Asthma and Women
As a woman, your body will go through changes that can affect your asthma. Here we answer questions about puberty, menstruation, the pill, menopause, osteoporosis and HRT.
Hormonal changes can affect asthma in adolescent girls. Some girls find their asthma is worse around the time their periods start for the first time. However, other factors such as the pressures of starting a new school and emotional stress need to be taken into account as well.
Their symptoms usually settle down once their menstrual cycle becomes established. However, some women continue to find that their asthma gets worse before their period.
Could my periods affect my asthma?
If you've noticed that your asthma is harder to control at certain times of the month, you are not alone. Studies have shown that around one-third of women think their symptoms are worse just before or during menstruation. This link seems to be stronger in women with severe asthma.
What can I do?
- Keep a peak flow diary to help you see if your periods are affecting your asthma.
- If, over a few months, you notice your asthma consistently gets worse before your period, go to see your doctor or asthma nurse. They may advise you take extra preventer medicine during the week before your period.
- Some women who experience very severe asthma attacks before their period may benefit from progesterone hormone therapy given either as a tablet or by injection. Your doctor or asthma nurse will be able to advise if this is appropriate for you.
- Aspirin and other medicines (non-steroidal anti-inflammatory tablets, eg Nurofen, ibuprofen and Ponstan) used for period pain may induce an asthma attack in a small number of people. Paracetemol is usually safe. If you take regular medicines for period pain check with your doctor or asthma nurse.
Will taking the pill affect my asthma?
No. Your asthma treatment is just as effective when you are taking the pill. As with all women taking the pill, it is best if you do not smoke and have your blood pressure checked regularly.
Menopause is a natural process. It marks the point at which the balance of hormones in a woman's body changes. You may find that, as at other times of hormonal fluctuation, your asthma becomes troublesome. It is important to keep an eye on your asthma at such times and discuss any problems you have with your doctor or asthma nurse specialist.
Osteoporosis - or brittle bones - is one of the major health concerns for older women. This bone-thinning disease affects one in three women after they reach the menopause.
However, for some women with asthma, the chances of suffering from osteoporosis are slightly higher than average. Studies have shown that taking steroid tablets continually or high doses of inhaled steroids (preventer inhalers) for a number of years may increase the risk of osteoporosis.
How can I prevent osteoporosis?
Here are steps you can take to make sure your bones stay healthy:
- Make sure your diet contains plenty of calcium-rich foods such as yoghurt, cheese, bread and milk. Other foods containing calcium include tinned fish with bones, tofu and green leafy vegetables.
- Take regular weight-bearing exercise at least three times a week, such as walking, dancing, light weight-training or running.
- Stop smoking. Smoking can bring on a premature menopause. Smokers are also more at risk of fractures as their bone mineral density is lower than non-smokers.
- Drink only moderate amounts of alcohol
You can reduce this risk of side effects from the steroids in preventer medicines by:
- Using a spacer to take your preventer.
- Rinsing your mouth and brushing your teeth after taking your steroid inhaler
Will the steroids I take for my asthma make me put on weight?
Steroid treatment is an essential part of asthma management. For most people, a regular dose of a steroid inhaler is all that is needed to keep their asthma under control. This contains a very low dose of steroid and it won't make you put on weight.
Steroid tablets are sometimes prescribed if your asthma gets more severe. They contain a higher dose of steroid than your inhaler. Steroid tablets themselves won't make you put on weight. However, they can make you feel hungry and, of course, if you eat more than usual you'll start to put on the pounds. Stick to your usual eating habits, take regular exercise, and you should be fine.
Asthma and Pregnancy
When asthmatic women become pregnant, they usually have three questions: (1) Will my asthma get worse? (2) Can I reduce my dosage? (3) Will my child have asthma?
The severity of asthma during pregnancy varies from one woman to another. There are observations that during pregnancy, asthma worsens in about one-third of women, improves in one-third, and remains stable in one-third. If asthma worsens, it usually happens between weeks 29 and 36 of pregnancy. It may be because some patients stop taking medications. Labour and delivery do not usually worsen asthma. It is difficult to predict the course that asthma will follow in a woman's first pregnancy. And many times, asthma will worsen or improve in the next pregnancy, or remain stable.
Pregnant women having asthma controlled with medication should not reduce or stop the medication. Compared to women who do not have asthma, women who have asthma have a higher risk for certain complications of pregnancy like preeclampsia, premature delivery, cesarean delivery, and a baby that is small for its age. If you stop taking asthma-controlling drugs, it may lead to asthma attacks and reduce oxygen supply , which will harm the baby. Please manage carefully the risk of the use of asthma-controlling drugs and asthma attacks.
Conventional asthma drugs including short-acting bronchodilators and theophylline are safe to use during pregnancy. Oral steroids may increase the risk of cleft lip or cleft palate in babies if used during the first three months of pregnancy. Inhaled steroids have been widely used and known for their safety records. Severe cases in need of more recently developed long-acting bronchodilators or inhaled steroids of the new generation should follow a doctor’s advice to help ease their anxiety.
Though it may be true that you may pass asthma to your baby, you can still lower the risk by staying away from second-hand smoke, quitting cigarettes and breastfeeding your child.