What sinus treatments are safe with hormonal birth control?

Question

Hi doctor,

My partner has recurring nasal polyps and asthma. Her ENT has recommended another steroid nasal spray. However, she is also on hormonal birth control and notices increased nasal congestion before her period. Could fluctuations in estrogen or progesterone be contributing to worsening nasal inflammation? Are there any sinus treatments that would not interfere with hormonal birth control or affect hormone levels?

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I hope you are doing well. Yes, your observations are correct; hormonal fluctuations, particularly changes in estrogen and progesterone levels, can worsen nasal congestion and inflammation. Many women experience increased symptoms before menstruation due to hormone-induced mucosal swelling, which can aggravate conditions such as nasal polyps and asthma, especially in the context of chronic rhinosinusitis with nasal polyps (CRSwNP).

Here are some helpful options:

Nasal steroid sprays – These remain the first-line treatment and are safe to use with hormonal birth control. They work locally and do not affect hormonal levels or contraceptive effectiveness.
Biologic therapy (such as Dupilumab) – These medications are effective in reducing inflammation and nasal polyps in patients who do not respond to sprays or surgery. They do not interfere with hormonal balance.
Saline rinses – Daily nasal irrigation using a neti pot or squeeze bottle can reduce congestion and remove irritants. This method is completely safe with respect to hormones.
Hormonal review – If symptoms worsen around the menstrual cycle, it may be helpful to discuss lower-dose or non-estrogenic contraceptive options with a gynecologist to minimize hormonal fluctuations.
Allergy evaluation – Hormonal changes can sometimes worsen allergic responses. If not already done, an allergy assessment may provide additional insights.

In summary, hormonal fluctuations can contribute to nasal inflammation, but several safe and effective treatment options are available.

I would appreciate it if you could provide your feedback.

I hope this answer helps you.

Thank you.