I have nasal polyps. Will it affect my fertility at 40?

Question

Hello doctor,

I am a 40-year-old woman struggling with chronic nasal polyps and sinus issues for the past few years. I also suffer from frequent migraines and hormonal fluctuations around my periods, which seem to make my sinus congestion worse.

I was advised to undergo endoscopic surgery, but I am anxious about whether the condition could return, and I have a few questions:

Can hormonal changes during menstruation or menopause worsen nasal polyp symptoms?
Is it safe to use steroid sprays long-term, especially since I am perimenopausal and have been told I have mild osteoporosis?
Also, could my nasal polyps affect fertility or pregnancy in any way?
I am worried about taking decongestants while trying to conceive. Are there safer alternatives?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Yes, hormonal fluctuations can influence sinus and nasal symptoms. Estrogen and progesterone affect the nasal mucosa and blood flow, which can cause nasal congestion or swelling around menstruation and perimenopause.

However, hormones do not directly cause nasal polyps, but may exacerbate inflammation or congestion, thereby worsening existing symptoms during hormonal shifts. During menopause, as estrogen declines, some women notice reduced mucosal swelling, while others experience dryness and irritation instead.

Recurrence after endoscopic sinus surgery. Endoscopic sinus surgery (ESS) can provide significant relief by clearing blocked sinuses and removing polyps; however, recurrence is possible, with studies showing rates of 20 to 60 percent, especially in individuals with allergies, asthma, or Aspirin-exacerbated respiratory disease (AERD).

Long-term medical management (for example, nasal corticosteroid sprays, saline irrigations, sometimes biologics like Dupilumab) is key to preventing regrowth. Regular follow-up with an ENT (ear, nose, and throat) helps monitor and manage inflammation early.

You should consult an ENT surgeon, start taking tablet Folic acid five milligrams before planning your pregnancy till the end of the first trimester. Inomel-F sachet once a sachet at night for three months, Tricovit plus IS 137 mcg (micrograms)or 50 mcg twice a day for three weeks.

I hope this helps.

Thank you.