A large-scale study involving nearly 260,000 women has revealed a concerning link between the progesterone-only contraceptive pill and an increased frequency of asthma attacks in certain women. The research, published in ERJ Open Research, highlights that women with asthma—particularly those under 35, using fewer asthma treatments, or diagnosed with eosinophilic asthma—are more likely to experience asthma attacks while using the progesterone-only contraceptive pill.
The study, however, found no such correlation in women taking the combined estrogen and progesterone contraceptive pill, suggesting that the progesterone component may be a contributing factor.
The research, led by Dr. Chloe Bloom, a clinical senior lecturer in respiratory epidemiology at the National Heart and Lung Institute, Imperial College London, underscores the broader implications of the findings for women’s health. According to Dr. Bloom, understanding why women are disproportionately affected by severe asthma compared to men is a critical area of research. “Asthma is common in women, and unfortunately, women are twice as likely to die from asthma as men. To help prevent these deaths, we need a better understanding of why women are at greater risk,” Dr. Bloom explained.
Hormonal Influence on Asthma Severity
The study specifically focuses on the potential role of sex hormones, including progesterone, in asthma severity. As Dr. Bloom notes, studying the effects of sex hormones can be challenging, particularly when factors like puberty and menopause are difficult to pinpoint in individuals. However, by analyzing the use of sex hormone-based medications like contraceptive pills, researchers can gain clearer insights into how hormones might influence asthma.
The study reviewed data from the UK’s Clinical Practice Research Datalink, focusing on 261,827 women between the ages of 18 and 50 who had been diagnosed with asthma. Researchers compared the asthma-related health outcomes of women who had never used contraceptive pills with those who used either the combined pill or the progesterone-only pill between 2004 and 2020. The outcomes were measured based on incidents requiring oral steroids for asthma, emergency department visits, or death from asthma.
Progesterone-Only Pill and Increased Asthma Risks
The results indicate a notable increase in asthma attacks among certain groups of women using the progesterone-only pill. Specifically, women under 35 were found to be 39% more likely to experience asthma attacks, while those using fewer asthma treatments had a 20% higher risk. Furthermore, women with eosinophilic asthma, a condition characterized by high levels of eosinophils (white blood cells that cause inflammation), had a 24% higher risk of experiencing asthma attacks.
Dr. Bloom emphasized the study’s significance, noting that this was the first large-scale investigation to examine the effects of contraceptive pill use on asthma over an extended period, using real-world health data. “Our study helps women and healthcare professionals make more informed decisions about which contraceptive pill might be best for them,” she said. “This also adds another layer to understanding why women may be more likely to experience severe asthma compared to men.”
A Call for Further Research
While the study provides important insights, Dr. Bloom cautioned that more research is needed, particularly regarding the role of progesterone in asthma. The study is one of the first to suggest that progesterone could significantly impact asthma severity, an area that has been underexplored in previous research, which has typically focused on estrogen and testosterone.
In light of the findings, the researchers are calling for further studies on how progesterone interacts with asthma medications such as steroids. Additionally, they are continuing to investigate the effects of hormone replacement therapy and pregnancy on asthma.
Professor Apostolos Bossios, head of the European Respiratory Society’s group on airway diseases, asthma, COPD, and chronic cough, who was not involved in the study, praised the research as a crucial step toward understanding the gender disparities in asthma. He urged women with asthma who are using or considering the combined pill to consult their healthcare provider about their contraceptive options and asthma management. “Women with asthma must ensure they use their preventer inhalers and any prescribed treatments regularly, regardless of their contraceptive choice,” he stressed.
This study represents an important contribution to asthma research, shedding light on how hormonal factors may influence asthma severity in women and paving the way for more personalized approaches to treatment.
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