Can a hysterectomy worsen asthma-COPD overlap syndrome?

Question

Hello doctor,

My mother is 58 years old and has been diagnosed with asthma-COPD overlap syndrome (ACOS). Over the past year, her condition has worsened, especially after she underwent a hysterectomy about eight months ago.

Her latest lung function test shows FEV₁ at 45 % of the predicted value, and she now requires three liters of oxygen continuously to maintain her oxygen saturation above 88 %. She is on triple inhaler therapy (Fluticasone, Vilanterol, and Umeclidinium) and uses Albuterol nebulizations four to six times daily, yet she still becomes short of breath even while walking short distances, like from her bedroom to the bathroom.

She has been hospitalized four times in the past six months for severe asthma flare-ups needing IV steroids, and once required ICU admission for respiratory failure. Her blood work shows elevated eosinophils (890 cells/µL) and IgE levels (520 IU/mL). Her allergist has suggested starting Benralizumab (Fasenra) injections.

Because of long-term steroid use, she now has osteoporosis with a T-score of -3.2, and she recently fractured her wrist from a minor fall. Since menopause, her asthma seems much harder to control, and her peak flow has dropped from 280 to 180 L/min. She has also developed steroid-induced diabetes, with HbA1c at 8.4 % and fasting glucose around 200 mg/dL.

Her pulmonologist mentioned that she might soon require home ventilator support.

I would like to know:

Can hormonal changes after hysterectomy or menopause make asthma and COPD symptoms worse?
Are there treatment options that can help reduce steroid dependence or control inflammation more effectively?
Would biologic injections like Benralizumab be suitable in her case, given her high eosinophil and IgE levels?
What can we do to protect her bones and blood sugar levels while managing her lung condition?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your mom’s lung disease is already quite advanced, so even small changes can make a big difference. After her hysterectomy, especially if her ovaries were removed, the sudden drop in hormones like estrogen and progesterone can make her airways more sensitive.

Normally, these hormones help keep inflammation in check, so when they drop suddenly (a state called surgical menopause), asthma can become harder to control. In women who have high levels of eosinophils (a type of white blood cell involved in allergies) and IgE (Immunoglobulin E, an antibody linked to allergic reactions), this can trigger serious flare-ups.

Probable reasons for worsening symptoms:

Loss of estrogen and progesterone balance after hysterectomy (removal of uterus) increased airway inflammation.
Already a severe asthma-COPD overlap (a condition where features of both asthma and chronic obstructive lung disease exist).
Long-term steroid use affects bones (osteoporosis) and blood sugar (risk of diabetes worsening).

Investigations to consider:

Check if her ovaries are still present (hormone status differs if only the uterus was removed).
Blood tests: estradiol, FSH (follicle-stimulating hormone), and LH (luteinizing hormone) to confirm menopause status.
Bone density scans (DEXA, dual-energy X-ray absorptiometry) to monitor osteoporosis.
Review blood sugar and overall endocrine health.

Other possibilities (differential diagnosis):

Severe eosinophilic asthma unrelated to hormones.
Steroid-resistant airway disease, when standard steroids do not work.
Other causes that can worsen asthma: acid reflux (GERD), sleep apnea (where a person briefly stops breathing or breathes very shallowly while sleeping), and heart issues.

Probable diagnosis:

Asthma-COPD overlap worsened by postmenopausal hormonal changes.

Treatment options

Hormone replacement therapy (HRT) can sometimes stabilize airways, but must be used cautiously due to risks of osteoporosis, diabetes, clotting, or cancer. Decisions need careful discussion with both a pulmonologist and a gynecologist.
Biologics like Benralizumab (anti-IL5) or Omalizumab (anti-IgE) can reduce inflammation and lower steroid needs.
Optimize diabetes and protect bones: Bisphosphonates, calcium, and vitamin D.
Oxygen support, and in some cases, home BiPAP (bilevel positive airway pressure) is a machine that helps with breathing at night, may help.

Preventive measures:

Avoid triggers: dust, smoke, cold air.
Keep vaccinations current: flu, pneumonia.
Pulmonary rehab, if possible, helps strengthen lungs.
If on biologics, practice strict sun protection.

Next steps or follow-up:

Confirm the exact surgery: were ovaries removed or not?
Share her fracture history, current diabetes treatment, and any mammogram results.
Continue following the pulmonologist’s advice on biologics; this is the best way to reduce steroid dependence.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.