10 Ways to Limit Your Period’s Affect On Your Asthma

It’s that time of the month.

Do you have your inhaler handy?

You may need it, because according to recent studies, your asthma is likely to get worse during your period.

Sounds a little strange, but when you think about how hormones fluctuate during a woman’s cycle, you can kind of understand.

What you’re probably wondering, though, is if you can do anything about it?

 Hormones Run Messengers in the Body

Hormones are substances like estrogen and progesterone (female hormones), testosterone (male hormone), adrenaline, and more that work like messengers between organs and systems in the human body.

Certain glands—like the adrenal glands, pituitary gland, thyroid gland, sex glands, etc.—release these hormones at various times. The hormones then go out and communicate with groups of cells to facilitate growth, reproduction, development, metabolism, emotions, energy, and more.

You can think of hormones as those chemicals that “set things in motion”—your period being one of them. Hormones produced by the pituitary gland in the brain regulate ovulation and stimulate the ovaries to produce female hormones like estrogen to prepare the body for fertilization. If fertilization doesn’t occur, the hormones decrease, bleeding occurs, and the cycle winds down to start again.

Many women have experienced an increase in symptoms of asthma during their menstrual cycle. Could all those hormones have something to do with it?

If you’re one of those women, you can relax. It’s not all in your head. Science has discovered some evidence supporting the fact that female hormones may affect the frequency of asthma attacks.

 How Hormones Affect Asthma Not Fully Understood

We don’t have all the answers yet. Scientists still don’t know how hormonal fluctuations may interact with the lungs to exacerbate symptoms, but they have seen it occur in controlled studies. It may be that the hormone changes activate proteins that encourage inflammation in the airways, or that female hormones like estrogen affect how bronchial muscles behave.

Dr. James T. C. Li, chair of the Division of Allergic Disease in the Department of Internal Medicine, states that because progesterone and estrogen decrease just before and during a woman’s period, asthma symptoms may become more pronounced. He adds that irregular periods, pregnancy, and menopause can also increase the risk of a severe asthma attack. “The relationship between hormones and asthma is complex,” he writes, “varies between individuals and isn’t fully understood.”

You may not have noticed a change in asthma symptoms during your period, whereas your friend may live on her inhaler during hers. Hormones don’t affect every woman in the same way. Just like you may have more abdominal cramps and your friend complaints about puffiness and bloating, you may also experience differences in how your asthma reacts.

 Women More at Risk from Asthma in General

Those women who do notice a worsening in asthma symptoms should be aware of their cycles, however, and take steps to take care of themselves. We now know that potentially dangerous things like wheezing, shortness of breath, and coughing can become more serious during that time of the month.

We also know that according to statistics, asthma is more common among adult women than adult men, and that women account for nearly 65 percent of asthma deaths. African American women have the highest mortality rate due to asthma. In 2011, eight million women suffered an asthma attack, compared to 5.1 million men. In 2008, hospitalizations because of asthma were 1.5 times higher in women than men.

 Studies Connect Asthma with a Woman’s Cycle

Scientists have thought for some time that hormones could have something to do with asthma in women. As early as 1931, they reported on a potential link between the two in a medical journal. The connection has never been actually proven, however.

In 1996, for instance, researchers looked at data for nearly 200 women with asthma aged 13 to menopause. They found that almost 50 percent of emergency room visits for acute asthma occurred during the “perimenstrual” phase, which is the period of about 2 days prior to when bleeding starts continuing through the first few days of menstruation. Study authors theorized that drops in estrogen levels may trigger changes in the immune system to make attacks more likely.

A later 2000 study found similar results, though not quite as dramatic. Researchers looked at data for nearly 300 women with acute asthma and found that 13 percent reported a worsening of symptoms related to their cycle. They also found that emergency room visits increased by 33 percent during the “preovulatory” phase, which is when the bleeding has usually stopped but before ovulation, and by 21 percent during the “perimenstrual” phase, the last few days before menstruation and the first few days of bleeding.

In 2005, researchers looked at data from nearly 800 women aged 18-54 who had suffered from acute asthma attacks. They found that women were slightly more likely to end up in the emergency room for acute asthma during the beginning and ending phases of their menstrual cycles, but their results were not as significant.

There have been other studies along the way, all suggesting that female hormones have something to do with asthma symptoms in many (if not all) women. In 2012, another small study found no association between hormones and asthma symptoms, but then that same year, a study of nearly 4,000 women found the opposite—symptoms varied significantly during the menstrual cycle and were most frequent during the time of ovulation.

Results also showed that wheezing was higher on days 10-22 (Day 1 is the first day of menstruation, ovulation occurs around day 10-14, and the cycle ends at about 28 days), shortness of breath was higher on days 7-21, and cough higher just after ovulation, with dips in symptoms occurring just before midcycle.

