Hormonal imbalance and asthma

Asthma is seen more commonly in females as compared to males, and one of the contributory factors leading to this gender difference is probably hormonal differences between males and females

Asthma is a common disease in which, there is inflammation or swelling of the airways (breathing tubes) is seen. It leads to narrowing of windpipes, because of which, patients experience chest tightness, dry cough, wheezing and difficulty in breathing. Asthma is seen more commonly in females as compared to males, and one of the contributory factors leading to this gender difference is probably hormonal differences between males and females.  Not only incidence, but even asthma related severity and mortality is higher in females as compared to males. 

There are growing evidences to prove that severity of asthma has direct links with sex hormones.  Ongoing researches have suggested that lung function majorly suffers when:

1. When levels of Estrogen (female hormone) are higher, which happens after puberty in girls

2. When levels of testosterones (male hormone) are lower, which happens before puberty in boys

Therefore, hospital visits and severity is seen more commonly seen  in pre-pubertal males, and post-pubertal females, especially in females around 45 years of the. Once the estrogen level starts falling with age, the severity and incidence again changes, with more severe disease seen in males. In fact, some studies have shown that menopause actually protects you from getting severe attacks of asthma.

Almost 30 percent of asthmatic women of childbearing age suffer asthma exacerbation before their menstrual cycle.

With this background, it is important to know five important things about hormonal imbalance and asthma:

1. That subpopulation of women who are exposed to higher level of estrogen, experience higher incidence of asthma. This includes 

a. Women who experience early puberty

b. Women who have had multiple pregnancies

c. Women with hormonal disease such as polycystic ovarian disease

2. Oral contraceptive pills and asthma. We know that oral contraceptive pills are hormonal pills. It acts by making hormonal changes within the body in relation to the menstrual cycle or fertile period. A study has shown that women who take oral contraceptive pills are more likely to develop asthma as compared to those who don’t.  However, this doesn’t mean that women of childbearing age should stop taking oral contraceptive pills. In fact, women of childbearing age group, who are already asthmatic, and who experience worsening of asthma symptoms when their menstrual cycle is approaching, taking contraceptive pills may actually benefit them. 

3 Menopause. After menopause, many patients take hormonal replacement therapy (HRT) to get rid of hot flashes and other menopausal symptoms. HRT contain estrogen. Women, who have preexisting asthma, may feel worsening of symptoms when they take HRT. However, this should not discourage them to take HRT if medically indicated. Only point is, they should be more vigilant, and must inform their doctor about their pre-existing asthma. 

4. Male sex hormones (Testosterones) have protective effect on asthma. With age, testosterone levels in males start falling, and males experience more asthma attacks with age. Therefore, whenever searching for trigger factor for asthma worsening in ageing males, this factor must always be in mind.

5. Pregnancy. It is a well known fact that about one third of pregnancy is associated with worsening of asthma control, one third will experience improvement, and one third will not experience any change. One research suggested that pregnant females carrying female fetus experience more severe attacks of asthma. Some suggest that it may be due to spillover of female sex hormones into the maternal circulatory system.