Hormone-induced breathing: why asthma is more difficult for women

After puberty, asthma becomes more common and severe in women than in men. Researchers attribute this, among other things, to changes in the level of sex hormones that can affect inflammation of the respiratory tract, and symptoms in some women change during the menstrual cycle, pregnancy and menopause. About why asthma manifests itself differently in men and women and what role hormones play in this, is in the "Izvestia" material.

After puberty, everything changes

In childhood, asthma is more common in boys: before puberty, they are also more likely to experience severe symptoms. However, after puberty, the situation changes: adult women have asthma more often than men, and the course of the disease may be more severe on average. According to National Geographic, in the United States, almost one in 10 adult women has asthma — almost twice as many as among men. Women are also more likely to experience seizures requiring emergency room treatment or hospitalization.

The exact reason for this change has not yet been determined. Researchers are looking at several factors at once: sex hormones, genetic differences, lung development, environmental influences, and differences in immune responses. A 2026 review published in The Journal of Allergy and Clinical Immunology (JACI) also notes that in women after puberty, the disease is more common and severe on average, and hormones can affect biomarkers of asthma and the nature of inflammation.

Thus, puberty may become one of the periods when already existing biological differences begin to have a stronger effect on the course of the disease. But the hormones themselves are only part of this system.

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How estrogen interferes with breathing

Female sex hormones remain one of the main candidates for the role of a binding mechanism. In a review in the journal Current Opinion in Allergy and Clinical Immunology, researchers noted that estrogen receptors are found on various cells that regulate the immune response, and the hormone itself is able to influence the processes associated with allergic inflammation and the work of the respiratory tract.

The researchers described a more specific mechanism in another paper published in JACI. They studied estrogen and progesterone and their effect on Th17 cells, a type of T—lymphocyte involved in the immune response. In an experiment with cells from people with severe asthma, researchers found a link between female sex hormones and increased production of interleukin-17A, or IL-17A, which is associated with a severe form of the disease.

It's not that estrogen alone causes asthma. Rather, hormonal signals can alter pre-existing inflammatory processes and thereby affect the severity of the disease. In another study this year, the authors also point out that estrogen and progesterone can contribute to certain types of inflammatory response, while androgens have a different immune-regulating effect.

The course of asthma can also be influenced by external factors. For example, a study in the American Journal of Industrial Medicine showed an association of occupational exposure to cleaning and disinfectants with more symptomatic and severe asthma in women. Therefore, the differences between men and women cannot be reduced solely to the hormonal background.

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The menstrual cycle changes the course of asthma

Another feature of female asthma is related to the menstrual cycle. In another JACI review, perimenstrual asthma worsening is described in about 30-40% of women with this disease. At the same time, the researchers emphasize that the exact mechanism of the phenomenon has not yet been established.

The first observations appeared several decades ago. In a study published in the same journal in 1986, of 57 women with asthma, 19 had a significant increase in pulmonary symptoms immediately before or during menstruation. Shortness of breath, wheezing, and chest tightness increased most noticeably.

One possible explanation is due to natural fluctuations in hormone levels. After ovulation, the concentrations of estrogen and progesterone change, and immediately before menstruation decrease. The researchers suggest that these changes may affect the inflammation of the respiratory tract and their hyperreactivity. However, this remains a hypothesis for now, and not a fully established mechanism.

Therefore, the association of symptoms with a certain phase of the cycle does not mean that hormonal fluctuations are the only cause of the deterioration. The severity of asthma can simultaneously be affected by inflammation, individual respiratory tract sensitivity, and other factors.

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What happens to asthma during pregnancy

Pregnancy makes the picture even more complicated. According to National Geographic, approximately 40% of women with asthma may experience symptoms during pregnancy, but this does not mean that the disease will necessarily become more severe. Some patients do not notice the changes, while others have symptoms that become weaker.

Current evidence shows that exacerbations are influenced not only by hormonal changes. A 2025 study in the European Respiratory Journal, based on data from more than 40,000 pregnancies, found that 31% of women reduced the use of inhaled corticosteroids during pregnancy. Decreased adherence to therapy was associated with an increased risk of exacerbations.

The authors found that the number of exacerbations did decrease in some women during pregnancy, but cases requiring hospital care increased. A particularly high risk was observed in women with more severe asthma, severe type 2 inflammation, and insufficient use of inhaled steroids.

Therefore, it would be wrong to associate the worsening of asthma during pregnancy only with an increase in hormone levels. The course of the disease is simultaneously affected by changes in the immune system, body weight, reflux, nasal congestion, the initial severity of asthma and compliance with prescribed therapy.

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After menopause, the rules change again

With menopause, the situation becomes even less clear. Some studies have linked this period to changes in the course of asthma, but the results could be influenced by age, weight gain, and hormone therapy. As a result, it turned out to be more difficult to determine the independent effect of menopause. One of the most revealing studies of recent years was published in 2025 in JACI. Its authors concluded that menopause itself was not associated with an increased likelihood of asthma or severe asthma after accounting for other factors.

At the same time, hormone therapy remains a separate issue. An earlier study in the same journal, based on 17 years of national cohort data, examined the association of hormone replacement therapy with the risk of severe asthma exacerbations in peri- and postmenopausal women.

Thus, the statement "menopause worsens asthma" cannot be considered a universal rule today. Studies give an ambiguous picture, and scientists continue to find out what role hormone reduction, age, body weight, concomitant diseases, and hormone therapy play here.

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One asthma — different scenarios

Another problem is that women are more likely to experience severe asthma, and some variants of the disease respond less well to standard therapy. Inhaled corticosteroids remain one of the main means of asthma control, but experts note that their effect may be weaker in some women. Researchers attribute this, among other things, to the possible effect of estrogen on inflammation and cell response to steroids.

This is not to say that inhalers generally "don't work" for women. The effectiveness of treatment depends on the specific asthma phenotype, the mechanism of inflammation, and the individual characteristics of the patient. For some severe forms of the disease, there are biological drugs that affect certain parts of the inflammatory response.

The problem is that many drug studies have historically not been designed to compare results in men and women in detail.

The situation is gradually changing. In the United States, the National Institutes of Health's "Gender as a Biological Variable" policy, which came into effect in 2016, reinforced the need to take biological gender into account when designing, analyzing, and presenting research results. However, even now the authors of the reviews emphasize that the mechanisms of differences in the course of asthma in men and women are not fully understood.