Another 2012 study found similar results. Researchers surveyed 1,260 female asthma patients aged 12-55 years. Women who reported experiencing changes in symptoms related to their menstrual cycle (about 11 percent) also had a greater frequency of urgent healthcare visits because of their asthma.

Do Hormones Actually Affect the Lungs and Bronchial Tubes?

These studies relied on personal questionnaires, however, to determine results. We all know that personal reporting can be unreliable at times. Has anyone found physical evidence of changes in the lungs and bronchial tubes with menstrual cycles?

A 2009 study did. It was a small study of only 23 women—13 with asthma and 10 without—but researchers actually measured airflow and lung diffusing capacity over the menstrual cycle. Results showed that both varied depending on where women were in their cycle, with lungs and airflow at their lowest capacity during the “early luteal phase,” which starts after ovulation and ends when the period begins.

“Women with asthma experience cyclic changes in airflow as well as gas transfer and membrane diffusing capacity supportive of a hormonal effect on lung function,” researchers wrote.

 10 Ways Women Can Take Control of Menstrual Ups and Downs

Does a woman’s menstrual cycle truly affect her asthma symptoms?

We’re still looking into it, but the evidence so far seems to say, “If you’re noticing it, it’s probably happening.”

While scientists try to figure out just what is going on between hormones and the immune system and the lungs and the bronchial tubes, women need to be concerned about keeping symptoms under control.

What can you do to lessen the ups and downs?

We’ve got some tips for you. First, you need to become more aware of your symptoms and how they may connect with your cycle. That requires some research on your part. Once you start to see the patterns, you can take steps to even them out a bit.

1. Keep track: Take at least one full cycle to keep track of your symptoms. Using a notebook, a file on your computer, a paper menstrual calendar or a menstrual calendar phone app, simply jot down at the end of each day the symptoms you suffered and where you are in your cycle. (It might be best to start at the beginning of your cycle, when your bleeding ends.) If you can keep it up for two cycles, you’ll have more data to help you determine what your patters may be.

2. Try the “peak flow meter”: This device measures lung capacity, and can help you and your doctor determine when your symptoms are getting worse. Use this tool while you’re keeping track of your cycle to help you see more clearly when your problems are actually starting. It can also help you and your doctor decide when you may need to increase your medications to prevent symptoms from getting worse.

3. Check on medications: If you notice a pattern of increasing symptoms during certain times in your cycle, check with your doctor about potentially increasing your medications during those times, or about using something different. Researchers have noted that using the same medication at the same does all the time may not be optimal—instead, you may want to adjust according to your cycle.

4. Consider birth control pills: A study in 2010 showed that oral contraceptives offered a protective effect against cyclic symptoms. Women who were taking them were less likely to have increases in symptoms. Other studies, however, have shown the opposite—that birth control pills may be linked to asthma risk, so talk to your doctor.

5. Relieve stress: If you find that PMS causes you stress, that could be part of the reason why your symptoms worsen. Focus on stress-relieving activities like exercise, yoga, meditation, long walks, hot baths, etc., and schedule time to relax specifically when you notice symptoms tend to increase.

6. Avoid triggers: You probably already know what triggers your attacks—besides your period. Try to be extra vigilant in reducing triggers during those times when your symptoms may peak. Control allergies, avoid pollutants, stay out of cold and dusty air, and take whatever other steps necessary to reduce your risk.

7. Be extra prepared: If you notice patterns in your cycles, note them on your calendar and be extra prepared on those days. Make sure you have your inhaler with you at all times (and that it hasn’t expired), be vigilant about taking any other medications you may take, and be prepared to manage an attack should one occur.

8. Avoid estrogenic materials: There are many things in the environment that can also disrupt our hormones. These include chemicals in some plastics (phthalates), BPA (which exists in the lining of most canned foods), mercury (found in some types of seafood), PFCs (in non-stick pans), pesticides, and more. It’s a good idea to limit your exposure to chemicals like these at any time, but you may want to be extra careful during those days in your cycle when you notice symptoms worsening.

9. Be cautious during pregnancy: About half of women find that their symptoms get worse during pregnancy, though some may experience the opposite. Talk to your doctor early on about your asthma so that you’re prepared should you notice changes.

10. Tame inflammation: Inflammation is key to asthma attacks, so reducing your risk of inflammation in general may help tame symptoms. Watch your diet—junk food has been linked with an increase in inflammation and an increase in asthma symptoms. In fact, a 2013 study found that in children and adolescents, consuming fruit more than three times a week had a protective effect against severe asthma, while consuming fast food more than three times a week increased risk of severe asthma symptoms. Eat more fruits and vegetables, and cut back on the unhealthy fatty and sugary foods, particularly when your symptoms may spike. Eat more fatty fish (omega-3 fatty acids are anti-inflammatory), nuts, garlic and onions, turn up the spices like ginger and turmeric, and add some tart cherries (known for their anti-inflammatory properties) or tart cherry juice to your daily diet.



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