Several years ago, I picked up on a pattern during which my asthma would get worse right before I started my period. At the time, when I was slightly less savvy and plugged my questions into Google instead of academic databases, I couldn’t find any real information about this phenomenon. So, I reached out to friends with asthma. One of them told me to reach out to Dr. Sally Wenzel, a research doctor at The University of Pittsburgh, to see if she could point me in the right direction. To my relief, Dr. Wenzel noted that many women do report having worsening asthma symptoms around their periods. But, there isn’t much research to confirm a connection or explain why.
Hormones and asthma: In the research
While a Google search didn’t point me to many answers about the link between menstruation and asthma, research journals have done a better job. One small study from 1997 studied 14 women over 9 weeks. While only 5 women noted premenstrual asthma symptoms, all 14 experienced a decrease in peak expiratory flow or an increase in symptoms before the onset of their periods. When the women in this study were given estradiol (the estrogen component found in birth control pills, patch, and ring), they reported significant improvements in both premenstrual asthma symptoms and peak expiratory flow.
In 2009, another small study of women and asthma was published in the American Journal of Critical Care and Respiratory Medicine. Researchers noted that women with asthma, regardless of whether or not they were using contraception, had decreased airflow during and right after menstruation. So it seems this data is consistent with older studies that suggest hormonal changes affect asthma. However, it is not completely clear how or why.
Essentially, this research would suggest that changes in hormone levels can cause a worsening of asthma symptoms for some women.
Something else worth noting is that the proportion of females to males with asthma changes dramatically at puberty. Prior to age 18, about 10 percent of boys have asthma compared with about 7 percent of girls. After age 18, these rates shift. Just 5.4 percent of men and 9.6 percent of women report an asthma diagnosis, according to the Centers for Disease Control and Prevention (CDC). Research suggests this flip in prevalence is caused by hormonal changes. Especially in women, asthma may begin at puberty and worsen with age. Recent animal studies have shown that estrogen can increase airway inflammation while testosterone can decrease it. This fact may a play a role in human asthma and partially explain the shift in asthma that occurs at puberty.
What to do about it
At the time, Dr. Wenzel’s only suggestion was that I consider asking my doctor about using oral contraceptives. This would cut back on hormonal swings before my period and would also enable me to bump up my treatment prior to my pill break to avoid any symptoms. Oral contraceptives, along with the patch and the ring, prevent pregnancy by decreasing spikes in hormones at certain points in the menstrual cycle. So it seems regulation of the hormonal cycle may benefit certain women with asthma.
While this may be a good option for some women, the use of hormonal contraceptives can actually make symptoms worse for other women. A 2015 study suggested this was especially true in women who are overweight. With that said, it’s important to discuss this treatment with your doctor and what it can mean for you.
A personal take
Given the rare, yet possible risks, of taking oral contraceptives (namely blood clots), I wasn’t about to start taking them just to see if they provided any relief from my hormone-induced asthma symptoms. But in May 2013, after dealing with severe uncontrolled bleeding from a then-undiagnosed uterine fibroid, I reluctantly began taking “the pill,” which is a common treatment for fibroids.
I’ve been on the pill for almost four years now, and whether it’s the pill or my asthma just being under better control, I’ve had fewer bad swings of my asthma before my periods. Perhaps this is because my hormone levels remain on a predictably steady state. I’m on a monophasic pill, in which my hormone dose is the same every day, consistently throughout the pack.
If your asthma worsens around your period, know that you’re certainly not alone! Like any other trigger, it’s worth discussing with your doctor to help establish whether your hormone levels have a role in triggering your asthma. Some doctors may not be familiar with this research, so bringing some highlights (three bullet points or so) from reading you’ve done may help them to get up to speed. Certain hormonal treatments, like the birth control pill, may have some positive effect on your asthma, especially around your period, but the research is not strikingly clear yet for how exactly this treatment helps.
Ask your doctor if increasing your asthma medications around your period may be an option for you. The good news is that choices exist. By having this conversation with your doctor, you can figure out if there are ways for you to improve your asthma control around your period and improve your quality of life.