Understanding Perimenstrual Asthma (PMA)

Perimenstrual asthma (PMA) occurs when a woman’s asthma symptoms get worse right before or during her menstrual period. Asthma flare-ups can occur. And asthma symptoms can be more severe during this time. A person with PMA may need to go to the emergency room or being admitted to the hospital. About 3 in 10 women with asthma have PMA.

Causes of PMA

Experts don’t know the exact cause of PMA. But it may be from changes in the levels of estrogen and progesterone. These changes have been linked to changes in asthma symptoms and inflammatory responses just before the menstrual period in women with asthma.

Who is more likely to get PMA?

PMA often affects women with asthma who:

• Are older

• Have more severe asthma

• Are overweight

• Are very sensitive to aspirin

• Have menstrual cramps

• Have premenstrual syndrome (PMS)

• Have irregular menstrual cycles

• Have longer menstrual bleeding

Symptoms of PMA

With PMA, severe asthma symptoms occur just before or during their menstrual period. These symptoms include:

• Wheezing

• Chest tightness

• Shortness of breath

• Cough

People who have PMA attacks are more likely to be treated in the hospital. Symptoms may be so severe that they may also need help with their breathing using an invasive mechanical breathing device (ventilator). In some cases, these attacks can be fatal.

Diagnosing PMA

Your healthcare provider will do a physical exam and take your health history. They will ask about any changes in your asthma symptoms. Watch your symptoms closely. Record any changes and when they occur. Also record the dates of your menstrual cycles. It’s important to write down and find or rule out the cause of any asthma flare-ups or worsening symptoms. Always bring this record of your symptoms to your provider visits.

Treatment for PMA

Asthma medicines are key in treating PMA. To help with symptoms, your healthcare provider may advise you to increase your dose of asthma-control medicine before your period starts. Or your provider may have you take a different medicine.

Create an asthma action plan with your provider. Update your action plan each year, or when you see your provider. There are different types of asthma medicines. You may need to take more than one as advised by your provider. Talk with your provider to be sure you know how to use all of your medicines correctly. Asthma medicines often used to treat PMA may include:

• Quick-relief (rescue) medicine. These medicines are fast-acting. They give you quick relief when your symptoms start. They relax and open up the airways. Take these medicines only when needed. Always carry this medicine with you.

• Long-term control (maintenance) medicine. These medicines help relax the muscles around your airways. They are often taken on a schedule. Don't skip doses unless your provider tells you to. They are often combined with inhaled corticosteroids.

• Inhaled corticosteroids. These medicines work to reduce airway swelling and inflammation. These medicines are often taken for severe symptoms. They open up the airways. They are inhaled right into the bronchial tubes of your lungs.

Living with PMA

• Keep taking your asthma medicines.

• When you have asthma flare-ups, follow your asthma action plan.

• Stay away from asthma triggers or allergens.

• Don’t use aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain from menstrual cramps.

• Think about trying hormone therapy. Talk with your gynecologist about this type of treatment.

When to call your healthcare provider

Call your healthcare provider right away if you have any of the following:

• Feeling dizzy, faint, or weak

• Lasting cough

• Fast heartbeat or pulse

• Having trouble doing normal activities

• Wheezing when you breathe in or out that is different from your normal breathing pattern

• Wheezing or chest tightness that gets worse, even after taking medicine

Call 911

Call 911 right away if you have any of the following:

• Trouble walking or talking

• Fingernails or lips turn blue or gray

• Trouble breathing

• Nostrils flare when you breathe

• With each breath you take, your chest, ribs, or neck are pulled in

• You take 30 or more breaths per minute