Asthma And The Menstrual Cycle: How Are They Connected?

  • Mfon EkanemBSc (Hons) Human Biology & Infectious Diseases - University of Salford, UK
  • Aisha Din BSc (Hons) Biomedical Science at De Montfort University
  • Reem Alamin HassanBachelor's degree, Biomedical Sciences, Queen Mary University of London, UK

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Asthma and the menstrual cycle may seem like two unrelated conditions, however, they have much more in common than it may seem. Asthma can have such a big impact on people's lives and in severe cases can lead to death.

During a menstrual cycle, many factors can come into play, leading to a worsening of symptoms in people with asthma. This article will explore the relationship between these two conditions and how they can influence one another.

What is asthma?

Asthma is a common chronic respiratory disease most prevalent in children and causes airway inflammation. It is characterised by the lung's hyperresponsiveness to specific triggers, which can lead to the excessive narrowing of the airways and give rise to asthmatic attacks and a flare-up of symptoms.1


Asthma can be associated with other conditions such as eczema and hay fever and it can manifest through frequent episodes of:

  • Wheezing
  • Coughing
  • Shortness of breath

These symptoms can range in severity from mild and occasional to acute and life-threatening, but they are usually reversible with the right medication. Due to its high mortality, asthma needs to be treated properly, which is why identifying triggers can be vital in the treatment of it.2


The specific asthma triggers include:

  • Viruses
  • Allergies
  • Exercise
  • Smoke
  • Obesity
  • Stress or emotional factors
  • Colds and flu

Asthma is however a very complex condition and not all factors are understood. Research shows that asthma is multifactorial, which means that asthma is a disease caused by multiple factors which are believed to be genetics and environment.2

Impact on life and health

Asthma can lead to a decrease in the quality of life, especially for people with severe symptoms. When poorly controlled it can be disabling and people with asthma often need life-long monitoring to decrease the impact of this disease on their lives along with medications to manage and treat their symptoms. With good management, life can improve to a great extent.2

What is the menstrual cycle?

The menstrual cycle is a process in which the reproductive system prepares for pregnancy and fertilisation in those assigned females at birth (AFAB). The menstrual cycle is the bleeding that is led by the shedding of the wall of the uterus (uterine mucosa).

This cycle can vary in length, averaging to last about 28 days. However, any cycle between 23 and 35 is still considered normal. The menstrual cycle can be measured from the start of one period to the start of another. Menstruation usually begins during puberty and can last until the person is in their 50s.3

Cycle and phases

The menstrual cycle follows phases:

Phase 1, the follicular or proliferative phase:

  • This phase occurs from day 1 to day 14 of the menstrual cycle. In this phase, the uterus is prepared for pregnancy by the thickening of the endometrium (inner lining of the uterus) and the growth of the gland
  • In this phase, an egg is preparing to enter ovulation (the release of the egg by the follicle), which usually happens on day 14 of the cycle. Ovulation is triggered by two hormones called luteinising hormone (LH) and follicle-stimulating hormone (FSH)
  • The follicular phase is the longest in the menstrual cycle3

Phase 2, The luteal or secretory phase:

  • This phase which lasts on average occurs from day 14 to day 28 of the menstrual cycle, where the body prepares for possible implantation of the embryo
  • Body temperature increases, and the egg changes into a structure called corpus luteum. If no pregnancy occurs, this structure will disappear during menstruation3

Menstruation or menses:

Hormonal changes

Menstruation is usually driven by hormones (chemical messengers in your body). During the menstrual cycle, your ovaries and pituitary gland (present in the brain) release hormones during specific phases of the menstrual cycle. Hormonal changes are caused by oestrogen, progesterone, LH, and FSH.

  • During phase 1, oestrogen, FSH, and LH increase in production
  • During ovulation, oestrogen levels are the highest, triggering a surge in LH and FSH (LH surge)
  • During phase 2, progesterone levels increase

During menstruation, if pregnancy does not occur, hormone levels decrease.3


Those AFAB can experience different symptoms during their period, with some not experiencing any at all.

The different symptoms that can occur during the menstrual cycle are:

  • Cramping
  • Mood changes
  • Headaches
  • Cravings
  • Acne
  • Bloating
  • Breast tenderness

How are asthma and the menstrual cycle connected?

Some of those AFABs present a worsening of asthmatic symptoms during their period. This can be referred to as perimenstrual asthma. A clear definition of this condition does not yet exist. During their period, 19-40% of asthmatic AFABs reported an increase in symptoms, which presents itself during the luteal phase or the first few days of the menstrual cycle.4

Which factors contribute to the worsening of these conditions?

