"The Pill" And Asthma: Do Oral Contraceptives Help With Premenstrual Asthma Symptoms?
There are some asthma triggers that you can eliminate from your environment, some that are harder to navigate, and some that are impossible to avoid. For us women, hormones are in that last category: for some of us, hormone fluctuations around the menstrual cycle can mess up our asthma control, coupled with the reality that you can’t just go on existing without your body, which is the source of the problem.
We can, however, to an extent, medically alter the hormone levels in our bodies. The other day, as the Science Vs. podcast switched from an episode about ecstasy to one about birth control, I decided it was time for a deeper dive into the subject as it relates to asthma (and, no, not in regard to pregnancy). Birth control, I mean, if that was unclear—not ecstasy.
It should go without saying that the oral contraceptive pill (also known as the “birth control” pill, or infamously, “The Pill”) is not a treatment for asthma. However, might its effects benefit women dealing with premenstrual asthma symptoms?
The hormone effect: A refresher
At the time of puberty, the prevalence of asthma swaps from being more common in boys in childhood, to girls in adolescence—no surprise we can blame female hormones for this.1 It is thought that both estrogen and progesterone are contributors to worsening of asthma symptoms around menstruation.2 Likewise, it is not necessarily menopause that causes a spike in adult onset asthma, but hormone replacement therapy providing a greater amount of estrogen and progesterone to the body, increasing asthma development in older women.2
These hormones—progesterone, estrogen, and cortisol (which you may remember from posts on stress reactions in asthma, is also elevated during certain parts of the menstrual cycle)—may either make us more sensitive to triggers, or more sensitive to the perception of asthma symptoms3 (I should add here that while the worsening premenstrual asthma phenomenon is well-documented, a measurable reduction in peak expiratory flow seems less reproducible4,5—weird, right? That’s where the “more sensitive to the perception of asthma symptoms” bit comes in!). And, interestingly, women with asthma were 80% more likely to have increased serum (blood) levels of one of these three hormones, above what is clinically normal to be produced by the body.3 Presumably, elevated levels of any one of these hormones could cause more issues related to asthma. No matter the cause of increased asthma symptoms in the days leading up to or during your period, be it inflammation or perception, it seems likely hormones are to blame.
Do oral contraceptives help with asthma control?
Theoretically, it would stand to reason that to decrease the ups and downs in female hormones that cause these drops in asthma control, providing a more consistent balance of hormones could help. While in some cases, oral contraceptives can cause worsening of asthma and a drop in asthma control6,7, many other studies show decreases in fluctuations of (premenstrual asthma symptoms when women are taking oral contraceptives.7,8 One study even presents the interesting result that in women without preexisting asthma, oral contraceptives may increase the risk of new-onset wheezing (a potential precursor to asthma), yet produce a “markedly reduced prevalence” of wheeze in women with a current asthma diagnosis.8
Personal experience: Your results may vary!
In my own experience, I can say that for me, they absolutely help. It took a shockingly long time for me to correlate the worsening of my asthma symptoms to my period—like, at least three years after my diagnosis. A lot of the time, just knowing what’s causing symptoms to get worse helps, so I didn’t act on it at the time, though I did ask a research doc about it by e-mail. She told me that it’s common, under-researched, and I could consider taking oral contraceptives if it was too bothersome. Not a route I was at all interested in going.
However, in 2013, I had to go on the combined oral contraceptive pill for other medical reasons—I still tried to avoid it given my history of eye problems, attempting briefly progesterone only, and within a month I had no choice but to begin taking it (in this case, it’s likely not an exaggeration to say it was life or death). Once I got the fibroids that required me to go on the pill sorted out surgically, all of my doctors still recommended I stay on it—my surgeon saying both in the hospital and his clinic, “If you were my daughter, I would want you to stay on it."
Well, here we are four years later, and while I still don’t want to be on the pill (and still ask if I can quit taking it every so often!), I do acknowledge that my asthma is likely much, much more stable on it. So, I guess that’s a plus? And while oral contraceptives are still not an asthma treatment, they might have benefits where it comes to asthma, too. Live and learn!
What has your experience with Singulair been like?