After suffering for ten years from agonizing pain caused by polycystic ovaries, Karen Bowen was delighted when her doctors suggested a full hysterectomy.
But while the operation was a success, it sent her directly into menopause, which triggered yet another problem: severe asthma.
Within months, Karen developed seizures that left her struggling to breathe and needing emergency hospital treatment.
“I felt like someone was sitting on my chest,” he recalls. ‘I couldn’t walk or speak in sentences while taking gasps of air.
“At the same time, my blood pressure and heart rate skyrocketed because my heart was desperately trying to make me breathe,” says Karen, 58, owner of a skin clinic and mother of twin girls.
“On about nine occasions they were so bad I thought I was going to die – it was terrifying.”
It was initially put down to a recurrence of childhood asthma he had briefly had and he was given standard inhalers, but these didn’t help much.
It was not until 2021, 15 years after her surgery, that she was finally diagnosed with severe asthma, which requires different treatment, caused by the rapid transition to menopause.
Karen Bowen, 58, developed asthma shortly after entering menopause following a complete hysterectomy.
Most people think that asthma is a condition that appears in childhood. But new research confirms that menopause can trigger asthma in women who have never had it before.
But experts fear that women may not realize they have it or may not receive the necessary medication, which is worrying. Especially since asthma that appears in adulthood is usually more difficult to treat.
Even some health professionals seem unaware of the link between asthma and hormones, says Erika Kennington, director of research and innovation at the charity Asthma & Lung UK.
She said: “Therefore, it is possible that this delays diagnosis in older women, leaving their symptoms untreated.” There is definitely a need to raise awareness about hormones as an asthma trigger.’
The research, published in the journal Menopause, showed that the maximum age of onset of asthma in adulthood was between 50 and 54 years.
It was based on ten years of data involving more than 14,000 postmenopausal women who did not have asthma before menopause and reflects what doctors see with their patients.
“Every week I see a spike in adult-onset asthma in women aged 40 to 50,” says Dr. Pujan Patel, a respiratory specialist at the Royal Brompton Hospital in London, adding that it can be triggered as much as by natural menopause and by surgical menopause. caused by a hysterectomy.
Asthma, which is when the airways become inflamed if they come into contact with a trigger, affects 7.2 million people in the UK. Another 200,000 suffer from severe asthma and cannot control their symptoms with regular medication.

Interestingly, studies have shown that the hormones contained in HRT can increase the risk of asthma (file photo)
While childhood asthma predominantly involves allergic triggers such as dust mites and pollen, asthma that develops in adulthood is more likely to be triggered by viruses, stress, and other non-allergic triggers. But why would menopause trigger asthma?
Previous studies have blamed low levels of the hormone estrogen for promoting inflammation, says Dr Viki Male, senior lecturer in reproductive immunology at Imperial College London. Estrogen is produced primarily by the ovaries, which can be removed through a hysterectomy.
She says: “Increased inflammation increases the risk of non-atopic asthma (asthma not caused by an allergic trigger).”
That said, high levels of synthetic estrogen, found in certain forms of hormone replacement therapy (HRT), appear to have the same effect, he says.
A 2021 article in the journal Chest found that women taking HRT had a 63 percent increased risk of asthma, while women who stopped treatment were twice as likely to no longer need asthma treatment.
Scientists in Denmark decided that women prescribed HRT should be informed that they may develop asthma symptoms.

But Dr. Male says, “If you take the right amount of estrogen, but not too much, increased inflammation should not be a risk.”
Researchers are investigating whether “male hormones” such as testosterone, also present in women in small amounts, could also be key “in the development of asthma around menopause,” explains Dr. Patel.
In men, testosterone and other androgens (hormones that primarily trigger masculine traits) are associated with lower inflammation.
Therefore, male hormones may exert more influence in menopausal women, who have less estrogen to balance it, and this may increase inflammation in the airways rather than reduce it (as it does in men).
“We don’t understand exactly what is happening, but the one thing that should not be ignored is that there is a hormonal influence on asthma, and that GPs and specialists should be aware that the risk is higher in women.” says Dr. Patel. .
Some women who develop asthma around menopause may need injections of laboratory-created proteins (biological treatment) to target specific parts of the immune response and control their symptoms.
“However, many asthma medications focus on the allergic pathway, so we see many older women with asthma who do not respond to asthma medications,” says Erika Kennington.
This is what happened to Karen, when doctors treated her symptoms as a recurrence of her childhood asthma, rather than adult-onset asthma.

HRT prescriptions for menopausal women have soared in recent years, with 11 million items distributed to help deal with symptoms in 2022/23.
After her hysterectomy, she started taking HRT and her asthma appeared within months.
“I started getting chest infections and was struggling to breathe,” says Karen, who lives with her husband Paul, 69, in Stone, Staffordshire. “But then I didn’t put the two things together.”
He was given a standard, low-dose steroid inhaler to reduce inflammation, as well as a reliever inhaler containing fast-acting medications to relax his airways. But he often still needed extra help breathing in the hospital.
“But every time I went to the hospital I felt like they didn’t take me seriously,” Karen says. He had had mild asthma until he was eight and his doctors told him it was a recurrence.
Finally, in 2021, Karen was referred to a specialized center where she was diagnosed with severe asthma and then started on different treatments.
In February last year he began a biological treatment called tezepelumab, an injection that blocks a chemical messenger believed to play a key role in airway irritation and inflammation.
It has helped reduce the severity of her attacks, but in August last year she was hospitalized again, so she may soon be switched to another medication.
Dr. Male suggests that women keep a symptom diary about their “hormonal and asthma situation where they are at different times.”
“Given evidence showing that HRT can increase the rate of adult-onset asthma, it is sensible to be alert for any respiratory symptoms if you have recently started taking it, and GPs should not rule out those who have noticed changes with HRT or menopause,” she says.
Karen is incredulous that it took so long to identify her severe asthma and its cause.
She says: “It’s really important that there is more awareness of this connection – there could be women who have respiratory symptoms and may not even know it’s asthma.” asthmaandlung.org.uk