I started having breathing/wheezing problems in my late 40s. I was in perimenopause then, and eventually reached menopause sometime after I turned 50. There’s an association of airway dysfunction and inflammation with low thyroid levels,[1] and when I initially got to a more optimal thyroid dose (while in perimenopause), the asthma went away. But a few years later, it came back. I wondered if the sex hormones (estradiol and/or progesterone) could have anything to do with asthma, and sure enough, menopause correlates with an increased risk of asthma.[2] One study found that women aged 40-54 had the highest incidence of asthma hospitalization rates.[3] That is exactly when I developed asthma.

Asthma is an inflammatory lung disease that affects a person’s ability to breathe. I found more than one study that implicated low estradiol in asthma. In one experiment on human lung tissue samples, the presence of estradiol decreased airway inflammation after exposure to asthma triggers.[4] In another study, asthmatic male mice treated with estrogen had less lung inflammation than other asthmatic mice.[5] A third study found that estrogens decrease intracellular calcium in airway smooth muscle, which leads to bronchodilation, or the relaxation of these tissues, which is a positive effect.[6] Finally, there are fewer estrogen receptors in the mitochondria of lung epithelial cells in those with asthma.[7] With fewer estrogen receptors, these cells cannot fully benefit from estrogen. This last study also found fewer glucocorticoid receptors in the same lung tissue, which means these cells cannot fully benefit from cortisol either. Cortisol is the anti-inflammatory hormone that would fit into a glucocorticoid receptor, and cortisol levels tend to fall in those who are hypothyroid, because corticosteroid-binding globulin (CBG) rises when thyroid levels are low.[8] CBG will bind up available cortisol, leaving less free cortisol available to the cells, so they can’t benefit from cortisol’s natural anti-inflammatory properties.

Earlier studies contradict the studies just mentioned, because they show an increased rate of newly diagnosed asthma in postmenopausal women who started hormone replacement therapy.[9] This may reflect the type of hormone replacement used. Oral estrogen and progesterone make a first pass through the liver, which can raise thyroid binding globulin (TBG), which binds to and reduces free T4, making these women somewhat hypothyroid.[10] As stated earlier, hypothyroidism is also a risk factor for airway dysfunction.

What do all these studies mean? They suggest that declining estradiol levels may be one cause of asthma that develops at menopause. Anyone (male or female) with asthma should request blood tests to check estradiol, cortisol, and thyroid (Free T3 and Free T4) levels. Since testosterone is the precursor to estradiol in men, a man who is low in testosterone could also be low in estradiol. Some studies indicate that testosterone and its metabolites relax airway smooth muscle and prevent bronchospasm.[11] For me, an adjustment in my topical tri-est formula (to give me more estradiol) is providing relief.

If you suffer from asthma, you may be interested in two chapters in my Tired Thyroid book. Chapter 7 is titled “Asthma, Eczema, Allergies, Hives, and Yellow #5 (Tartrazine or E102),” while Chapter 8 is titled “Autoimmunity, Autism, and Asthma May be Triggered by Acetaminophen, Amalgams, or Aluminum.” If you are sensitive to sulfites or suffer from an autoimmune condition, you may benefit from reading these chapters.

[1] Birring, S. S., Patel, R. B., Parker, D., McKenna, S., Hargadon, B., Monteiro, W. R., & Pavord, I. D. (2005). Airway function and markers of airway inflammation in patients with treated hypothyroidism. Thorax, 60(3), 249-253.

[2] Triebner, Kai, et al. “Late-breaking abstract: Asthma risk increases when women become menopausal: A Northern European longitudinal survey.”European Respiratory Journal 44.Suppl 58 (2014): P1941.

[3] Lin, Robert Yao-wen, Rong Ji, and William Liao. “Age dependent sex disproportion in US asthma hospitalization rates, 2000-2010.” Annals of Allergy, Asthma & Immunology 111.3 (2013): 176-181.

[4] Freeman, M. R., Manlove, L. J., Thompson, M. A., Pabelick, C. M., Prakash, Y. S., & Sathish, V. (2014). Estrogen Receptor Beta (erβ) Blunts Inflammation-Induced Human Airway Smooth Muscle Proliferation And Remodeling. Am J Respir Crit Care Med, 189, A5318.

[5] El-Desouki, N. I., Tabl, G. A., & Elkhodary, Y. A. (2013). Biological studies on the effect of estrogen on experimentally induced asthma in mice. Toxicology and industrial health, 0748233713486959.

[6] Townsend, E. A., Sathish, V., Thompson, M. A., Pabelick, C. M., & Prakash, Y. S. (2012). Estrogen effects on human airway smooth muscle involve cAMP and protein kinase A. American Journal of Physiology-Lung Cellular and Molecular Physiology, 303(10), L923-L928.

[7] Simoes, D. C., Psarra, A. M. G., Mauad, T., Pantou, I., Roussos, C., Sekeris, C. E., & Gratziou, C. (2012). Glucocorticoid and estrogen receptors are reduced in mitochondria of lung epithelial cells in asthma. PloS one, 7(6), e39183.

[8] Dumoulin, S. C., Perret, B. P., Bennet, A. P., & Caron, P. J. (1995). Opposite effects of thyroid hormones on binding proteins for steroid hormones (sex hormone-binding globulin and corticosteroid-binding globulin) in humans.European journal of endocrinology, 132(5), 594-598.

[9] Barr, R. G., Wentowski, C. C., Grodstein, F., Somers, S. C., Stampfer, M. J., Schwartz, J., … & Camargo, C. A. (2004). Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease. Archives of internal medicine, 164(4), 379-386.

[10] Mazer, N. A. (2004). Interaction of estrogen therapy and thyroid hormone replacement in postmenopausal women. Thyroid, 14(3, Supplement 1), 27-34.

[11] Montaño, L. M., Espinoza, J., Flores-Soto, E., Chávez, J., & Perusquía, M. (2014). Androgens are bronchoactive drugs that act by relaxing airway smooth muscle and preventing bronchospasm. Journal of Endocrinology, 222(1), 1-13.

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