end up in the ER because asthma symptoms worsen and can lead to severe problems.
Women have woken up in the middle of the night, confused because they struggle to breathe. I can’t imagine the thought of lying in bed, not being able to stop coughing or wheezing—not even being able to rely on my inhaler, the thing that is supposed to provide relief. The first questioning thought for me would be, “I need my inhaler for this too?” Then having an ‘aha moment’ of, “oh, my period is coming.” Some women notice for a few days each month that their asthma would flare, and tasks as simple as folding laundry or talking on the phone would leave them breathless.
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The Larger Puzzle of Menstruation & Sex Differences
The aggravation of symptoms during menstruation is just one piece of the greater puzzle that is the role of gender variations in asthma. In general, differences in sex hormone levels between males and females seem to increase the prevalence and severity of asthma episodes in adult women. Furthermore, the increase and fall of hormones throughout the menstrual cycle seem to aggravate asthma symptoms.
Asthma differences between men and women begin early and alter substantially as individuals mature. Then the “puberty switch” happens. While adult women had more asthma than males, the pattern is reversed in children. Boys are 1.5 times more likely than girls to suffer from asthma before puberty and twice as likely to be hospitalized for their symptoms.
Experts ascribe this partly to anatomical lung abnormalities since males’ airways are abnormally small relative to their lungs’ big capacity. It’s amazing how certain stages of our life can have such huge impacts on medical issues. Not only do we have to worry about not feeling right in our bodies at this time in our teen lives, but we also have to try to make sure we are as healthy as we can be medically.
Women begin to overtake men in the number of new asthma cases, with about two adult women diagnosed for every one man. And as much as we women like to be ahead of men at times, it’s not quite so here.
Females get higher levels of estrogen and progesterone, and males get higher testosterone levels. Each sex hormone affects the lungs in intricate ways that vary by cell.
“After puberty, testosterone protects guys against asthma by reducing inflammation. Estrogen and progesterone enhance inflammation, worsening asthma,” says a Mayo Clinic allergist-immunologist named Sergio Chiarella.
A Phenomenon Experts Call “Perimenstrual Asthma”
According to researchers, changes in asthma symptoms correspond to the ebb and flow of estrogen and progesterone throughout the menstrual cycle, which lasts 28 days.
Part of the reason women with asthma often have worsening symptoms approximately a week before their period begins is that their progesterone and estrogen levels have started to fall. Exacerbations of asthma remain when hormone levels fall to their lowest point during menstruation.
The fall in progesterone before menstruation seems to play an essential role in triggering perimenstrual asthma. But exactly how it triggers it is unclear to many researchers and is associated with increased asthma-related ED visits, hospitalizations, and ICU admissions in women. Asthma worsening during this perimenstrual period is a specific condition—a highly symptomatic asthma phenotype. Aspirin sensitivity, decreased atopy, and poorer lung capacity separates it from classic asthma.
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How Can We Help These Symptoms of Asthmatic Menstruation?
Changes in hormones seem to cause perimenstrual asthma; researchers thought that treatments giving constant amounts of hormones, like some types of oral birth control, might make symptoms less severe. But Joe Zein, a pulmonologist and researcher, says that the scientific evidence for this prediction is “kind of a mixed bag.” One study found that hormonal birth control improves symptoms, while another did not.
One explanation for the uncertainty over oral birth control’s effectiveness for asthma symptoms might be the timing of the research. The majority of the studies on oral birth control date back decades when the levels of hormones in the tablets differed from the alternatives available now.
Increasing your asthma meds during this period is one option to explore. Women suffering from this condition might take one kind of asthma medicine every four hours and another every eight hours, of course, after consulting with a trusted healthcare provider about what is best for their body. Keep speaking with your doctor so that they can help you throughout your perimenstrual asthma.
Medical professionals and academics still have many doubts regarding the connections between asthma and sex hormones. Because there hasn’t been enough study to fill in such holes, patients and physicians must continue practicing without “clear-cut advice.” And considering that asthma has been the cause of death for twice as many females as males throughout history, these concerns must be answered.