Are inhaled or oral steroids safe in pregnant asthmatic women?

Question

Hello doctor,

I am 36 years old and have had asthma since childhood, but over the last two years, my pulmonologist said it is now “asthma‑COPD overlap.” I am using Symbicort inhaler twice daily and sometimes need nebulization during flare‑ups.

Lately, I have noticed my menstrual cycles are becoming irregular, and sometimes I skip a month or get a heavier flow than usual.

Could my steroid inhaler or frequent oral steroids (Prednisolone) be causing hormonal changes?
My husband and I were planning to try for a baby, but I am scared about pregnancy with such weak lungs. Would it be dangerous for me or the baby?
Also, is it safe to continue my inhalers during pregnancy, or are there alternative medications? Does asthma get worse during pregnancy?
I sometimes get anxiety before sleep because I wake up breathless. Could anxiety itself worsen asthma attacks?
Also, does regular exercise help or make my breathlessness worse since I am already underweight (BMI 18)?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Let me explain to you steroid use and hormonal/menstrual changes.

Yes, frequent or long‑term oral steroid (Prednisolone) use can affect menstrual cycles by influencing the hypothalamic–pituitary–ovarian (HPO) axis. Possible effects include:

Irregular or skipped periods.
Heavier or lighter bleeding.
Temporary changes in fertility.

However, inhaled corticosteroids (like in Symbicort containing Budesonide or Formoterol) are mostly localized to the lungs and have very minimal systemic absorption, so they rarely cause hormonal changes unless used in very high doses for a long time.

In your case, the menstrual changes are more likely due to systemic oral steroid courses or stress, weight loss, or underweight status (BMI - basal metabolic rate of 18).

Regarding pregnancy safety with asthma-COPD (chronic obstructive pulmonary disease) overlap, asthma and COPD overlap do not automatically make pregnancy unsafe, but close monitoring is essential.

The main risk during pregnancy is poorly controlled asthma, which can lower oxygen for both you and the baby. Well‑controlled asthma leads to a healthy pregnancy. Poor control can increase the risk of preterm birth, low birth weight, or preeclampsia.

So the key is preconception optimization:

Have your lung function (spirometry) and oxygen levels evaluated.
Ensure vaccinations (influenza, pneumococcal) are updated.
You should consult a consultant pulmonologist and a consultant obstetrician and gynecologist.
Aim for at least three months of stable control before trying to conceive.

Regarding the safety of inhalers during pregnancy, yes, Symbicort (Budesonide or Formoterol) is generally considered safe during pregnancy. Budesonide is the preferred inhaled steroid for pregnant women, the most studied, and proven to be safe. Formoterol (the long‑acting bronchodilator part) has no major adverse fetal effects reported when used as prescribed.

It is much safer to continue your inhalers than to risk uncontrolled asthma. Stopping them can cause serious flare‑ups that endanger both mother and baby.

During pregnancy, one-third of women get better, one‑third stay the same, and one‑third get worse.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.