In childhood, asthma’s more common in boys than in girls. But in adulthood, it affects more women than men.
This may be at least partly down to female hormones. Girls and women with asthma often notice changes to their asthma symptoms around puberty, when they have their period (menstruation), when they're pregnant and when they're approaching menopause. This is because of changes to levels of the female hormones, oestrogen and progesterone, in the body. Medicines just for women, such as the oral contraceptive pill, the morning-after pill and Hormone Replacement Therapy (HRT) can affect these hormone levels too, and may also have an effect on asthma symptoms. Also, women are at a higher risk than men of osteoporosis, and the use of some asthma medicines can increase this risk.
A written asthma action plan will help you to look after your asthma during all these changes. We've also gathered some expert tips to help you ward off potential problems and to help you cope if you do get any.
Times of hormonal change
The physical and emotional changes of puberty can bring new challenges to girls managing their asthma. After puberty, women are more likely than men to have asthma.
If you're a girl going through puberty, you might find:
- you're experiencing stronger allergic responses (for example, your hay fever symptoms get worse especially when you've got your period)
- you feel more sensitive to stress
- you notice a change in your sleep patterns and/or experience mood swings.
Hormonal changes and the effect they have on your body are a normal part of growing up. Knowing that they can have an effect on your asthma will help you feel more prepared and you can take some simple steps to increase your chances of staying well with your asthma.
If you're finding your asthma difficult to manage during puberty:
- Take your medication exactly as prescribed. If you've been given a preventer inhaler, take it every day - usually morning and evening. Even if you have no asthma symptoms at all and feel well, you still need to take your preventer inhaler every day to help you stay well.
- Go for an asthma review. Everyone under 16 with asthma should have an asthma review with their GP or asthma nurse at least every six months. You can talk to them about what's been happening, get advice on how to manage things and check that you're taking the right medicines and the correct dose at the right times.
- Use a written asthma action plan to keep track of your asthma symptoms. If you haven't got one, download one and fill it in with your GP or asthma nurse.
Periods (menstrual cycle)
"I'd had asthma for about two years before we noticed the connection between symptoms and hormones. It was only when I started a diary that I realised the attacks always happened two or three days before my period was due." - Sarah Broom
If you've noticed that your asthma is harder to control at certain times of the month, you're not alone. Research has shown that just over one-third of women find their asthma symptoms are worse just before or during their period. You can stay well with your asthma by:
- using a written asthma action plan to keep track of your asthma symptoms. If you haven't got one, download one and fill it in with your GP or asthma nurse.
- keeping a peak flow diary to see if your peak flow score is lower around the time of your period, or keeping a symptom diary.
- having an asthma review at least once a year. If you do notice your asthma gets worse before your period, talk to your GP or asthma nurse about taking extra preventer medicine during the week before your period. This can help some women, but you should only do this if your GP or asthma nurse advises you to do so.
- talking to your GP or asthma nurse about taking the contraceptive pill. Some women with mild to moderate asthma (but not severe asthma) have found that taking an oral contraceptive ("the pill") helps reduce asthma attacks linked to their menstrual cycle.
It's important for you, and your baby, that your asthma is well managed during your pregnancy. You can lower your risk of symptoms and having an attack by:
- taking your asthma medicines as prescribed and discussed with your GP or asthma nurse, even if you have no symptoms
- downloading a written asthma action plan to fill in with your GP or asthma nurse specialist
- reviewing your asthma regularly with your GP or asthma nurse.
"For the past nine months, my periods have been irregular and heavy and I've been getting night sweats and waking up with a heavy chest. I had asthma as a child, but had been symptom-free for years until I recently had two attacks - both occurred a couple of days before my period started and I'm sure my hormones were triggers." - Delia Williams
The perimenopause is the time in a woman's life when periods can become irregular and may get longer or shorter, heavier or lighter. Common symptoms include hot flushes, insomnia and irritability. This usually happens in your 40s, but some women notice changes as early as their mid-30s.
During the perimenopause, some women with asthma find their symptoms get worse. And some women develop asthma for the first time around menopause.
