Endogenous and exogenous sex steroid hormones and asthma and wheeze in young women

Background

Emerging evidence suggests that both endogenous and exogenous sex steroid hormones may influence the occurrence of asthma and wheeze among women.

Objective

We investigated the associations between exogenous sex hormone (oral contraceptive [OC]) use and wheezing in young women with and without asthma history. To investigate the role of endogenous sex hormones, we examined the association between age at menarche and the development of asthma after puberty.

Methods

We conducted a study among 905 women who had undergone menarche. Subjects were between 13 and 28 years of age and had participated in the Children's Health Study.

Results

In women without asthma, OC use was associated with higher risk of current wheeze (odds ratio [OR], 1.75; 95% CI, 1.15-2.65). In contrast, OC use was associated with a markedly reduced prevalence of current wheeze in women with a history of asthma (OR, 0.18; 95% CI, 0.06-0.56; P value for interaction = .003). These associations showed significant trends with duration of OC use. Age at menarche was associated with new-onset asthma after puberty. Compared with women who had menarche after age 12 years, women with menarche before age 12 years had a 2.08-fold (95% CI, 1.05-4.12) higher risk of asthma after puberty.

Conclusion

Both endogenous and exogenous sex steroid hormones affect asthma and wheeze occurrences in young women.

Clinical implications

Because women have higher asthma risk after puberty, and OC use is common among young women, clinicians may inform women with asthma about the potential effects of OC on asthma-related respiratory symptoms.

Key words: Oral contraceptives, sex hormones, estrogen, progesterone, puberty, menarche, wheeze, asthma

Abbreviations used: AHR, Airway hyperresponsiveness, BMI, Body mass index, CHS, Children's Health Study, HR, Hazard ratio, OC, Oral contraceptive, OR, Odds ratio, PEFR, Peak expiratory flow rate, SES, Socioeconomic status