Are steroid nasal sprays for polyps safe during pregnancy?

Question

Hello doctor,

I have been experiencing chronic nasal congestion and loss of smell for over a year, and my ENT specialist has diagnosed me with nasal polyps. I also have mild asthma and recurrent sinus infections.

I am currently using intranasal steroid sprays, but I am concerned about their long-term use, especially since I am planning to conceive in the coming months.

So my concerns are:

Are steroid nasal sprays or oral corticosteroids safe while trying to conceive or during pregnancy?
I have noticed that my nasal symptoms tend to worsen around the time of my menstrual cycle. Can hormonal changes influence the growth of nasal polyps or sinus inflammation?
If medications do not provide adequate relief, my doctor has suggested surgery. Would anesthesia or postoperative medications have any effect on fertility or future pregnancy?
Is it safe to breastfeed while using steroid nasal sprays?
Finally, if nasal polyps remain untreated, could they worsen breathing problems or affect oxygen levels during pregnancy?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com

I have read your query and understand your concerns, and it is completely valid to be cautious when planning a pregnancy while managing a chronic condition such as nasal polyps.

Nasal polyps are commonly associated with underlying inflammation linked to asthma and chronic sinusitis, and consistent treatment is important to control symptoms and prevent complications.

Intranasal steroid sprays, such as Fluticasone or Mometasone, are considered very safe for long-term use, including during pregnancy and while trying to conceive. Their systemic absorption is minimal, as they act locally within the nasal passages.

For this reason, they are preferred over oral corticosteroids, which are generally reserved for short courses during severe flare-ups. Prolonged or repeated use of oral steroids should be avoided during pregnancy unless clearly indicated, as higher systemic doses may potentially affect fetal growth.

Your observation that symptoms worsen around your menstrual cycle is insightful. Hormonal fluctuations, particularly changes in estrogen and progesterone, can influence nasal congestion and mucosal swelling. While hormones are not the primary cause of nasal polyp formation, they may contribute to symptom variation.

If medical therapy is ineffective and surgery becomes necessary, it is generally advisable to schedule it before conception. This is because general anaesthesia and certain postoperative medications are safest when avoided during pregnancy.

Importantly, sinus surgery does not affect fertility, and with appropriate timing and recovery, it does not pose a risk to future pregnancy. Breastfeeding while using intranasal steroid sprays is also considered safe, as only negligible amounts of the medication pass into breast milk.

If left untreated, nasal polyps may worsen nasal obstruction, contribute to sleep disturbance, and, in individuals with asthma, exacerbate breathing difficulties due to shared airway inflammation.

While nasal polyps do not directly reduce oxygen levels during pregnancy, poorly controlled sinus disease can make breathing less efficient and increase discomfort.

Maintaining good nasal hygiene with saline rinses, continuing prescribed nasal sprays, and ensuring optimal asthma control are important steps in managing your condition at this stage.

I hope this information is helpful, and I would greatly appreciate your feedback.

Thanks and regards.