How can I manage asthma and menopausal symptoms effectively?

Question

Hello doctor,

I am 54 and have had asthma since childhood, but in the last few years, it has worsened to the point I have been told it is “COPD with an asthmatic component.” I am on inhaled steroids and bronchodilators, but I still wake up breathless at night. I also reached menopause two years ago and have been having severe hot flashes, fatigue, and occasional palpitations.

Could hormonal changes be making my breathing worse?
My pulmonologist suggested biologic therapy. How does that work, and is it safe for women of my age with osteoporosis?
I am also wondering if hormone replacement therapy (HRT) would worsen my asthma.
I have been avoiding it out of fear, but I cannot sleep properly due to menopausal symptoms. How can I manage both conditions together safely?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am really sorry you are dealing with both worsening breathing and difficult menopausal symptoms at the same time, and it makes sense that it feels overwhelming. Hormonal changes after menopause can definitely influence asthma by increasing airway inflammation and making symptoms like breathlessness and nighttime attacks more noticeable, especially when estrogen levels drop suddenly.

In your situation, the diagnosis of COPD (chronic obstructive pulmonary disease) with an asthmatic component means the airways are both inflamed and chronically narrowed, so standard inhalers sometimes are not enough.

Biologic therapies target specific inflammatory pathways in asthma, such as eosinophils or IgE (immunoglobulin E), and many women in their 50s and 60s use them safely, even with osteoporosis, because they are not steroid pills and they do not thin the bones. They are usually given as injections every few weeks and often reduce night attacks and the need for rescue inhalers.

Regarding hormone replacement therapy (HRT), it usually does not worsen asthma, and in some women, it actually stabilizes breathing because it smooths out the hormonal fluctuations that irritate the airways. The key is choosing the right dose and type, especially if you have palpitations or bone loss.

You and your doctors can safely combine HRT with asthma and COPD treatment as long as you are monitored for blood pressure, bone health, and breathing control. You deserve better sleep and better breathing, and with the correct combination of inhalers, possibly a biologic, and well-chosen menopause treatment, it is very possible to get both conditions under good control.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.