Asthma and Hormones in Women

asthma and hormones in womenFrom the John R. Lee, M.D. Medical Letter, 2001

Q: I am 32 years old and have had asthma since I was a child. I use inhalers to control it, but it tends to get worse before I get my period. I’ve ended up in the emergency room many times in my life with these asthma attacks, and am scared to do anything that might make them worse. I’d like to try progesterone cream for my PMS, but I want to make sure it won’t make my asthma worse.

A: I have many letters from women telling me that their premenstrual asthma cleared up when they started using progesterone. I also have letters from postmenopausal women reporting that their asthma and allergies cleared up when their hormones were balanced. Please read What Your Doctor May Not Tell You about Premenopause for detailed information on using progesterone cream.

An excellent new study on premenstrual asthma and hormones coming from Australia looked at 51 women with asthma. A reported 47% of them had constant symptoms, 41.2% had perimenstrual asthma, and 11.8% had mid-cycle deterioration in peak expiratory flow and other signs. The researchers measured hormone levels and found that, “The magnitude of the drop in progesterone from day minus 7 to day minus 2, premenstrual tension symptoms, and age explained 89.2% of the variability in perimenstrual asthma symptom scores, with the progesterone gradient being the major determinant.” In other words, low progesterone levels correlated strongly with asthma symptoms.

Unfortunately the researchers concluded that the response to this information should be to increase asthma medication premenstrually. If they used physiologic doses of progesterone cream to replace what the ovaries aren’t producing, they would have much better success in treating this problem!

2009 Update on Asthma and Hormones from Virginia Hopkins
Since Dr. Lee wrote the above answer in 2001, even more good research has come out supporting his advice.

Before puberty, asthma is more common in males, but after puberty it is more common in females, which is our first indicator of the connection between estrogen and asthma. We also know that in women with menstrual cycle-related asthma, it gets worse during the 5 to 10 days before menstruation. This is when women are normally producing progesterone, but ovarian dysfunction is epidemic among young women these days, and many are producing little to no progesterone during this phase of their menstrual cycle, which creates estrogen dominance. Young women with asthma are also more likely to have irregular periods. Over a decade ago, Dr. Lee listed asthma as one of the symptoms of estrogen dominance. As women age, more of them die from asthma than men. After menopause, women’s rate of asthma is closer to that of men.

Asthma and Estrogen Replacement
A large 2004 Harvard study published in the Archives of Internal Medicine showed that postmenopausal women using estrogen replacement were more than twice as likely to develop asthma than similar women not taking the hormone. The results were similar for women taking estrogen and a progestin, or estrogen alone.

Asthma and Birth Control Pills
A 2009 study from Norway found that women from 25 to 44 years old who used oral contraceptives (OCs) were nearly 50 percent more likely to have asthma than women who didn’t use them. The findings applied to women who were of normal weight or overweight, but not lean women. Most oral contraceptives contain synthetic estrogens and progestins, which suppress normal production of hormones in the ovaries. The synthetic hormones have different effects on the body than the natural hormones made by the ovaries.

We also know that for women who have pre-menstrual asthma and postmenopausal asthma, the usual inhalers normally used to control asthma can make it worse. This is likely because the inhalers dispense synthetic corticosteroids that occupy progesterone receptors in the cells, thus blocking the action of progesterone and creating even more estrogen dominance.

The research on estrogen and asthma has appeared contradictory, because studies that measure airway constriction and flow in asthma show that estrogen keeps airways more open during an asthma attack. This is due to the well known effect of estrogen in increasing nitric oxide, which helps keep airways open and more relaxed. However, because estrogen is also pro-inflammatory, there is at point at which excess estrogen cancels out the benefit.

The research on progesterone and asthma has been muddied by the fact that much of it was done with the synthetic progestins, but this distinction was not made. Progestins often make asthma worse.

The bottom line is that our hormones work in concert, and it’s well worth working towards hormone balance to help control asthma.

If you want to find out what your progesterone levels are, and whether you are estrogen dominant, you can Take the Hormone Balance Test and/or test your hormone levels. Women who have asthma will want to test their progesterone, estrogen, testosterone and cortisol levels.

References

Barr RG, Wentowski CC, Grodstein F et al, “Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease,” Arch Intern Med 2004 Feb 23;164(4):379-86.

Lim RH, “Sexual Tension in the Airways: The Puzzling Duality of Estrogen in Asthma,” American Journal of Respiratory Cell and Molecular Biology Vol. 38, pp. 499-500, 2008.

Macsali F, Real FG, Omenaas ER, “Oral contraception, body mass index, and asthma: a cross-sectional Nordic-Baltic population survey,” J Allergy Clin Immunol 2009 Feb;123(2):391-7.

Ravelo RL, Rodríguez GB, Collazo AJJ et al, “Comparative study of progesterone, estradiol and cortisol concentrations in asthmatic and non-asthmatic women,” Allergol Immunopathol (Madr) 1988;16:263-266.

Salam MT, Wenten M, Gilliland FD, “Endogenous and exogenous sex steroid hormones and asthma and wheeze in young women,” J Allergy Clin Immunol.  2006; 117(5):1001.

Troisi RJ, Speizer FE, Willett WC et al, “Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma: a prospective cohort study,” Am J Respir Crit Care Med. 1995;152:1183-1188.

Vrieze A, Postma DS, Kerstjens HA, “Perimenstrual asthma: a syndrome without known cause or cure,” J Allergy Clin Immunol. 2003;112:271-282.