Perimenstrual asthma is mainly connected to the inflammatory nature of the menstrual cycle and the hormonal fluctuations that happen during a period.

  • As said previously, during the monthly cycle, levels of oestrogen and progesterone change. This change can lead to a reaction carried out by certain immune cells (for example eosinophils or mast cells)
  • Oestrogen in particular can influence the activity of the immune cells, modifying the behaviour of eosinophils (immune cells involved in allergic reactions and inflammatory processes)
  • Fluctuations in the hormone oestrogen and menstrual blood can also activate mast cells in the endometrium These cells are in charge of inflammatory processes that occur in various organs, including the endometrium. When mast cells are activated, they might release signals which can trigger multiple immune and inflammatory responses in different zones, including the lungs

How are mast cells connected to asthma?

In people suffering from asthma, mast cells, which are in charge of the inflammatory processes, can be found in the lung tissue (specifically the bronchial tissue). The activation of the mast cells during ovulation and menstruation due to hormonal fluctuation can worsen the inflammation present in the lungs of asthmatic people, leading to asthmatic attacks.

In simple terms, the activation of immune cells during ovulation and menstruation due to hormonal fluctuation can lead cells to increase inflammation not only in the uterus but also in the lungs in individuals with asthma, resulting in worse symptoms.4

How can asthma be managed during the menstrual cycle?

There are no specific studies investigating the treatment of this condition, however, listed below are the therapies investigated so far.

Conventional asthma therapy

A combination of inhaled corticosteroids (inhaler) and long-acting beta2-antagonist (LABA), studies suggest that the standard treatment can prevent perimenstrual asthma.

Hormonal treatment

Oral contraceptives can help to stabilise hormone levels and regulate the menstrual cycles, however, there is conflicting research with some studies showing positive outcomes and some showing potential risks.

Vitamin D

Low levels of vitamin D have been linked to an increase in asthmatic symptoms and perimenstrual asthma. Vitamin D supplements have shown positive outcomes in reducing symptoms and inflammation.5

Creating an action plan alongside a healthcare provider can help you manage your symptoms, and decide which therapy best suits your case. To best manage asthma during the menstrual cycle:

  • Don’t forget to take asthma medicine
  • Stay away from allergens and triggers
  • Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to manage cramps7

Who is more likely to get perimenstrual asthma?

People assigned females at birth that:5

  • Have severe asthma
  • Have premenstrual syndrome
  • Have irregular periods
  • Have longer bleeding
  • Are older
  • Are overweight
  • Are more sensitive to aspirin
  • Are anaemic


In conclusion, while asthma and the menstrual cycle may seem like unrelated conditions, they can have a significant impact on each other. Understanding the symptoms and triggers of asthma and the phases of the menstrual cycle can help individuals manage their health better and improve their quality of life. It is essential to seek medical attention and treatment for both conditions to ensure proper management and control.


  1. Quirt J, Hildebrand KJ, Mazza J, Noya F, Kim H. Asthma. Allergy Asthma Clin Immunol [Internet]. September 12, 2018 [cited March 3, 2024];14(Suppl 2):50. Available at: 
  2. Hashmi MF, Tariq M, Cataletto ME. Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited March 2, 2024]. Available at: 
  3. Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, menstrual cycle. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited March 3, 2024]. Available at: 
  4. Graziottin A, Serafini A. Perimenstrual asthma: from pathophysiology to treatment strategies. Multidisciplinary Respiratory Medicine [Internet]. August 1, 2016 [cited March 3, 2024];11(1):30. Available at: 
  5. Calcaterra V, Nappi RE, Farolfi A, Tiranini L, Rossi V, Regalbuto C, et al. Perimenstrual asthma in adolescents: a shared condition in pediatric and gynecological endocrinology. Children (Basel) [Internet]. February 10, 2021 [cited March 3, 2024];9(2):233. Available at: 
  6. Understanding perimenstrual asthma (Pma) | saint luke’s health system [Internet]. [cited March 3, 2024]. Available at: 

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Mfon Ekanem

Bachelor of Science in Human biology and Infectious Diseases – Bsc(Hons), University of Salford, United Kingdom

Mfon is a recent graduate with a Bachelor of Science degree in Human Biology and Infectious Diseases, with a comprehensive understanding of genetics and physiology. With a profound passion for both medicine and writing, Mfon is dedicated to delivering engaging and accurate content tailored for both general audiences and enthusiasts of the medical field alike.

Throughout her academic journey, Mfon has gained knowledge of the human body, focusing particularly on the mechanisms of infectious diseases and their impact on human health. She has developed a keen insight into the complex interplay between pathogens and host organisms, as well as the body's defence mechanisms against diseases.

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