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Relation between phase of the menstrual cycle and asthma presentations in the emergency department

¹ Department of Emergency Medicine, University Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
² Department of Emergency Medicine, Massachusetts General Hospital, and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Correspondence to:
Correspondence to:
Dr B E Brenner
Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; brennerbarry{at}uams.edu

Background: The phase of the menstrual cycle is thought to influence the course of asthma in women. One recent study reported a large increase in exacerbations during the perimenstrual phase, while another found a preovulatory increase. A study was undertaken to determine the relation between phase of the menstrual cycle and acute asthma in patients presenting to the emergency department (ED).

Methods: All women aged 18–54 years presenting with a diagnosis of acute asthma exacerbation were considered for enrolment in the study. Women who were pregnant, postmenopausal, following hysterectomy, with a >28 day menstrual cycle or incomplete reproductive history were excluded. The 792 eligible women were classified by menstrual phase based on both date of symptom onset and date of ED visit.

Results: When classified by date of symptom onset, 28% were preovulatory (days 5 to 11), 25% were periovulatory (days 12 to 18), 21% were postovulatory (days 19 to 25), and 27% were perimenstrual (days 26 to 4; p = 0.03). When classified by date of ED visit, 28% were preovulatory, 22% were periovulatory, 22% were postovulatory, and 27% were perimenstrual (p = 0.004). Using either approach, there were no significant differences in demographic factors or in asthma severity of women in the various menstrual phase groups.

Conclusion: Acute asthma exacerbations do not markedly increase during the perimenstrual phase. The results support the suggestion that both preovulatory and perimenstrual phases are actual triggers of asthma exacerbation in some women, or that these two phases serve as "co-factors" that worsen other recognised triggers of acute asthma.

Keywords: asthma; sex hormones; menstruation; emergency department

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