Perimenstrual Asthma (PMA)
Do your asthma symptoms increase during certain phases of your menstrual cycle? If so, you may be one of many women who have PMA, and you may want to consider balancing your hormones as part of your treatment.
A strong hormonal connection for asthma in women is reflected in the following observations:
women and men have similar rates of asthma during puberty and after menopause, whilst ages 20-50 see a three-fold increase of asthma related hospital admissions in women over men (2).
Most asthma related ER visits and hospitalisations in women occur during their pre-menstrual phase (2).
40-100% of asthmatic women report worsening of their asthmatic symptoms during the times of the month when they are hormonally most active - i.e. around ovulation and prior to menstruation (1,2).
Both non-allergic and allergic asthmatic and sinus reactions seem to increase with fluctuations in oestrogen, and total IgE increase during the perimenstrual phase (1).
Treatment with Oral Contraceptives (1) and gonadotrohin-releasing hormone analogues (2) have a positive response on PMA and are thought to warrant further investigation.
The hormonal connection has to do with the fact that fluctuations of female sex hormones (estrogen and progesterone) induce inflammation. Mast cell and eosinophilic degranulation are promoted by decline in estrogen/progesterone levels (as is seen just prior to onset of menstruation). This occurs locally in the endometrium, and anywhere else where hyperactive mast cells and eosinophils are already present (as in the bronchials of asthmatic women). Male sex hormones (testosterone and androgens) on the other hand, stabilise inflammatory processes. Not just asthma symptoms worsen around the pre-menstrual phase, so do other inflammatory conditions such as headaches, body aches and auto-immune disorders.
Estrogen levels in particular influence the course of autoimmune disorders as well as certain types of infections (1). There is evidence that both eosinophil and mast cell activity is much lower with higher Estrogen levels (1)
Women with PMA tend to have more severe asthma and are more likely to have non-allergic asthma (3).
If you think you may suffer from PMA, keep a diary of your asthma symptoms related to your menstrual cycle. Doing so will help you determine if there is a correlation.
1. Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma
R.D. Murray, J.P. New, P.V. Barber, S.M. Shalet
Eur Respir J 1999; 14: 966±967
2. Perimenstrual asthma: from pathophysiology to treatment strategies
Alessandra Graziottin and Audrey Serafini
Multidisciplinary Respiratory Medicine (2016) 11:30
3. Perimenstrual Asthma Is Associated with More-Severe Symptoms
David J. Amrol, MD reviewing Rao CK et al.
Chest 2013 April