Last year my childhood asthma came back. I’d always associated the illness with kids puffing on inhalers in gym class, so its adult return was a bit of a surprise. Especially since, while my childhood asthma had been down to obvious triggers - doing exercise or a high pollen count - this time around the coughing and wheezing symptoms seemed to pop up randomly each month. One day cold weather wouldn’t affect me, then a week later it would leave me feeling like I was being choked. In fact, the only similarity between each few days of symptoms was the fact they always came just before my period. The idea that the two could be connected seemed unlikely.
I was wrong. When I looked online, I found loads of tweets from women confused by the relationship between their period and their asthma. Esme, 18, from Nottingham was one of them.
She tweeted this after spotting the apparent connection, Googling it and then finding out it was a real thing last year. Speaking to me this week, she explained she's had asthma since she was born but has found it's got better as she's grown older - except around her period. 'I do find that my asthma flares up considerably when I do happen to have a very heavy period,' she says. 'I tend to find that I am out of breath a lot or often find myself breathing harshly and very quickly.'
Esme and I aren’t alone. Research has found that while boys are more likely than girls to have the illness before puberty, women are the main sufferers of asthma in adulthood. A study from 2015 suggested that ‘biological factors that significantly differ between men and women are likely to be involved in the development of non-allergic asthma [asthma caused by irritants but not actual allergies].’ It’s thought that those ‘biological factors’ are probably our fluctuating hormones, meaning that our asthma could worsen during puberty, the menopause and even in the few days when we’re pre-menstrual. Yes, our periods can impact our airways.
I asked Asthma UK spokesperson and GP Dr Andy Whittamore to explain the relationship between periods and the allergens which cause inflammation in asthma sufferers' throats and make us cough and wheeze. He says: ‘I see women of all ages whose hormones affect every little bit of their being, whether that’s their skin, their mood, their appetite, and we do see that hormone fluctuations do seem to affect the immune system, sensitivity to allergens that increases women’s asthma.’
He explains that it’s not the oestrogen and progesterone themselves that cause the problems, they’re actually caused when their levels change. It means that we’re most likely to find our asthma’s triggered in the two-week run up to our periods, along with other more typical PMS symptoms like mood swings. While research is still on-going, he says that what seems to happen is that as hormone levels change the body’s ability to produce different ‘allergy cells’ is increased making us more prepared to fight infections and allergies. ‘At different parts of the cycle you will feel asthma more,’ he says. ‘Or be more likely to get chest infections and even have asthma attacks which can be fatal.’ On top of that, PMS can cause us to be more susceptible to stress and high emotion which can trigger asthma symptoms.
The findings from studies dating as far back as the 1980s support this suggestion. In fact, a research paper from 2011 reports an increase in ‘hospitalisation rates for complications and respiratory failure at the same time during the hormonal cycle’. The paper goes on to explain that progesterone increases respiratory rates and plays a role as a ‘smooth muscle relaxant’ in the airways. Oestrogen, meanwhile, is thought to have a controlling effect on immune function. When levels of both drop before we menstruate, it causes our immune system run a bit wild.
It means that research into the impact dropping hormone levels have on asthma is vital for older women. Asthma UK’s National Review of Asthma Deaths showed that there was a very high death rate in women in the post-menopausal period. Whittamore explains: ‘It seems like the dropping off of hormones creates different problems for people. That needs a lot of research, but because the cause is a ‘dropping off’, not a chemical signal that can be blocked off, drug companies aren’t doing the research into that moment.’
It’s not all bad news though. Whittamore says that Asthma UK is funding research into whether hormone-based contraceptives could potentially lessen hormone-triggered asthma symptoms. ‘The theory is hormone contraception even out hormones throughout the whole month, rather than having high or low hormones. By stopping those fluctuations you’re therefore hopefully stopping the symptoms,’ he explains. ‘Some suggestions from early research indicate that it could make a difference, but we’re looking to see if it could be a treatment in the long term.’
Ultimately, the easiest way to keep tabs on your asthma is to report any mild symptoms you do have to a doctor - even if you’ve never had it before. Whittamore says that asthma diagnoses in adults are becoming increasingly common, even in people who didn’t have it as a child. He says that just ‘putting up’ with symptoms can put people at serious risk. ‘The National Review of Asthma Deaths showed that it was people with very mild disease who were dying more than people with severe disease,’ he says. ‘Because if you’ve got severe asthma you do everything you can to stay well, if your asthma’s just flaring up just once a month around your period, it increases your risk of not taking it seriously.’
I understand that. It took me six months to drag myself to the walk-in clinic to get checked out. I’d assumed my monthly symptoms were just down to stress until they got so bad I could barely breathe at my desk. Whittamore says I was lucky that I didn’t end up in more serious trouble. He says: ‘If you’d have been unlucky and the weather had really changed you could have had a much more severe attack that had left you in hospital or worse.’
If you’re worried about asthma symptoms you can visit Asthma UKfor more information or talk to asthma nurses via their helpline: 0300 222 5800
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This article originally appeared on The Debrief.