As children, more boys than girls have asthma. But things change around puberty. After that girls are twice as likely to develop asthma than boys. This is partly because of hormones.
One theory is that the male hormone testosterone protects the airways of boys after the age of 11. And at the same time female hormones are kicking in for girls.
The numbers even out again once women have passed through the menopause, but the risks for women still remain higher than for men.
Studies show that compared to men, women can have worse symptoms more often, are more at risk of asthma attacks and are admitted to hospital more often with their asthma.
Added to this, women who develop asthma for the first time later in life, after menopause, are more likely to have asthma that’s difficult to control. This means they’re more likely to need specialist care and treatments to help deal with their symptoms.
Everyone’s lung function starts to decline after about the age of 35. For women it declines more quickly after the menopause. And statistics show that women with asthma over 65, are more at risk of life-threatening asthma attacks.
Women can have all the same triggers as men. But the main difference for women is that female hormones can trigger their asthma symptoms too.
Some triggers may be worse for women, for example:
- Food allergies are more common in women than men, and female hormones can make them worse
- Women are more sensitive to cigarette smoke, and girls with asthma who start to smoke take longer to quit, and need more help
- Some studies suggest women are more likely than men to experience stress and depression
- Women may be more exposed to indoor triggers such as cleaning products because stats show they’re more likely to be doing the cleaning and cooking at home.
Women are more likely to notice worse symptoms around times of hormonal change like puberty, periods, pregnancy and perimenopause (the time leading up to menopause).
- The risk of getting asthma around puberty doubles for girls who start their periods early
- One third of women report worse asthma symptoms before a period
- Some women notice worse symptoms during pregnancy, although others notice an improvement or no change at all
- You may notice your asthma getting worse around perimenopause
- Some women develop asthma for the first time around perimenopause
- Hormones are an asthma trigger in themselves. And they can also make you more sensitive to other triggers, such as hay fever.
“It’s particularly important for women with asthma to get regular, individual advice from their doctor or asthma nurse,” says Kathy Mascarenhas, Specialist Asthma Nurse. “This can help make sure any changes brought about by hormonal changes, or by getting older, are sorted out.”
Every woman can take these extra steps:
- Take your preventer medicine every day as prescribed so you’re less likely to react to any asthma triggers.
- Keep a symptom diary to help you know what’s triggering your asthma, including hormones.
- Be aware of breathlessness. Some studies have suggested that women are more likely to overlook symptoms like breathlessness. If you notice you’re less able to climb stairs, run for the bus, or get active, talk to your GP or asthma nurse. You could also try a peak flow diary to help you spot a dip in asthma control if your peak flow scores drop.
- Have an asthma review at least once a year so you can:
- Check on your medicines – for example your GP or asthma nurse may recommend extra preventer medicine at certain times in your menstrual cycle or if menopause is affecting you.
- Update your asthma action plan. This is the best way to make sure you’re on the right treatment plan to stay well, particularly if you’re going through hormonal changes.
- Check your inhaler technique – lots of people are missing out on the full benefits of their asthma medicines because they’re not taking their inhaler in the right way.
As you get older you can:
- Keep an eye on your weight. Being very overweight (obese) puts you more at risk of asthma symptoms getting worse as you get older. It also increases the risk of women getting asthma for the first time around menopause. Your GP can give you support and advice on losing weight.
- Talk to your GP about the risk of osteoporosis. Women are four times more at risk than men of developing osteoporosis. This is where your bones get thinner and you’re more at risk of fractures. And for women who have asthma, the chances of developing osteoporosis are slightly higher than average. You can get lots of advice from the National Osteoporosis Society on how to strengthen your bones with diet and exercise.
- Keep to regular asthma reviews to:
- Check that your medicines are still working well for you
- Talk through any other conditions that might be making your asthma worse – for example, acid reflux, which is more common in women
- Ask about any new symptoms or side effects you’re worried about
“Going for regular asthma reviews is the best way to make sure you’re on the lowest dose of your steroid inhaler to keep you well and lower the risk of side effects,” says Dr Andy Whittamore, Asthma UK’s in-house GP.
Taking medicine for period pain when you have asthma
“If you need to take medicine for period pain, talk to your GP, asthma nurse or pharmacist about which painkiller is best for you,” says Kathy Mascarenhas, Specialist Asthma Nurse.
“Paracetamol is usually safe, but aspirin, and non-steroidal anti-inflammatory tablets (NSAIDs) such as ibuprofen (e.g. Nurofen) and mefenamic acid (e.g. Ponstan) may make asthma symptoms worse or trigger an asthma attack in some people.”
Taking contraceptives when you have asthma
Oral contraceptives (either the combined pill or the progestogen-only pill) are safe to take if you have asthma. And taking them at the same time as your usual asthma medicines won’t make either the pill or your asthma medicines work less well.
But it’s always worth telling your GP or pharmacist that you have asthma, and what asthma treatments you’re using. For example, the morning after pill ellaOne is not recommended for women with severe asthma. And the combined pill Cilest is not recommended if you’re taking theophylline.
Some women with have found that taking an oral contraceptive (‘the pill’) helps cut down on asthma symptoms they get around their periods.
Taking HRT when you have asthma
Hormone Replacement Therapy (HRT) replaces the hormones no longer produced at menopause and some women decide to take it to cut down menopausal symptoms such as hot flushes and headaches. Sometimes it’s also prescribed to help with osteoporosis.
Some research has shown that HRT may increase the risk of women getting asthma. It’s also linked to more asthma symptoms after menopause – where symptoms generally improve after the menopause, this is not the case for women taking HRT.
But there are also studies that show HRT improves symptoms in women who already have asthma.
“If you’re thinking about taking HRT, talk to your GP or asthma nurse about how it might affect your asthma,” says Dr Andy Whittamore.
The good news is that if you take your preventer every day as prescribed, even when your asthma’s feeling OK, it makes no difference to how long it will take you to get pregnant.
In fact, keeping your asthma under control by taking a preventer inhaler every day is important for you and your unborn child. And it won’t cause harm to your unborn baby.
Some research has shown that women who don’t use a preventer inhaler and rely just on a reliever inhaler to deal with their symptoms, can take longer to get pregnant.
“If you take any regular medicines talk to your doctor to check they’re the safest for you and your pregnancy,” says Dr Andy Whittamore.
You can also talk to one of our asthma nurse specialists on our Helpline on 0300 222 5800 (9am-5pm; Monday-Friday). Or you can WhatsApp them on 07378 606 728.
Last updated March 2019
Next review due March 2022