European Journal of Applied Physiology

, Volume 96, Issue 6, pp 703–710 | Cite as

Influence of menstrual cycle phase on pulmonary function in asthmatic athletes

  • Kristin I. Stanford
  • Timothy D. Mickleborough
  • Shahla Ray
  • Martin R. Lindley
  • David M. Koceja
  • Joel M. Stager
Original Article


The main aim of this study was to investigate whether there is a relationship between menstrual cycle phase and exercise-induced bronchoconstriction (EIB) in female athletes with mild atopic asthma. Seven eumenorrheic subjects with regular 28-day menstrual cycles were exercised to volitional exhaustion on day 5 [mid-follicular (FOL)] and day 21 [mid-luteal (LUT)] of their menstrual cycle. Pulmonary function tests were conducted pre- and post-exercise. The maximal percentage decline in post-exercise forced expiratory volume in 1 s (FEV1) and forced expiratory flow from 25 to 75% of forced vital capacity (FEF25–75%) was significantly greater (P<0.05) on day 21 (mid-LUT phase) (−17.35±2.32 and −26.28±6.04%, respectively), when salivary progesterone concentration was highest, compared to day 5 (mid-FOL phase) (−12.81±3.35 and −17.23±8.20%, respectively), when salivary progesterone concentration was lowest. The deterioration in the severity of EIB during the mid-LUT phase was accompanied by worsening asthma symptoms and increased bronchodilator use. There was a negative correlation between the percent change in pre- to post-exercise FEV1 and salivary progesterone concentration. However, no such correlation was found between salivary estradiol and the percentage change in pre- to post-exercise FEV1. This study has shown for the first time that menstrual cycle phase is an important determinant of the severity of EIB in female athletes with mild atopic asthma. Female asthmatic athletes may need to adjust their training and competition schedules to their menstrual cycle and to consider the potential negative effects of the LUT phase of the menstrual cycle on exercise performance.


