Can Your Period Worsen Your Asthma?

Just as premenstrual syndrome (PMS) may cause a number of annoying symptoms, you may also experience "premenstrual asthma" just before and during the early part of your period. Patients with more severe asthma are thought to be at greater risk. This is characterized by a worsening of your asthma symptoms, such as:

• Wheezing
• Chest tightness
• Shortness of breath
• Cough

In fact, anywhere from 19% to 40% of women report a worsening of asthma symptoms during the premenstrual time of the month. In the premenstrual, or luteal phase, progesterone and estrogen rise and then fall right before menstruation occurs. The increase in asthma symptoms is thought to be related to the shifting hormone levels, but the exact reasons are not completely understood.

A small number of studies have documented increases in hyperresponsiveness and mast cell activation during the menstrual period. Additionally, studies have shown elevated levels of nitric oxide, a known marker for airway inflammation, to be elevated during the menstrual cycle.

Finally, other studies have demonstrated that there are decreases in responsiveness in the cells (beta adrenergic receptors) that rescue inhalers act on and this may impact asthma symptoms in patients with premenstrual asthma.

Most individuals with premenstrual asthma respond to standard asthma treatment.

What to Do

If you are unsure if your period is affecting your asthma, you may want to monitor your symptoms closely and keep an asthma diary. Here are some potential treatments you and your healthcare provider might discuss if you have premenstrual asthma:

• Increasing controller medication the week before your period starts. In essence, your pre-menstrual is treated like any other trigger and you and your practitioner develop a strategy for addressing it. There is some thought that the addition of a long-acting beta-agonist during the second half of the menstrual cycle may help.
• Hormone therapy with oral contraceptive pills to better regulate hormone levels. Small case reports have shown improvements in reported asthma symptoms and in lung function tests as well as decreases in hospitalizations and decreases in total daily steroid dosage with the use of oral contraceptives. Additional small studies document improvements when medications targeting the skipping, or cessation, of periods are used.
• Using your rescue inhaler as needed and be careful to avoid other asthma triggers.
• Leukotriene inhibitors like Singulair (montelukast) or Accolate (zafirlukast) are sometimes added if asthma is difficult to control.
• Avoiding NSAIDs for the treatment of PMS symptoms if you are sensitive to them.