Recent research has uncovered significant connections between female hormones and asthma risk, revealing important patterns that could influence clinical care for women across different life stages.
Late Menopause Associated with Higher Asthma Risk
A new study published in the journal Menopause has found that women who experience menopause later in life have a greater risk of developing asthma, while those with early menopause (ages 40-44) show a reduced risk. These findings challenge previous research suggesting that early menopause typically leads to more detrimental health outcomes, including increased risks of heart disease, diabetes, osteoporosis, and depression.
Researchers led by Durmalouk Kesibi from York University in Toronto analyzed data from more than 14,000 postmenopausal women with 10 years of follow-up. Their work provides compelling evidence for a link between female hormones and asthma development.
"This study highlights sex-based differences in asthma, with women at a greater risk for asthma than men in adulthood," said Dr. Stephanie Faubion, medical director for The Menopause Society. "It also showed that women with later onset of menopause are at greater risk than those with early onset of menopause. Clinicians should be aware of this link and should monitor women with later age at natural menopause for asthma symptoms."
The researchers noted that both natural and synthetic estrogen increase asthma risk. Women using hormone therapy have a 63% increased risk of asthma, while those who discontinue hormone therapy are twice as likely to stop asthma treatment. Higher BMI also emerges as an asthma risk factor for women, as adipose tissue produces estrogen.
Progesterone-Only Contraceptives Increase Asthma Attack Risk in Young Women
In a separate study published in ERJ Open Research, researchers found that young women taking progesterone-only contraceptive pills face an increased risk of asthma attacks. The research team, led by Dr. Chloe Bloom from Imperial College London, examined data from nearly 262,000 UK women aged 18 to 50 diagnosed with asthma.
The study compared asthma attack rates between women who had never used oral contraceptives and those who started taking either progesterone-only or combined estrogen/progesterone pills between 2004 and 2020. The results showed that women under 35 taking progesterone-only pills had a 39% higher risk of asthma attacks. No similar risk was observed among women taking combined pills.
"We found that the combined pill did not affect whether women had asthma attacks, but some women who took the progesterone-only pill had more asthma attacks," Dr. Bloom explained. "These included women under 35 years old, those who used fewer asthma medications, like inhaled or oral steroids, and those with higher levels of inflammation linked to asthma in their blood."
Women relying on fewer asthma medications showed a 20% higher risk of asthma attacks when taking progesterone-only pills. Additionally, women with eosinophilic asthma—characterized by high levels of eosinophils that cause inflammation—demonstrated a 24% higher risk.
Gender Disparities in Asthma Prevalence and Severity
Both studies highlight significant gender differences in asthma patterns. While childhood asthma is more common in boys, adult-onset asthma predominantly affects women. Women also tend to experience more severe asthma and are less likely to achieve remission.
"Asthma is common in women, and unfortunately, women are twice as likely to die from asthma as men," noted Dr. Bloom. "To help prevent these deaths, we need a better understanding of why women are at greater risk."
Researchers theorize that excessive progesterone could contribute to increased airway inflammation in women. Those using progesterone-only contraceptives might also possess unique characteristics that make them more vulnerable to asthma.
Clinical Implications
These findings have important implications for clinical practice. Apostolos Bossios, an associate professor of respiratory medicine at Karolinska University Hospital in Stockholm who was not involved in the research, emphasized the importance of these studies in understanding women's vulnerability to asthma.
"Women with asthma who are taking the progesterone-only pill, or considering it, should speak to their doctor about their contraception options and their asthma symptoms," Bossios advised. "Whichever contraception they use, it's vital that women with asthma use their preventer inhalers and any other prescribed treatments regularly."
For healthcare providers, these studies underscore the need for personalized approaches to asthma management in women, particularly when considering hormonal contraception or managing menopausal symptoms. Monitoring for asthma symptoms should be heightened for women experiencing later menopause or those using progesterone-only contraceptives.
Researchers continue to investigate the effects of sex hormones on asthma, with ongoing studies examining potential impacts of pregnancy and hormone replacement therapy on asthma risk and severity.
