Do asthma symptoms worsen in women during perimenopause?

Question

Hello Doctor,

I am 45 years old, currently going through perimenopause, and have had a history of asthma since childhood. Recently, my symptoms have worsened despite being on a combination of inhaled corticosteroids (such as Budesonide or Fluticasone) and long-acting beta-agonists (LABA) like Formoterol or Salmeterol. I continue to experience wheezing, particularly around the time of my menstrual cycle.

My most recent complete blood count showed an eosinophil count of 650 cells per microliter, total immunoglobulin E (IgE) at 260 international units per milliliter, and a forced expiratory volume in one second (FEV₁) at 68 percent of the predicted value. I would like to know if hormonal fluctuations during perimenopause can worsen asthma symptoms. Would I qualify for any biologic treatments targeting eosinophilic asthma?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Yes, hormonal shifts in women can worsen asthma symptoms. Fluctuations in estrogen and progesterone, especially during puberty, menstruation, pregnancy, and menopause, can influence airway inflammation and sensitivity, leading to increased coughing, wheezing, and shortness of breath. In your case, with a blood eosinophil count of 650 cells per microliter and an elevated immunoglobulin E (IgE) level of 260 IU/mL(international units per milliliter), biologic therapy may be an appropriate option. Eosinophilic asthma is typically considered when asthma remains severe and uncontrolled despite the use of inhaled corticosteroids (such as Budesonide or Fluticasone) and other long-term controller medications, including long-acting beta-agonists (such as Formoterol or Salmeterol). Biologic agents like Benralizumab and Mepolizumab are used as add-on treatments in such cases.

Benralizumab may be considered when blood eosinophil counts are 300 cells per microliter or higher and the patient has experienced four or more asthma exacerbations requiring oral corticosteroids in the past year, or at least three such exacerbations with eosinophil counts of 400 cells per microliter or more. Mepolizumab may be appropriate when the eosinophil count is at least 150 cells per microliter at screening or 300 cells per microliter within the past year, with a history of two or more asthma exacerbations in the previous year. It is important to note that biologics are used as add-on therapies and do not replace existing controller medications or quick-relief inhalers. Treatment decisions should always be made in consultation with a healthcare professional who can assess your specific medical history and needs.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq. Thank you.