Lung Diseases Linked to Hormones in Women

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The number of women suffering from lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) is increasing and researchers speculate hormones may have something to do with this. A recent report  found that women experience higher morbidity and mortality from these diseases but also linked the onset and progression of the disease to the presence or absence of steroid hormones.

Women and Lung Disease: the Statistics

Asthma: According to the CDC, over 60% of asthma patients in the US are female. Female asthmatics are 50% more likely to visit the physician, have more frequent hospitalizations and are 40% more likely to die from asthma than their male counterparts.

COPD: Although, the incidence of COPD is currently higher in men, it is on a steady rise for women due to an increased rate of smoking.  Women, it appears, develop COPD more easily than men, with much less exposure and die more frequently from the disease. Despite a lower incidence, the number of women dying from COPD now surpasses men.

Cystic Fibrosis is a rare genetic disorder affecting both genders, but for unknown reasons life expectancy for women is shorter. Epidemiological data for lung diseases affecting women suggest the involvement of female hormones in meditating the onset of asthma, COPD, and CF.

Steroid Hormones: Background

Steroid hormones are made in the ovaries, adrenal glands, placenta (when pregnant), adipose (fat) tissue and even in the brain. Three major natural estrogens in women are estriol, estradiol, and estrone. Estriol is the predominant estrogen in pregnant women, while estradiol is the predominant form in the non-pregnant premenopausal women. Estrone is the predominant estrogen in menopausal women. For more information on hormones, click HERE.

Estradiol and progesterone concentrations fluctuate dramatically across the menstrual cycle, but also across pregnancy/postpartum and again at menopause.

Sex hormone binding globulin (SHBG) is an important steroid hormone binding protein in human plasma and regulates sex hormone delivery to tissues and cells. In healthy men and women, between 40-65% of circulating testosterone and between 20-40% of circulating estradiol is bound to SHBG. When the hormone is bound to SHBG it is considered inactive and, in that way,  hormones bound to SHBG act much like reserve storage.

Why Hormones may be Linked to Lung Disease in Women

Before puberty the incidence of asthma is higher in boys than in girls, but following puberty, the pattern switches, and by adulthood, the prevalence of asthma is nearly 50% higher in women than in men. It is also well known that asthma severity fluctuates over the course of the menstrual cycle. As with asthma, menstrual cycles may also affect lung function in female patients with CF but not in the same phasic manner. Asthmatics demonstrate the best lung function in the peri-menstrual period, while female CF patients have the highest lung function during the luteal phase and the lowest lung function during the pre-ovulatory phase.

Researchers have found that fluctuating estradiol concentrations may, via some very specific mechanisms (estradiol inhibits Cl- secretion in the CF lung and up-regulates mucus production) impact lung function. Progesterone may also play a role in inflammatory airway disease by amplifying airway inflammation.

Not only do women have a higher prevalence of asthma, CF, and COPD, they appear to have worse prognoses than their male counterparts. The exact mechanism of this process is still uncertain. Emerging data suggest that female sex hormones play a role in these inflammatory airway conditions through different, but related, mechanisms. With the rise in the burden of these diseases worldwide, there is a pressing need to better understand the biological roles of sex hormones in modulating airway inflammation, mucus production and cigarette de-toxification and other processes relevant to COPD, asthma and CF.

Synthetic versus Endogenous Hormones

It is not clear from this review whether the risk for these diseases changes or is resultant from the use of synthetic hormones. Most of the studies reviewed did not account for hormonal contraceptives or hormone replacement therapies. Instead they looked receptor distribution and other variables that would fluctuate relative to cycling hormones. Additional research should be undertaken to disentangle the effects of endogenous hormones versus those associated with synthetic hormones. Particularly in the longer term, the effects at the receptor are likely to be different.

This article was originally published on Hormones Matter in May of 2012.

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4 Comments

  1. Did you know that ovary removal (castration) increases risk of lung cancer? The studies vary as to the relative risk. This one says a 45% increase – http://www.imsociety.org/manage/updates_export_press.php?menopauseliveID=2755. This one puts it at 92% increased risk – http://onlinelibrary.wiley.com/doi/10.1002/ijc.24560/abstract. According to this article http://onlinelibrary.wiley.com/doi/10.1002/ijc.21229/full “Induced menopausal women with experience of hormone replacement therapy had a significantly elevated risk compared to naturally menopausal women without female hormone use, with an RR of 2.40 (95% CI 1.07–5.40). These findings suggest that both endogenous and extraneous estrogen may be involved in the etiology of lung cancer.” © 2005 Wiley-Liss, Inc.

    Ovary removal is associated with many increased health risks and all-cause mortality. Yet women’s ovaries are removed at an alarming rate in the U.S. Ditto for the uterus. The oophorectomy rate is about 70% of the hysterectomy rate and 40% of women aged 45 to 54 have had a hysterectomy! Clearly, female organ removal is grossly overused causing an epidemic of permanent harm.

    The former article cited above states:
    “The ovaries are both reproductive and endocrine organs. They secrete hormones both before menopause (primarily estrogen, progesterone, and testosterone) and after (primarily testosterone, androstenedione, and dehydroepiandrosterone). Ovarian hormones have important reproductive actions; however, they also have important endocrine actions mediated by receptors spread throughout most tissues and organs of the body [2]. Removal of the ovaries reduces the risk of ovarian (by 80–90%) and breast (by 50–60%) cancer; however, it increases the risk of all-cause mortality (28%), lung cancer (45%), coronary heart disease (33%), stroke (62%), cognitive impairment (60%), parkinsonism (80%), psychiatric symptoms (50–130%), osteoporosis and bone fractures (50%), and impaired sexual function (40–110%). The magnitude of the risk varies depending on the study referenced, the age at the time of oophorectomy, and the use of estrogen therapy after the surgery [2].”

  2. Excellent piece. Am surprised that progesterone may play a role in increasing inflammation. I’ve thought of progesterone (bioidentical) as necessary to balance estrogens because so many women suffer from estrogen dominance.

    1. It turns out that hormonal regulation of inflammation is more complicated and involves a number of different hormones.

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