Asthma may change with life stages

Women with asthma may have particular times in their lives when their asthma is better or worse, due to fluctuations in hormone levels. These include pregnancy, menopause, and related to menstruation (periods).

Asthma affects more women than men

Although boys are more likely than girls to have asthma, adult women are more likely than men to have asthma. Women are more likely than men to be hospitalised or to die from asthma. Research now shows that asthma may be linked to women's hormonal changes.

Asthma and periods

Some girls find that their asthma is worse around the time their periods start, although this usually settles down as their menstrual cycle becomes established.

However, women with severe asthma may find that their symptoms are worse just before or during menstruation. Keeping a peak flow and/or symptom diary around this time will help clarify whether this is an issue for you. If you don't already have one, talk to your doctor about an asthma self management plan, and if you should take extra treatment during the week before your period.

Some medications used for period pain (aspirin and other non-steroidal anti-inflammatory drugs [NSAIDs], eg, ibuprofen) may make asthma worse in some people. Paracetamol is usually considered safer than other analgesics (pain relievers) for occasional use in people with asthma, preferably in low doses.

The oral contraceptive pill has no effect on asthma.

Asthma during pregnancy

Around one third of women find their asthma improves in pregnancy, one third stay the same and one third find their asthma gets worse. If your asthma gets worse you may need to increase your medication, and to revise your asthma self management plan with your doctor. You will also need to discuss your plans for the delivery of your baby. If your asthma is severe, the delivery may be best handled in a hospital environment in order to access appropriate support if required.

Inhaled asthma medicine will not harm your baby during pregnancy. Controlling asthma during pregnancy is important for the health and wellbeing of the mother, as well as for the healthy development of the baby. It is also very important not to smoke during your pregnancy, in the presence of your baby, or in the enclosed spaces where the baby and children will sleep and play. Exposure to secondhand smoke increases the risk of children developing asthma, or suffering sudden infant death syndrome (SIDS).

Steroid tablets during pregnancy

A very small minority of women with severe asthma need to take steroid tablets at some stage during their pregnancy. Using steroid tablets for long periods of time or repeatedly during pregnancy can increase the risk of your baby being born underweight. However, the risk to the baby of uncontrolled asthma is potentially much more harmful. You and your doctor need to weigh up the risks against the benefits.

During labour and delivery you have the same choice of pain medication as any woman. If you do happen to have an asthma attack at this time, treat it as you would normally.

Breastfeeding

Your inhaled asthma medications are not found in breast milk, and even if you have to use steroid tablets the small quantities that are found in breast milk will not have any harmful effect on your baby.

Asthma and menopause

As at any time when hormone levels are fluctuating (ie, menstruation and pregnancy), menopause may have an effect on your asthma.

The use of steroid tablets or high doses of inhaled steroids for a number of years may increase your risk of osteoporosis. You can reduce this risk by using a spacer to take your inhaled preventer medication, and rinsing your mouth out and cleaning your teeth after taking it.

The risk of osteoporosis can also be reduced by:

• ensuring that you have a diet high in calcium (eg, yoghurt, cheese, milk)
• undertaking regular weight-bearing exercise (walking is ideal)
• don't smoke
• drink only moderate amounts of alcohol.

Related topics

See also Asthma and allergy; Asthma and other medicines

Original material provided by The Asthma Foundation of New Zealand, 2010. Edited by everybody, November 2010.