Exercise-induced bronchoconstriction Progesterone Asthma Hormones Female 


  1. American Thoracic Society Guidelines for Methacholine and Exercise Challenge Testing—1999 (2000). Am J Respir Crit Care Med 161:309–329Google Scholar
  2. American Thoracic Society Standardization of Spirometry—1994 update (1995). Am J Respir Crit Care Med 152:1107–1136Google Scholar
  3. Anderson SD, Holzer K (2000) Exercise-induced asthma: is it the right diagnosis in elite athletes? J Allergy Clin Immunol 106:419–428CrossRefPubMedGoogle Scholar
  4. Anderson SD, Kippelen P (2005) Exercise-induced bronchoconstriction: pathogenesis. Curr Allergy Asthma Rep 5:116–122PubMedCrossRefGoogle Scholar
  5. Balzano G, Fuschillo S, Melillo G, Bonini S (2001) Asthma and sex hormones. Allergy 56:13–20CrossRefPubMedGoogle Scholar
  6. Barnes PJ, Chung KF, Page CP (1998) Inflammatory mediators of asthma: an update. Pharmacol Rev 50:515–596PubMedGoogle Scholar
  7. Beck KC, Offord KP, Scanlon PD (1994) Bronchoconstriction occurring during exercise in asthmatic subjects. Am J Respir Crit Care Med 149:352–357PubMedGoogle Scholar
  8. Brannan JD, Gulliksson M, Anderson SD, Chew N, Kumlin M (2003) Evidence of mast cell activation and leukotriene release after mannitol inhalation. Eur Respir J 22:491–496CrossRefPubMedGoogle Scholar
  9. Brutsaert TD, Spielvogel H, Caceres E, Araoz M, Chatterton RT, Vitzthum VJ (2002) Effect of menstrual cycle phase on exercise performance of high-altitude native women at 3600 m. J Exp Biol 205:233–239PubMedGoogle Scholar
  10. Busse WW, Lemanske RF Jr (2001) Advances in immunology: asthma. N Engl J Med 344:350–362CrossRefPubMedGoogle Scholar
  11. Chandler MH, Schuldheisz S, Phillips BA, Muse KN (1997) Premenstrual asthma: the effect of estrogen on symptoms, pulmonary function, and beta 2-receptors. Pharmacotherapy 17:224–234PubMedGoogle Scholar
  12. Chapman RF, Emery M, Stager JM (1999) Degree of arterial desaturation in normoxia influences VO2max decline in mild hypoxia. Med Sci Sports Exerc 31:658–663CrossRefPubMedGoogle Scholar
  13. Choe JK, Han-Dawood FS, Dawood MY (1983) Progesterone and estradiol in the saliva and plasma during the menstrual cycle. Am J Gynecol Obstet 147:557–562Google Scholar
  14. Fonseca-Guedes CH, Cabral AL, Martins MA (2003) Exercise-induced bronchospasm in children: comparison of FEV1 and FEF25–75% responses. Pediatr Pulmonol 36:49–54CrossRefPubMedGoogle Scholar
  15. Haggerty CL, Ness RB, Kelsey S, Waterer GW (2003) The impact of estrogen and progesterone on asthma. Ann Allergy Asthma Immunol 90:284–291; quiz 291–3, 347Google Scholar
  16. Hanley SP (1981) Asthma variation with menstruation. Br J Dis Chest 75:306–308CrossRefPubMedGoogle Scholar
  17. Hellings PW, Vandekerckhove P, Claeys R, Billen J, Kasran A, Ceuppens JL (2003) Progesterone increases airway eosinophilia and hyper-responsiveness in a murine model of allergic asthma. Clin Exp Allergy 33:1457–1463CrossRefPubMedGoogle Scholar
  18. Horan JD, Lederman JJ (1968) Possible asthmogenic effect of oral contraceptives. Can Med Assoc J 99:130–131PubMedGoogle Scholar
  19. Janse de Jonge XA (2003) Effects of the menstrual cycle on exercise performance. Sports Med 33:833–851CrossRefPubMedGoogle Scholar
  20. Keppel G, Wickens T (2004) Design and analysis: a researchers handbook, 4th edn. Pearson Prentice Hall, Upper Saddle RiverGoogle Scholar
  21. Lu Y, Bentley GR, Gann PH, Hodges KR, Chatterton RT (1999) Salivary estradiol and progesterone levels in conception and nonconception cycles in women: evaluation of a new assay for salivary estradiol. Fertil Steril 71:863–868CrossRefPubMedGoogle Scholar
  22. Mickleborough TD, Murray RL, Ionescu AA, Lindley MR (2003) Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med 168:1181–1189CrossRefPubMedGoogle Scholar
  23. Miyaura H, Iwata M (2002) Direct and indirect inhibition of Th1 development by progesterone and glucocorticoids. J Immunol 168:1087–1094PubMedGoogle Scholar
  24. Oguzulgen IK, Turktas H, Erbas D (2002) Airway inflammation in premenstrual asthma. J Asthma 39:517–522CrossRefPubMedGoogle Scholar
  25. O’Rorke A, Kane MM, Gosling JP, Tallon DF, Fottrell PF (1994) Development and validation of a monoclonal antibody enzyme immunoassay for measuring progesterone in saliva. Clin Chem 40:454–458PubMedGoogle Scholar
  26. Pauli BD, Reid RL, Munt PW, Wigle RD, Forkert L (1989) Influence of the menstrual cycle on airway function in asthmatic and normal subjects. Am Rev Respir Dis 140:358–362PubMedGoogle Scholar
  27. Piccinni MP, Giudizi MG, Biagiotti R, Beloni L, Giannarini L, Sampognaro S, Parronchi P, Manetti R, Annunziato F, Livi C et al (1995) Progesterone favors the development of human T helper cells producing Th2-type cytokines and promotes both IL-4 production and membrane CD30 expression in established Th1 cell clones. J Immunol 155:128–133PubMedGoogle Scholar
  28. Skobeloff EM, Spivey WH, St Clair SS, Schoffstall JM (1992) The influence of age and sex on asthma admissions. JAMA 268:3437–3440PubMedCrossRefGoogle Scholar
  29. Soferman R, Spirer Z, Topilsky M (2003) Small airway responsiveness to exercise as an objective measure of exercise-induced asthma in children. Pediatr Asthma Allergy Immunol 16:77–84CrossRefGoogle Scholar
  30. Szekeres-Bartho J, Wegmann TG (1996) A progesterone-dependent immunomodulatory protein alters the Th1/Th2 balance. J Reprod Immunol 31:81–95CrossRefPubMedGoogle Scholar
  31. Tan KS, McFarlane LC, Lipworth BJ (1997) Loss of normal cyclical beta 2 adrenoceptor regulation and increased premenstrual responsiveness to adenosine monophosphate in stable female asthmatic patients. Thorax 52:608–611PubMedCrossRefGoogle Scholar
  32. Zhao XJ, McKerr G, Dong Z, Higgins CA, Carson J, Yang ZQ, Hannigan BM (2001) Expression of oestrogen and progesterone receptors by mast cells alone, but not lymphocytes, macrophages or other immune cells in human upper airways. Thorax 56:205–211CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Kristin I. Stanford
    • 1
    • 2
  • Timothy D. Mickleborough
    • 2
  • Shahla Ray
    • 3
  • Martin R. Lindley
    • 2
  • David M. Koceja
    • 2
  • Joel M. Stager
    • 2
  1. 1.Biomedical SciencesUniversity of California San DiegoLa JollaUSA
  2. 2.Human Performance Laboratory, Department of KinesiologyIndiana UniversityBloomingtonUSA
  3. 3.Department of Applied Health ScienceIndiana UniversityBloomingtonUSA

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