Harmonizing Hormones and Breathing: The Interplay Between Menstruation, Hormonal Contraceptives, Pregnancy, and Menopause

By Kat Burns, PT, DPT and David Deppeler, PT, DSc

Hormone fluctuations change breathing in ways that change health and performance. Knowing this, we can adjust breathing performance expectations, and even leverage the breath to improve some of the uncomfortable symptoms associated with menstruation, contraception, pregnancy, and menopause.

Background Scoop

Breathing is a fundamental process that allows oxygen to reach our organs and tissues. However, many people suffer from dysfunctional breathing patterns, leading to poor oxygenation.  It’s estimated that a staggering 80% of people breathe poor enough to negatively affect functional movement (Keisel 2020)! 

This article explores the impact of the most common breathing dysfunction, hyperventilation (AKA over breathing) on oxygenation and reviews specific considerations for hormone fluctuations associated with menstruation, hormonal contraceptive use, pregnancy and menopause.  Most medical research on breathing has not taken these factors into consideration.  

How Breathing Works

When you inhale, oxygen goes into the lungs and into the small air sacs called alveoli.  There are small blood vessels, called capillaries, that wrap around the alveoli to gather oxygen.  Once oxygen hits our blood stream, hemoglobin in our red blood cells picks it up and travels around to all our organs, muscles, brain, etc. for delivery. The hemoglobin will then release oxygen in exchange for carbon dioxide (CO2).  If you don’t have enough CO2, oxygen won’t be released to the tissues.  Unfortunately, hyperventilation or over breathing is common these days. You might even say, it’s become the norm.   Hyperventilation leads to CO2 being released from the body too quickly, so we don’t have enough to “pay the piper” for the oxygen. In this case, oxygen gets trapped in the blood and the body is starved of proper oxygen. 

However, in addition to hyperventilation as a behavioral pattern, there are many other reasons that can cause decreased CO2 in the body. 

Breathing Changes During the Menstrual Cycle

Menstruation involves hormonal fluctuations that change breathing. Understanding these influences can shed light on the challenges women may face in maintaining healthy breathing during menstruation.  Let’s explore the different phases of the menstrual cycle and their impact on breathing:

  • Menstruation: The “period” where the lining of the uterus is shed and excreted as water and blood. Estrogen and progesterone are low during this time.
  • Follicular Phase: Between the first day of your period and ovulation. Estrogen rises to prepare for release of an egg.
  • Proliferative Phase: Uterine lining building up.
  • Ovulation: An egg is released. Estrogen peaks and then drops quickly. 
  • Luteal Phase: Between ovulation and starting menstruation. The body is preparing for a potential pregnancy, so progesterone is produced, peaks, and then quickly drops. This phase is commonly linked to hyperventilation due to the variable progesterone levels.  CO2 can drop by more than 25% during this phase.  
  • Secretory Phase: Uterine lining is prepped for pregnancy or to be shed for menstruation.

It’s the luteal phase that causes the biggest changes in breathing with CO2 dropping by 25% on average.  As CO2 drops, there may not be enough CO2 for the efficient release of oxygen from the blood  to the tissue that needs it. During this phase, over breathing is common.

Symptoms may include: (Chaitow 2014)

  • Feeling of “air hunger” or not getting enough air
  • Low tolerance to exercise (especially more vigorous such as running, stairs)
  • Dry cough
  • Frequent sighing/yawning
  • Pain and fatigue
  • Increased muscle tone (tenderness/spasms/cramping)
  • Dizziness
  • Headaches
  • Fainting
  • Tingling
  • Chest pain
  • Arrhythmias
  • Difficult to control blood pressure
  • Impaired thinking
  • Anxiety/panic

About Contraception

It makes logical sense that using hormonal contraceptives such as the pill would affect breathing as well. However, the little research there is on this topic is very inconsistent with their findings. Some research shows that there was a decrease in asthma risk associated with oral contraceptives and other studies that show the exact opposite. This may be due to what reason someone has for taking the pill.  Many take it to prevent pregnancy, but others take it to manage medical conditions like polycystic ovary syndrome (PCOS). PCOS has a known link to asthma and lower lung function. If people with PCOS were included in some studies but not others, it may have swayed the results. A 2012 review stated it was “likely and biologically plausible” that oral contraceptives can affect the airway in many ways (Macsali 2012). Oral contraceptives are an excellent way to manage several different health conditions but can have side effects like any other medication.

It seems the research is split on how breathing is affected by contraceptives.  Since hormones affect CO2 sensitivity, it makes sense that hormonal contraceptives would impact breathing.  But because the reasons for using hormonal contraceptives are broad, more specific research will need to be done to see how breathing is truly affected for different people.

During Pregnancy

Pregnancy understandably affects breathing due to several factors including body changes and hormones.  As the fetus grows and the uterus expands, the rest of the organs are pushed up against the diaphragm making it difficult to breathe into the belly and back resulting in shallow chest breathing. Other changes include a 15% increase in metabolic rate and a 20% increased demand for oxygen (McKeown 2021). In terms of hormones, progesterone increases 100-fold during pregnancy and acts as a respiratory stimulant which generally leads to hyperventilation (McKeown 2021). 

So in effect, it makes sense that pregnancy will increase breathing. This means more energy has to be spent on breathing. Bigger breathing can also contribute to more anxiety – that’s just how our nervous system works. Additional time for rest, as well breathing practices that reduce anxiety may be helpful.

Now For Menopause

In general, perimenopause lasts for approximately five years (late 40s) before going into true menopause in the early 50s. Progesterone and estrogen levels drop significantly which generally increases CO2 in the body (remember, this is a good thing!).  

However, recent research has shown that going through natural menopause early is associated with reduced lung function (Campbell 2020). This highlights the relationship between breathing and hormonal changes. It’s not fully understood why this is the case, but the most notable factor was a history of smoking or being exposed to second-hand smoke.  

So the bottom line is that breathing will typically improve during menopause but try to limit exposure to cigarette smoke as early as you can.  

Anatomical Size Matters

Besides hormonal changes, anatomical size can  contribute to breathing differences. Smaller airways, rib cages, and shorter diaphragms can change resting CO2 levels by 8% (McKeown 2021).  Additionally, poor diaphragm function, often linked to chronic pelvic pain and dysfunction, can lead to an upper chest breathing pattern, further exacerbating respiratory challenges.

We can’t change the size of our airways or rib cages, but we can increase the strength and resiliency of the diaphragm!  Exercises such as inversions (bridges, downward dog) are helpful.

The Good News.

Fortunately, research demonstrates that breath work can significantly improve dysfunctional breathing patterns – even those resulting from hormone changes and anatomical differences. Engaging in guided breathing exercises can lead to clinically significant changes in respiratory function. The guidance of a trained professional can be helpful to getting the most out of breath work, but we’re happy to share a couple practices that we know get many people moving in the right direction.  

 

Click here to learn more about developing good breathing behaviors.

 

Learn more about Breathe Your Truth

References: 

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