Hormonal fluctuations may play a part in the link between menopause and asthma. Studies have produced mixed results. While some women may develop new or worsening respiratory symptoms during menopause, others may experience improvement in symptoms, which may be influenced by the use of hormone replacement therapy (HRT).(1)
It’s important to understand how hormonal changes during menopause can influence respiratory function, as adult-onset asthma has been shown to be more common in women than men.(2) This article will discuss whether menopause can trigger asthma and explore strategies for maintaining long-term respiratory health.
How Hormonal Changes Affect Asthma
Asthma is a chronic health condition where the narrowing and inflammation of the airways cause bouts of respiratory symptoms due to obstructed airflow.(2)(3) In addition to common triggers such as pollen, physical activity, or infection, changes in levels of sex steroid hormones may also affect asthma symptoms.
Estrogen, progesterone, and testosterone all influence respiratory function. Estrogen promotes mucus production and supports the healthy functioning of airway smooth muscle (ASM). Progesterone plays a role in mucus clearance and minimizes structural changes in the airways caused by asthma. Androgens have anti-inflammatory properties, and higher levels of testosterone have been linked with improved lung function. As levels of these hormones fluctuate and progressively decline during different stages of menopause, some women may develop asthma symptoms.(4)
Can menopause trigger or worsen asthma?
Menopause may increase the risk of new-onset asthma. Findings of a longitudinal study of European women revealed that new-onset asthma was more common in perimenopausal, early postmenopausal, and late postmenopausal women in comparison to women in their reproductive years.(1)
Another longitudinal study of postmenopausal women in Canada between the ages of 45 and 85 found that the age at natural menopause may also influence asthma risk later in life. Findings showed that women who reached natural menopause between the ages of 40 and 44 were 30% less likely to develop asthma compared to those who reached menopause between the ages of 50 and 54. Certain respiratory symptoms, such as wheezing, have also been noted in connection with surgical menopause.(1)(2)
Perimenopause and Asthma Symptoms
Some women may experience asthma symptoms starting in perimenopause as hormone levels begin to change. A study published in The Journal of Allergy and Clinical Immunology (JACI) found that respiratory symptoms were twice as common among asthmatic women during the menopause transition.(5)(6)
Some women may experience the following respiratory changes during perimenopause:(6)
Wheezing
Wheezing with breathlessness
Shortness of breath during the day
Shortness of breath after physical activity
Being woken up by chest tightness, shortness of breath, or cough attacks
Asthma Treatment Options During Menopause
The following are standard asthma treatment methods that may be recommended for women during menopause to help manage symptoms:
Quick-Relief Medications
Quick-relief inhalers may be prescribed for mild cases of asthma. These fast-acting medications are intended to be used during an asthma attack to reduce swelling and increase airflow through the airways.(7)
Long-Term Control Medications
These medications are used long term to prevent and manage asthma symptoms. A patient may be prescribed oral drugs, inhaled long-acting bronchodilators, or allergy shots, among other treatment options.(7)
Oral Corticosteroids
Oral corticosteroids may be recommended if asthma doesn’t improve with other quick-relief medicines. They may also be prescribed as a long-term control medication. Oral corticosteroids can help prevent hospitalizations from severe asthma attacks.(7)(8)
Bronchial Thermoplasty Procedure
A bronchial thermoplasty may also be recommended if medication doesn’t improve symptoms. This minimally invasive procedure uses heat to thin the muscles of the airways and reduce constriction, resulting in fewer asthma attacks.(7)
Lifestyle Modifications
Dust, pet dander, and pollen are common asthma triggers. Limiting exposure to known triggers with routine cleaning or by staying indoors during allergy season can reduce the risk of asthma attacks. Maintaining a healthy weight, increasing fruit and vegetable intake, managing stress, and engaging in safe amounts of exercise can also help control asthma symptoms and promote women’s overall health.(9)
HRT Considerations for Women with Asthma
HRT is used to reduce menopausal symptoms; it’s not a treatment method for asthma. Research is inconclusive regarding the effects of HRT on asthma among menopausal women. Some research has shown that HRT may increase the risk of newly diagnosed asthma in postmenopausal women. However, other studies have shown that symptoms may improve with HRT use in women already diagnosed with asthma.(5)
Another study found a link between previous HRT use and severe asthma exacerbation in asthmatic perimenopausal and postmenopausal women. This relationship was not observed with current HRT use. Additionally, the study found that body mass index (BMI) and smoking status are contributing factors.(10) For these reasons, a doctor will consider a patient’s eligibility for HRT on an individual basis, factoring in menopausal symptom severity, health status, and asthma history.
When to Seek Medical Advice
Women should talk to their doctor if they experience new or worsening symptoms of asthma during menopause. A healthcare provider can diagnose the condition using a variety of tools, including lung function tests, bronchial provocation tests, or allergy tests, and develop an individualized treatment plan.(11
Increased education around changes in respiratory health that can occur as women approach menopause is also important. Clinicians can empower women with the information they need about asthma prevention and treatment in order to maintain respiratory health during this phase of life.
