Asthma In Women: What Hormones Have To Do With It

General Health & Wellness Women's Health

October 29, 2025

The way asthma affects men and women is a study in contrasts. According to the Asthma and Allergy Foundation of America, more than 28 million, or about 1 in 12, people in the United States have asthma. But asthma is more common in male children than female children, and more common in female adults than male adults.

Why is that? Govind Jha, MD, an internal medicine physician specializing in pulmonary and critical care medicine at Franciscan Physician Network Pulmonary, Critical Care & Sleep Medicine in Lafayette, Indiana, points, in part, to hormonal changes — especially fluctuations in estrogen and progesterone.

“It’s an interesting flip,” Dr. Jha said. “Before puberty, more boys than girls have asthma. After puberty, it’s the opposite.”

Key Takeaways: Asthma In Women

After puberty, asthma becomes more common and often more severe in women.
Hormonal changes during puberty, menstruation and pregnancy can affect asthma symptoms.
Modern treatments, including combination medications and biologic therapies, make asthma highly manageable.
Most asthma medications are safe during pregnancy. In fact, stopping them can actually be riskier for mom and baby.

What Is Asthma?

Asthma is a chronic lung condition characterized by inflammation and narrowing of the airways. It often starts in childhood but can also develop in adulthood. It causes airway swelling, shortness of breath and extra mucus, which can make breathing difficult.

Typical asthma symptoms include:

Chest tightness
Coughing, especially at night or after exercise
Shortness of breath
Wheezing

If you have asthma, you always have asthma. But you only have asthma “attacks” when something — often called an asthma trigger — bothers your lungs. When this happens, the airways narrow, meaning less air gets in and out of your lungs.

Common asthma triggers include:

Acid reflux
Air pollution
Dust mites
Exercise
Mold
Pet dander
Pollen
Smoke
Stress
Viral and sinus infections

Asthma attacks can range in severity from being bothersome to interfering with daily activities. In rare cases, severe asthma attacks can be life-threatening.

How Hormones Influence Asthma

Before puberty, boys have smaller airways compared to girls, making them more likely to experience asthma symptoms. But once puberty starts, researchers believe hormones may affect the airways, making women more sensitive to asthma triggers.

“It’s thought that progesterone is a little more protective and estrogen a little more inflammatory,” Dr. Jha said. “That’s why during puberty, menstruation or pregnancy, when hormones change, we sometimes see asthma symptoms worsen.”

To date, scientists haven’t found a single causal pathway that links hormones to asthma. However, studies — including research funded by the National Institutes of Health — suggest estrogen increases and testosterone decreases airway inflammation. Research has also found that starting puberty early or having a multiple-gestation pregnancy (a pregnancy with twins, triplets or more) increases a woman’s risk of having asthma, as well as its severity.

Asthma Management For Women

There isn’t a cure for asthma, but we can manage it effectively. (Learn about creating an individualized treatment plan.)

Depending on the severity and frequency of symptoms, treatment usually begins with an inhaled corticosteroid combined with a long-acting beta agonist (LABA). Corticosteroids suppress the immune system and reduce inflammation in the airways . LABAs relax the muscles in the airways and make it easier to breathe.

Examples of frequently prescribed, first-line asthma treatments include Symbicort® — a combination of budesonide, an inhaled corticosteroid, and formoterol, a LABA — and Advair®, a combination of fluticasone, an inhaled corticosteroid, and salmeterol, a LABA.

If these treatments alone don’t control asthma symptoms, Dr. Jha said he may increase the dose of the corticosteroid or add another medication such as Spiriva®, a long-acting bronchodilator that relaxes the muscles around the airways.

In addition, Dr. Jha said he often orders blood tests for patients with uncontrolled asthma symptoms. These tests look at your levels of immunoglobulin E (IgE) antibodies/eosinophils in the body, which trigger allergic responses. Elevated IgE antibodies/eosinophils may mean you’ll respond to certain biologic therapies — injectable drugs that can help with asthma control. Xolair®, for example, is a biologic medication that works by blocking IgE.

Even if you have uncontrolled asthma symptoms with treatment but don’t have an elevated IgE count, other therapies are still available, Dr. Jha said.

“We have great therapies today for asthma control,” he said. “Previously, a lot of patients were on oral steroids. But they had side effects like worsening bone density, hypertension, diabetes and a predisposition to infection. Today, we can avoid that.”

Asthma management for women whose symptoms worsen with menstruation

Dr. Jha said the treatment plan typically remains the same for women whose asthma symptoms get worse just before their menstrual cycle begins.

“There’s no clear evidence that hormone therapy helps,” he said. “Some people might improve on birth control pills while others may get worse, so it really depends on the person. If a certain patient’s situation makes me consider an oral contraceptive, I work with my OBGYN colleagues to make a plan.”

Asthma management for women who are pregnant

Dr. Jha also wants to reassure women who are pregnant or plan to become pregnant: “The biggest mistake I see is patients who stop their asthma medicine out of fear for the baby. I understand why they do it, but we have strong evidence that inhalers and most asthma medications are safe during pregnancy. And, in fact, the risk of not treating asthma is far greater.”