Menopause & Asthma

Research over the last few years has shown that women going through menopause have double the risk of experiencing asthma. Although it seems that hormone replacement therapy (HRT) would help these women, other studies have shown just the opposite.

Research on Estrogen and Asthma

• Asthma involves inflammation in the airways and constriction of the muscles around airways, causing shortness of breath. A study in 2005 at the Medical College of Georgia showed that elevated estrogen levels reduced the severity of asthma and other chronic lung diseases involving airway constriction. But, women going through menopause have reduced levels of estrogen in their body. If a woman has asthma, the reduced estrogen levels may set her up for more asthma flares.

Research on Menopause and Asthma

• Hormonal fluctuations that occur during menopause may play a role in adult onset asthma where women can develop asthma symptoms for the first time. According to Dr. Francisco Gomez Real of the University of Bergen in Norway, asthma risks double during menopause. His research suggests the women who go through the menopause have nearly double the risk of suffering respiratory diseases such as asthma, but could protect themselves by taking HRT.

  Dr. Gomez also found that thin women have a fourfold higher risk of asthma than do heavier, but not obese, women who are still menstruating. Obese women are also at a greater risk of getting asthma when they go through menopause. "Women undergoing the menopausal transition might be at risk of deteriorating lung health," Gomez Real and colleagues suggest. "This applies to lean women and, to some extent, to obese women," said Gomez.

  The same study showed that a woman's insulin resistance is increased due to declining estrogen levels that occur during menopause. This increases lung inflammation and can lead to asthma symptoms. Fat tissue produces estrogen, so the leanest women are at the greatest risk. And even though obese women have more fat, the obesity increases insulin resistance, negating any protection fat cells may afford.

Research on HRT and Asthma

• Although Dr. Real's study suggests that HRT could protect menopausal women against asthma, a Harvard Nurses' Health Study found that women who took estrogen supplements after menopause for ten years or more were 50 percent more likely to develop asthma than women who never used estrogen.

  This 20-year study showed that HRT actually makes asthma symptoms worse for menopausal women. "The Nurses' Health Study" found that HRT caused inflammation that precipitated symptoms of adult-onset asthma in menopausal women. The risk of asthma increased with the use of high doses and longer use of estrogen. A total of 121,701 women ages 33 to 55 were included in the study.

The Risk Is Low

• R. Graham Barr, MD, MPH, a research fellow in Pulmonary Epidemiology at the Channing Laboratory at Brigham and Women's Hospital in Boston, who ran The Nurses' Study noted, however, that although HRT use in these women increased their incidence of asthma, that the overall chance of developing asthma is very low----only about 1 percent or less. And the risk applies only to women who have gone through a natural menopause and not those who have had their ovaries removed through surgery.

Should Menopausal Women With Asthma Take HRT?

• Although studies show that HRT can worsen asthma, in some women HRT actually improves their asthma, according to J. Brostoff and L. Gamilin in "Asthma: The Complete Guide to Integrative Therapies." When considering these conflicting reports and studies, the best thing you can do if you are a going through menopause and are concerned about asthma is to discuss your options with your doctor. The disadvantage of HRTs and their effect on asthma must be weighed against the advantages they provide in terms of bone density and protection against osteoporosis.