Hormones can influence
asthma and other allergic diseases. In some cases, hormone
replacement or oral contraceptives ("the pill") may be therapeutic
while in others they may instead be the culprit. The mechanisms
by which these changes occurs is unknown.
MENSTRUAL
CYCLE
Premenstrual
or menstrual flare of asthma occurs in about 1/3 of female asthmatics.
While the mechanism is unknown, it appears that regulation of the cycle
with oral contraceptives in some patients is helpful. Alternatively
some woman actually suffer from worsening allergies or asthma when they
start taking the pill. The reasons are unclear. The medical
literature is not clear in this area. Patient care must be individualized.
Any decision to start hormone therapy should only be made after careful
consideration of all risks and benefits.
MENOPAUSE
Women going through menopause can develop asthma symptoms for the first
time. Estrogen replacement therapy may improve asthma control
in some cases. However, there is also some data that estrogen
replacement may precipitate asthma in some patients.
PREGNANCY
In general,
1/3 of women with asthma become worse, 1/3 improve, and 1/3 remain unchanged
during pregnancy. Most asthma medications are safe during pregnancy.
General Facts
The risks of
uncontrolled asthma are far greater than the risks to the mother
or fetus from the medications used to control asthma. Pregnant
women are breathing for two. It is important to have the asthma
under good control: breathing difficulties in the mother affect the
fetus by compromising the oxygen supply. When asthma is controlled,
women with asthma have no more complications during pregnancy and labor
than other women. However, uncontrolled asthma during pregnancy can
produce serious maternal and fetal complications. Uncontrolled
asthma is associated with complications such as:
- premature birth
- low birth weight
- maternal blood
pressure changes (which may be very serious)
Many allergy and asthma
medications are considered relatively safe in pregnancy. If you
are a woman of child-bearing age and planning a pregnancy, review all
of your medications with your doctor before, or as soon as possible
into pregnancy. Inhaled steroids are generally considered
safe and effective and only rarely cause any of the more serious side
effects reported with prolonged use of oral steroids. They are considered
safe for pregnant women and their babies, according to a 1999 study,
although pregnant women taking both beta2-agonists and corticosteroids
are at higher risk for diabetes during pregnancy (gestational diabetes).
BREASTFEEDING
ISSUES:
In general few medications are contraindicated for use during lactation.
Most medications do pass through to breast milk but usually in very
small amounts (less than 1% of the adult dose). There may be some
slight concern that antihistamines may reduce the amount of milk produced.
Infants of mothers taking sedating antihistamines or decongestants could
be slightly drowsy or irritable. Inhaled steroids (nasal or asthma
sprays) are probably safer than pills. More Information may be
found here.