A written asthma action plan will help you spot any signs that your asthma is getting worse, and will tell you what you can do to lower your risk of an asthma attack.
It's commonly agreed that once you've gone through 12 consecutive months without a menstrual period, you've reached menopause. Some women find that asthma symptoms reduce at this time.
Medicines just for women
Asthma medicines are safe to take at the same time as an oral contraceptive - either the combined pill or the progestogen-only pill, and won't make either of them less effective. Even so, as a precaution, you should always discuss any medicines you're taking with your GP or asthma nurse.
The morning-after pill (also known as the emergency contraceptive pill) is a drug a woman can take after having sex to stop her from becoming pregnant. You can buy it from a pharmacy or get it for free from your GP surgery, a sexual health or family planning clinic or a walk-in centre.
Some morning-after pills should not be taken by women with severe asthma. If you need the morning-after pill, make sure you tell the pharmacist, the clinic staff or prescribing doctor that you have asthma so they can advise you which option is best for you.
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) replaces the hormones no longer produced at menopause and some women decide to take it to reduce menopausal symptoms, such as hot flushes and headaches.
Some research has shown that HRT can be linked to an increased risk of developing asthma, as well as an increase in asthma symptoms. This is because of the way it affects the balance of hormones in a woman's body.
If you're thinking about taking HRT, talk to your GP or asthma nurse about how it might affect your asthma. Seeing your GP or asthma nurse regularly for asthma reviews is a good way to make sure you're taking the right medicines.
Medicines for period pain
If you need to take medicine for period pain, talk to your GP, asthma nurse or pharmacist about which painkiller is best for you. 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 a small number of people.
Other things that may affect women
If you have asthma, you can breastfeed your baby. Talk to your GP, asthma nurse or health visitor if you have any questions or concerns. Or you can call our Helpline on 0300 222 5800 (9am-5pm; Mon-Fri) to speak to one of our friendly asthma nurse specialists.
Sex, like exercise, can be an asthma trigger for some people. If you do get asthma symptoms during sex, it can mean that your asthma isn't well managed. If you're worried about your asthma symptoms getting worse during sex, take your reliever inhaler (usually blue) beforehand and keep it close by.
Osteoporosis is a condition where your bones become more fragile or "brittle" and are more likely to break. Women are more at risk than men of developing osteoporosis, and for women who have asthma, the chances of developing osteoporosis are slightly higher than average.
While asthma itself does not increase your risk of osteoporosis, some medicines used to help manage asthma (steroids) may increase the risk of osteoporosis if used over a number of years. Your GP or asthma nurse will be able to give you more information about this.
Here's what you can do to protect yourself against osteoporosis:
- Make sure you have regular asthma reviews to check you're using your inhaler(s) in the best way, and that you're on the most appropriate dose for managing your asthma.
- Get plenty of exercise as this will strengthen bone tissue. Weight-bearing activities are best, such as walking, running, weight training, racquet sports, basketball or dancing.
- Eat a balanced diet, including foods rich in calcium, a mineral that helps bones stay strong (e.g. leafy green vegetables, dried fruit, tofu, yoghurt, milk). Vitamin D is also essential for bone health because it helps the body absorb calcium. It can be found in some foods (e.g. egg yolks, oily fish).
- Get out in the sun - sunlight stimulates the body to make vitamin D in the skin. If you don't get out in the sun much or you always use high-factor sunscreen when you do, talk to your GP or asthma nurse about taking vitamin D supplements.
- Give up smoking - women who smoke may absorb less calcium, and tend to experience earlier menopause. This increases the risk of osteoporosis because the female hormone oestrogen has a protective effect on bones. When periods stop at menopause, the ovaries almost stop producing this hormone, reducing the protection it gives your bones.
- Avoid too much alcohol - heavier drinkers are more prone to bone loss and fracture through poor nutrition and an increased risk of falling. Also, for some people, asthma symptoms can be triggered by alcohol.
For more information on how to prevent osteoporosis, call the National Osteoporosis Society helpline on 0845 450 0230 or visit www.nos.org.uk.
Last updated March 2016
Next review due March 2019